We aimed to evaluate the detection rates of prostate cancer (PCa) and clinically significant PCa (csPCa) using magnetic resonance imaging-targeted biopsy (MRI-TBx) in men with low prostate-specific antigen (PSA) levels (2.5–4.0 ng/mL). Clinicopathologic data of 5502 men with PSA levels of 2.5–10.0 ng/mL who underwent transrectal ultrasound-guided biopsy (TRUS-Bx) or MRI-TBx were reviewed. Participants were divided into four groups: LP-T [low PSA (2.5–4.0 ng/mL) and TRUS-Bx, n = 2018], LP-M (low PSA and MRI-TBx, n = 186), HP-T [high PSA (4.0–10.0 ng/mL) and TRUS-Bx, n = 2953], and HP-M (high PSA and MRI-TBx, n = 345). The detection rates of PCa and csPCa between groups were compared, and association of biopsy modality with detection of PCa and csPCa in men with low PSA levels were analyzed. The detection rates of PCa (20.0% vs. 38.2%; P < 0.001) and csPCa (11.5% vs. 32.3%; P < 0.001) were higher in the LP-M group than in the LP-T group. Conversely, there were no significant differences in the detection rates of PCa (38.2% vs. 43.2%; P = 0.263) and csPCa (32.3% vs. 39.4%; P = 0.103) between the LP-M and HP-M groups. Multivariate analyses revealed that using MRI-TBx could predict the detection of csPCa (odds ratio 2.872; 95% confidence interval 1.996‒4.132; P < 0.001) in men with low PSA levels. In summary, performing MRI-TBx in men with low PSA levels significantly improved the detection rates of PCa and csPCa as much as that in men with high PSA levels.
Purpose: The aim of this study was to investigate the rate and pattern of recurrence for patients with Hunner lesion (HL) type interstitial cystitis/bladder pain syndrome (IC/BPS) after transurethral ablation.Methods: This prospective study included 210 patients with HL type IC/BPS. The primary outcomes were the recurrence rate according to 3 patterns of recurrence: pattern A (according to the relationship with the previous surgical site), pattern B (according to the bladder zone), and pattern C (according to the number of lesions). The secondary outcomes were recurrencefree time after treatment according to pattern A and pattern C.Results: The pattern A recurrence rate was 50.8% in the same site (A1), 6.7% at a new site (A2), and 42.5% at mixed sites (A3). The pattern B recurrence rate was 10.5% for the anterior wall, 59.0% for the posterior wall, 69.5% for the lateral wall, and 69.0% for the dome area. Multiple lesions recurred as multiple lesions in 75.8% of cases. The pattern C recurrence rate was 10.8% for C1 (single → single), 6.7% for C2 (single → multiple), 6.7% for C3 (multiple → single), and 75.8% for C4 (multiple → multiple). The recurrence-free time in pattern A was 13 months for A1, 12.5 months for A2, and 8 months for A3, with a significant difference between A1 and A3 (P=0.008). There was no significant difference in recurrence-free time in pattern C, either with single or multiple HLs.Conclusions: The distinct recurrence characteristics of HLs was not predictable despite repeated ablations. Complete remission should not be expected because the whole bladder was to have the potential to develop the HLs even after repeated transurethral ablation.
Purpose To diagnose lower urinary tract symptoms (LUTS) in a noninvasive manner, we created a prediction model for bladder outlet obstruction (BOO) and detrusor underactivity (DUA) using simple uroflowmetry. In this study, we used deep learning to analyze simple uroflowmetry. Materials and Methods We performed a retrospective review of 4,835 male patients aged ≥40 years who underwent a urodynamic study at a single center. We excluded patients with a disease or a history of surgery that could affect LUTS. A total of 1,792 patients were included in the study. We extracted a simple uroflowmetry graph automatically using the ABBYY Flexicapture ® image capture program (ABBYY, Moscow, Russia). We applied a convolutional neural network (CNN), a deep learning method to predict DUA and BOO. A 5-fold cross-validation average value of the area under the receiver operating characteristic (AUROC) curve was chosen as an evaluation metric. When it comes to binary classification, this metric provides a richer measure of classification performance. Additionally, we provided the corresponding average precision-recall (PR) curves. Results Among the 1,792 patients, 482 (26.90%) had BOO, and 893 (49.83%) had DUA. The average AUROC scores of DUA and BOO, which were measured using 5-fold cross-validation, were 73.30% (mean average precision [mAP]=0.70) and 72.23% (mAP=0.45), respectively. Conclusions Our study suggests that it is possible to differentiate DUA from non-DUA and BOO from non-BOO using a simple uroflowmetry graph with a fine-tuned VGG16, which is a well-known CNN model.
Background: To evaluate the feasibility of robotic assisted ureteral reconstruction for managing ureteric complications in transplanted kidney as the minimally invasive alternative to open surgery. Methods: From January 2020 to November 2021, robot-assisted ureteral reconstruction was performed for a total of nine patients with transplanted kidney who had vesico-ureteral reflux (VUR) or ureteral stricture and had failed to treat with previous endoscopic treatments. Results: Patients were eight females and one male, mean age was 53.7±6.6. Five (55.6%) Patients underwent surgery due to VUR (grade III) on transplanted kidney while four (44.4%) patients had transplanted ureteral stricture. Seven (77.8%) received kidney transplants from living donors while two (22.2%) received from deceased donors. For VUR patients, average number of endoscopic injections were 2.2±0.8. Four transplanted ureteral stricture patients had a balloon dilatation with keeping ureteral catheter. Preoperative creatinine level was 1.1±0.2. Post-op voiding-cystourethrography (VCUG) was performed on 3.8±1.6 months. Four (80%) patients had no VUR and one (20%) had VUR regression from grade III to I. Four patients who underwent reconstruction due to anastomosis site stricture, became stenosis free without indwelling ureteral catheter. For one male patient with a long stenosis length of 5 cm, a boari flap was performed during reimplantation. In total, mean operators console time was 138.1±32.6 minutes and patients stayed in hospital for average 6.7±4.2 days. Urethral catheter was removed on 17.5±5.3 days and the ureteral catheter was removed after 4.9±1.5 weeks. The mean serum creatinine level was 1.2±0.1 mg/dL on 1 month after the surgery. The mean followed up period was 13.7±6.1 without having additional intervention after robot ureteral reconstruction. There were no recorded complications above Clavien-Dindo grade II. Conclusions: Robot ureteral reconstruction is a technically feasible and may provide effective treatment for ureteric complications in transplanted kidney as minimally invasive alternative to open surgery.
Purpose For transperineal (TP) prostate biopsy, target biopsy for visible lesions on MRI is important, but there is no consensus of the number of systemic biopsy cores. Our study aimed to confirm the diagnostic efficiency of 20-core systemic biopsy by comparison with 12-core using propensity score matching (PSM). Methods The 494 patients conducted the naive TP biopsy were retrospectively analyzed. There were 293 patients with 12-core biopsy and 201 patients with 20-core biopsy. PSM was performed for minimizing confounding variables, and the established effects’ value was analyzed for ‘index-positive or negative’ clinically significant prostate cancer (csPCa) (Index means PIRADS Score ≥ 3 on multiparametric prostate MRI). Results At 12-core biopsy, there were 126 cases of prostate cancer (43.0%), and 97 cases of csPCa (33.1%). At 20-core biopsy, there were 91 cases (45.3%) and 63 cases (31.3%). After propensity score matching, for index-negative csPCa, the estimated odds ratio was 4.03 (95% CI 1.35–12.09, p value 0.0128), and for index-positive csPCa, the estimated odds ratio was 0.98 (95% CI 0.63–1.52, p value 0.9308). Conclusions The 20-core biopsy did not show a higher detection rate for csPCa in comparison with the 12-core biopsy. However, when MRI did not show a suspicious lesion, 20-core biopsy showed higher odd ratio in comparison with 12-core biopsy. Therefore, if there is a suspicious lesion in MRI, 20-core biopsy is excessive and 12-core biopsy is sufficient. Whereas if there is no suspicious lesion in MRI, it is better to proceed with 20-core biopsy.
This study is to evaluate a novel Quantum Molecular Resonance energy device as a laparoscopic bipolar vessel sealer. The majority of conventional bipolar energy-based vessel sealing devices utilize energy at frequencies between 300 kHz and 500 kHz. The use of such frequencies has disadvantages including unintended damage to surrounding tissues and excessive surgical smoke production. Here, we developed a bipolar energy source using Quantum Molecular Resonance (QMR) energy of 4–64 MHz and combined this into a laparoscopic vessel sealer. We investigate the microscopic tissue effect and surgeon’s experiences of the laparoscopic bipolar vessel sealer using a novel QMR energy source through animal experiments. QMR energy sources showed higher sealing success rates (100% vs. 66.7%) and a higher burst pressure (963 mmHg vs. 802 mmHg) of the sealed vessels compared to LigaSure™. Histological analysis showed less vessel wall injury in the QMR energy source (55.0% vs. 73.9%). In the laparoscopic setting experiments, compared to LigaSure™, QMR energy sources showed statistically significantly less smoke formation (p = 0.014), less tissue carbonization (p = 0.013), and less stickiness (p = 0.044) during sealing tissues. A novel QMR energy source for a laparoscopic bipolar vessel sealer could produce a better sealing performance and less surrounding tissue damage.
This study aimed to compare the anti-adhesive effect of collagen type-I (COL) agent and hyaluronic acid-carboxymethylcellulose (HA/CMC) following laparoscopic and robotic radical prostatectomies. This study was a randomized, controlled, single-blind, multicenter study using COL and HA/CMC in patients who underwent laparoscopic and robotic radical prostatectomies. All patients were randomly assigned to either the COL (n = 66) or HA/CMC (n = 65) group. Viscera slide ultrasound sonography was recorded on the day of surgery (V2) and 12 weeks later (V4). The primary end point was the difference in the excursion distance in the viscera slide ultrasonography between V2 and V4. A total of 131 patients participated in this study. The viscera slide distance in the test and control groups was 1.89 ± 0.49 cm and 1.80 ± 0.45 cm, respectively, at V2 (p = 0.275). The average distance of the viscera slide in the test and control group was 1.59 ± 0.49 cm and 1.64 ± 0.45 cm, respectively at V4 (p = 0.614). None of the patients showed significant adverse effects. This randomized study showed that the efficacy and stability of the gel-type COL anti-adhesion agent are not inferior to those of HA/CMC, of which the properties are established.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.