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ABSTRACT Purpose To assess the incidence of the most common intra- and early postoperative complications following RIRS in a large series of patients with kidney stones. Methods We conducted a retrospective analysis of patients with kidney stones who underwent RIRS across 21 centers from January 2018 to August 2021, as part of the Global Multicenter Flexible Ureteroscopy Outcome (FLEXOR) Registry. Results Among 6669 patients undergoing RIRS, 4.5% experienced intraoperative pelvicalyceal system bleeding without necessitating blood transfusion. Only 0.1% of patients, required a blood transfusion. The second most frequent intraoperative complication was ureteric injury due to the ureteral access sheath requiring stenting (1.8% of patients). Postoperatively, the most prevalent early complications were fever/infections requiring antibiotics (6.3%), blood transfusions (5.5%), and sepsis necessitating intensive care unit admission (1.3%). In cases of ureteric injury, a notably higher percentage of patients exhibited multiple stones and stone(s) in the lower pole, and these cases were correlated with prolonged lasing and overall surgical time. Hematuria requiring a blood transfusion was associated with an increased prevalence of larger median maximum stone diameters, particularly among patients with stones exceeding 20 mm. Furthermore, these cases exhibited a significant prolongation in surgical time. Sepsis necessitating admission to the intensive care unit was more prevalent among the elderly, concomitant with a significantly larger median maximum stone diameter. Conclusions Our analysis showed that RIRS has a good safety profile but bleeding requiring transfusions, ureteric injury, fever, and sepsis are still the most common complications despite advancements in technology.
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PURPOSE: To assess the incidence of the most common intra- and early postoperative complications following RIRS in a large series of patients with kidney stones. METHODS: We conducted a retrospective analysis of patients with kidney stones who underwent RIRS across 21 centers from January 2018 to August 2021, as part of the Global Multicenter Flexible Ureteroscopy Outcome (FLEXOR) Registry. RESULTS: Among 6669 patients undergoing RIRS, 4.5% experienced intraoperative pelvicalyceal system bleeding without necessitating blood transfusion. Only 0.1% of patients, required a blood transfusion. The second most frequent intraoperative complication was ureteric injury due to the ureteral access sheath requiring stenting (1.8% of patients). Postoperatively, the most prevalent early complications were fever/infections requiring antibiotics (6.3%), blood transfusions (5.5%), and sepsis necessitating intensive care unit admission (1.3%). In cases of ureteric injury, a notably higher percentage of patients exhibited multiple stones and stone(s) in the lower pole, and these cases were correlated with prolonged lasing and overall surgical time. Hematuria requiring a blood transfusion was associated with an increased prevalence of larger median maximum stone diameters, particularly among patients with stones exceeding 20 mm. Furthermore, these cases exhibited a significant prolongation in surgical time. Sepsis necessitating admission to the intensive care unit was more prevalent among the elderly, concomitant with a significantly larger median maximum stone diameter. CONCLUSIONS: Our analysis showed that RIRS has a good safety profile but bleeding requiring transfusions, ureteric injury, fever, and sepsis are still the most common complications despite advancements in technology.
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Cálculos Renais , Complicações Pós-Operatórias , Sistema de Registros , Ureteroscopia , Humanos , Ureteroscopia/efeitos adversos , Ureteroscopia/métodos , Estudos Retrospectivos , Feminino , Cálculos Renais/cirurgia , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pessoa de Meia-Idade , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Idoso , Adulto , Resultado do TratamentoRESUMO
INTRODUCTION: Artificial intelligence (AI) shows immense potential in medicine and Chat generative pretrained transformer (ChatGPT) has been used for different purposes in the field. However, it may not match the complexity and nuance of certain medical scenarios. This study evaluates the accuracy of ChatGPT 3.5 and 4 in providing recommendations regarding the management of postprostatectomy urinary incontinence (PPUI), considering The Incontinence After Prostate Treatment: AUA/SUFU Guideline as the best practice benchmark. MATERIALS AND METHODS: A set of questions based on the AUA/SUFU Guideline was prepared. Queries included 10 conceptual questions and 10 case-based questions. All questions were open and entered into the ChatGPT with a recommendation to limit the answer to 200 words, for greater objectivity. Responses were graded as correct (1 point); partially correct (0.5 point), or incorrect (0 point). Performances of versions 3.5 and 4 of ChatGPT were analyzed overall and separately for the conceptual and the case-based questions. RESULTS: ChatGPT 3.5 scored 11.5 out of 20 points (57.5% accuracy), while ChatGPT 4 scored 18 (90.0%; p = 0.031). In the conceptual questions, ChatGPT 3.5 provided accurate answers to six questions along with one partially correct response and three incorrect answers, with a final score of 6.5. In contrast, ChatGPT 4 provided correct answers to eight questions and partially correct answers to two questions, scoring 9.0. In the case-based questions, ChatGPT 3.5 scored 5.0, while ChatGPT 4 scored 9.0. The domains where ChatGPT performed worst were evaluation, treatment options, surgical complications, and special situations. CONCLUSION: ChatGPT 4 demonstrated superior performance compared to ChatGPT 3.5 in providing recommendations for the management of PPUI, using the AUA/SUFU Guideline as a benchmark. Continuous monitoring is essential for evaluating the development and precision of AI-generated medical information.
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Inteligência Artificial , Incontinência Urinária , Masculino , Humanos , Comportamento Social , Pelve , Prostatectomia , Proteínas RepressorasRESUMO
ABSTRACT Objectives To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020. Materials and Methods A 39-question, web-based survey was sent to all urologist members of the Brazilian Society of Urology. We assessed socio-demographic, professional, health and behavior parameters. The primary goal was to evaluate changes in urologists' clinical practice and income after two months of COVID-19. We also looked at geographical differences based on the incidence rates of COVID-19 in different states. Results Among 766 urologists who completed the survey, a reduction ≥ 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of ≥ 50% was reported by 54.3%. Measures to reduce costs were implemented by most. Video consultations were performed by 38.7%. Modifications in health and lifestyle included weight gain (32.9%), reduced physical activity (60.0%), increased alcoholic intake (39.9%) and reduced sexual activity (34.9%). Finally, 13.5% of Brazilian urologists were infected with SARS-CoV-2 and about one third required hospitalization. Urologists from the highest COVID-19 incidence states were at a higher risk to have a reduction of patient visits and non-essential surgeries (OR=2.95, 95% CI 1.86 - 4.75; p< 0.0001) and of being infected with SARS-CoV-2 (OR=4.36 95%CI 1.74-10.54, p=0.012). Conclusions COVID-19 produced massive disturbances in Brazilian urologists' practice, with major reductions in patient visits and surgical procedures. Distressing consequences were also observed on physicians' income, health and personal lives. These findings are probably applicable to other medical specialties.
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Humanos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Doenças Urológicas/terapia , Urologia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Carga de Trabalho , Infecções por Coronavirus , Pandemias , Urologistas/psicologia , Betacoronavirus , Estilo de Vida , Qualidade de Vida , Doenças Urológicas/complicações , Doenças Urológicas/epidemiologia , Padrões de Prática Médica/tendências , Brasil , Inquéritos e Questionários , Telemedicina , Urologistas/estatística & dados numéricos , SARS-CoV-2 , COVID-19RESUMO
OBJECTIVES: To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020. MATERIALS AND METHODS: A 39-question, web-based survey was sent to all urologist members of the Brazilian Society of Urology. We assessed socio-demographic, professional, health and behavior parameters. The primary goal was to evaluate changes in urologists' clinical practice and income after two months of COVID-19. We also looked at geographical differences based on the incidence rates of COVID-19 in different states. RESULTS: Among 766 urologists who completed the survey, a reduction ≥ 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of ≥ 50% was reported by 54.3%. Measures to reduce costs were implemented by most. Video consultations were performed by 38.7%. Modifications in health and lifestyle included weight gain (32.9%), reduced physical activity (60.0%), increased alcoholic intake (39.9%) and reduced sexual activity (34.9%). Finally, 13.5% of Brazilian urologists were infected with SARS-CoV-2 and about one third required hospitalization. Urologists from the highest COVID-19 incidence states were at a higher risk to have a reduction of patient visits and non-essential surgeries (OR=2.95, 95% CI 1.86 - 4.75; p< 0.0001) and of being infected with SARS-CoV-2 (OR=4.36 95%CI 1.74-10.54, p=0.012). CONCLUSIONS: COVID-19 produced massive disturbances in Brazilian urologists' practice, with major reductions in patient visits and surgical procedures. Distressing consequences were also observed on physicians' income, health and personal lives. These findings are probably applicable to other medical specialties.
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Betacoronavirus , Infecções por Coronavirus , Estilo de Vida , Pandemias , Pneumonia Viral , Padrões de Prática Médica/estatística & dados numéricos , Doenças Urológicas/terapia , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologistas/psicologia , Urologia/estatística & dados numéricos , Carga de Trabalho , Brasil , COVID-19 , Humanos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/tendências , Qualidade de Vida , SARS-CoV-2 , Inquéritos e Questionários , Telemedicina , Doenças Urológicas/complicações , Doenças Urológicas/epidemiologia , Urologistas/estatística & dados numéricosRESUMO
OBJECTIVE: To evaluate the surgical morbidity and effectiveness in improving symptoms of benign prostatic hyperplasia (BPH), comparing 'button-type' bipolar plasma vaporisation (BTPV) vs transurethral resection of the prostate (TURP). METHODS: We conducted a literature search of published articles until November 2014. Only prospective and randomised studies with comparative data between BTPV and conventional TURP (mono- or bipolar) were included in this review. RESULTS: Six articles were selected for the analyses. In the 871 patients evaluated, 522 underwent TURP and 349 BTPV. There was a tendency for a higher transfusion rate in the TURP group, with two BTPV cases (0.006%) and 16 TURP cases (0.032%) requiring transfusions (P = 0.06). The number of complications was similar between the groups (odds ratio 0.33, 95% confidence interval [CI] 0.8-1.31; P = 0.12; I(2) = 86%). When subdivided by severity, 10.7% (14/131) and 14.6% (52/355) of complications were classified as severe (Clavien 3 or 4) in patients who underwent BTPV and TURP, respectively (P = 0.02). The average duration of indwelling catheterisation was significantly less in patients who underwent BTPV (standardised mean difference [SMD] -0.84; 95% CI -1.54 to 0.14; P = 0.02; I(2) = 81%). Both treatments significantly improved symptoms and the postoperative International Prostate Symptom Score was similar in both groups (SMD 0.09, 95% CI -1.56 to 1.73; P = 0.92). CONCLUSION: BTPV is an effective and safe treatment for BPH. The improvement of urinary symptoms and overall complications are comparable to conventional TURP. However, BTVP appears to be associated with a lower rate of major complications and duration of indwelling catheterisation.
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Terapia a Laser/métodos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Idoso , Transfusão de Sangue/estatística & dados numéricos , Cateteres de Demora/estatística & dados numéricos , Humanos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: NTx is a type I collagen metabolite previously shown to be increased in patients with bone metastasis. We evaluate NTx potential prognostic role in PCa at diagnosis, when most of the patients have no overt bone involvement. METHODS: Men with histologic diagnosis of PCa were included at diagnosis. Serum NTx was measured serially every 3 months up to two years by ELISA. Fifty-five PCa patients with a median age of 67 y (51-83 y) were included. Most (86%) had stage I; 4% stage II; 2% stage III and 10% stage IV disease. RESULTS: At entry, median NTx was 14.65 nMBCE and it did not correlate with age, Gleason score or PSA, but we observed a significant direct correlation with stage (p=0.0094). With a median follow up of 23 months, serum NTx correlated significantly with biochemical recurrence (p=0.012), as did Gleason score (p=0.00056), stage (p=0.012) and PSA (p<0.0001). By multivariate analysis the only 2 independent variables significantly correlated with biochemical recurrence were PSA (p=0.046) and NTx (p=0.021). CONCLUSIONS: NTx serum concentrations may have a prognostic value in patients with PCa at diagnosis. These results emphasize the importance of bone metabolism biomarkers in patients with PCa even without evident overt bone involvement.
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Colágeno Tipo I/química , Fragmentos de Peptídeos/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Projetos Piloto , Modelos de Riscos ProporcionaisRESUMO
BACKGROUND: Osteoporosis could be associated with the hormone therapy for metastatic prostate carcinoma (PCa) and with PCa per se. The objective of this review is to determine the incidence of bone loss and osteoporosis in patients with PCa who are or are not treated with hormone therapy (ADT). METHODS: The Medline, Embase, Cancerlit, and American Society of Clinical Oncology Abstract databases were searched for published studies on prostate cancer and bone metabolism. The outcomes assessed were: fracture, osteoporosis and osteopenia. RESULTS: Thirty-two articles (116,911 participants) were included in the meta-analysis. PCa patients under ADT had a higher risk of osteoporosis (RR, 1.30; p < 0.00001) and a higher risk of fractures (RR, 1.17; p < 0.00001) as compared to patients not under ADT. The total bone mineral density was lower in patients under ADT when compared with patients not under ADT (p = 0.031) but it was similar to bone mineral density found in healthy controls (p = 0.895). The time of androgen deprivation therapy correlated negatively with lumbar spine and total hip bone mineral density (Spearman's rho = -0.490 and -0.773; p = 0.028 and 0.001, respectively) and with total hip t score (Spearman's rho = -0.900; p = 0.037). CONCLUSION: We found consistent evidence that the use of androgen deprivation therapy in patients with PCa reduces bone mineral density, increasing the risk of fractures in these patients.
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Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/epidemiologia , Inibidores da Angiogênese/uso terapêutico , Osteoporose/epidemiologia , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/epidemiologia , Causalidade , Comorbidade , Humanos , Incidência , Masculino , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
PURPOSE: Penile carcinoma is a rare but mutilating malignancy. In this context, partial penectomy is the most commonly applied approach for best oncological results. We herein propose a simple modification of the classic technique of partial penectomy, for better cosmetic and functional results. TECHNIQUE: If partial penectomy is indicated, the present technique can bring additional benefits. Different from classical technique, the urethra is spatulated only ventrally. An inverted "V" skin flap with 0.5 cm of extension is sectioned ventrally. The suture is performed with vicryl 4-0 in a "parachute" fashion, beginning from the ventral portion of the urethra and the "V" flap, followed by the "V" flap angles and than by the dorsal portion of the penis. After completion of the suture, a Foley catheter and light dressing are placed for 24 hours. CONCLUSIONS: Several complex reconstructive techniques have been previously proposed, but normally require specific surgical abilities, adequate patient selection and staged procedures. We believe that these reconstructive techniques are very useful in some specific subsets of patients. However, the technique herein proposed is a simple alternative that can be applied to all men after a partial penectomy, and takes the same amount of time as that in the classic technique. In conclusion, the "parachute" technique for penile reconstruction after partial amputation not only improves the appearance of the penis, but also maintains an adequate function.
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Carcinoma/cirurgia , Neoplasias Penianas/cirurgia , Pênis/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Humanos , Masculino , Retalhos Cirúrgicos , Procedimentos Cirúrgicos Urológicos Masculinos/instrumentaçãoRESUMO
PURPOSE: Penile carcinoma is a rare but mutilating malignancy. In this context, partial penectomy is the most commonly applied approach for best oncological results. We herein propose a simple modification of the classic technique of partial penectomy, for better cosmetic and functional results. TECHNIQUE: If partial penectomy is indicated, the present technique can bring additional benefits. Different from classical technique, the urethra is spatulated only ventrally. An inverted "V" skin flap with 0.5 cm of extension is sectioned ventrally. The suture is performed with vicryl 4-0 in a "parachute" fashion, beginning from the ventral portion of the urethra and the "V" flap, followed by the "V" flap angles and than by the dorsal portion of the penis. After completion of the suture, a Foley catheter and light dressing are placed for 24 hours. CONCLUSIONS: Several complex reconstructive techniques have been previously proposed, but normally require specific surgical abilities, adequate patient selection and staged procedures. We believe that these reconstructive techniques are very useful in some specific subsets of patients. However, the technique herein proposed is a simple alternative that can be applied to all men after a partial penectomy, and takes the same amount of time as that in the classic technique. In conclusion, the "parachute" technique for penile reconstruction after partial amputation not only improves the appearance of the penis, but also maintains an adequate function.