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Öğe Catheter-associated urinary infections and consequences of using coated versus non-coated urethral catheters-outcomes of a systematic review and meta-analysis of randomized trials(MDPI, 2022) Gauhar, Vineet; Castellani, Daniele; Teoh, Jeremy Yuen-Chun; Nedbal, Carlotta; Chiacchio, Giuseppe; Gabrielson, Andrew T.; Heldwein, Flavio Lobo; Wroclawski, Marcelo Langer; de la Rosette, Jean J. M. C. H.; Donalisio da Silva, Rodrigo; Galosi, Andrea Benedetto; Somani, Bhaskar KumarCoated urethral catheters were introduced in clinical practice to reduce the risk of catheter-acquired urinary tract infection (CAUTI). We aimed to systematically review the incidence of CAUTI and adverse effects in randomized clinical trials of patients requiring indwelling bladder catheterization by comparing coated vs. non-coated catheters. This review was performed according to the 2020 PRISMA framework. The incidence of CAUTI and catheter-related adverse events was evaluated using the Cochran-Mantel-Haenszel method with a random-effects model and reported as the risk ratio (RR), 95% CI, and p-values. Significance was set at p < 0.05 and a 95% CI. Twelve studies including 36,783 patients were included for meta-analysis. There was no significant difference in the CAUTI rate between coated and non-coated catheters (RR 0.87 95% CI 0.75-1.00, p = 0.06). Subgroup analysis demonstrated that the risk of CAUTI was significantly lower in the coated group compared with the non-coated group among patients requiring long-term catheterization (>14 days) (RR 0.82 95% CI 0.68-0.99, p = 0.04). There was no difference between the two groups in the incidence of the need for catheter exchange or the incidence of lower urinary tract symptoms after catheter removal. The benefit of coated catheters in reducing CAUTI risk among patients requiring long-term catheterization should be balanced against the increased direct costs to health care systems when compared to non-coated catheters.Öğe Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: A systematic review and meta-analysis of randomized clinical trials(Springer, 2022) Gauhar, Vineet; Traxer, Olivier; Rojo, Esther Garcia; Scarcella, Simone; Pavia, Maria Pia; Chan, Vinson Wai-Shun; Pretore, Eugenio; Wroclawski, Marcelo Langer; Corrales, Mariela; Tiong, Ho Yee; Lim, Ee Jean; Teoh, Jeremy Yuen-Chun; Heng, Chin-Tiong; de la Rosette, Jean J. M. C. H.; Somani, Bhaskar Kuman; Castellani, DanieleWe aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy (PCNL) (ureteral stent/catheter, no nephrostomy) compared to Standard PCNL (nephrostomy, with/without ureteral stent/catheter) to evaluate if the tubeless approach is better. The inverse variance of the mean difference with a random effect, 95% Confidence Interval (CI), and p values was used for continuous variables. Categorical variables were assessed using Cochran-Mantel-Haenszel method with the random effect model, and reported as Risk Ratio (RR), 95% CI, and p values. Statistical significance was set at p < 0.05 and a 95% CI. 26 studies were included. Mean operative time was significantly shorter in the Tubeless group (MD-5.18 min, 95% CI - 6.56, - 3.80, p < 0.00001). Mean postoperative length of stay was also significantly shorter in the Tubeless group (MD-1.10 day, 95% CI - 1.48, - 0.71, p < 0.00001). Incidence of blood transfusion, angioembolization for bleeding control, pain score at the first postoperative day, the number of patients requiring postoperative pain medication, fever, urinary infections, sepsis, perirenal fluid collection, pleural breach, hospital readmission, and SFR did not differ between the two groups. Incidence of postoperative urinary fistula was significantly lower in the Tubeless group (RR 0.18, 95% CI 0.07, 0.47, p = 0.0005). This systematic review shows that tubeless PCNL can be safely performed and the standout benefits are shorter operative time and hospital stay, and a lower rate of postoperative urinary fistula.Öğe Concomitant bladder tumor is a risk factor for bladder recurrence but not upper tract(MDPI, 2022) Liu, Kang; Zhao, Hongda; Alvarez-Maestro, Mario; Gravas, Stavros; Van Renterghem, Koen; Zeng, Guohua; Ng, Chi-Fai; del Pilar Laguna Pes, Maria; Teoh, Jeremy Yuen-Chun; de la Rosette, Jean J. M. C. H.Objective: To evaluate the clinical outcomes of UTUC patients with or without concurrent bladder tumor. Design, Setting, and Participants: The Clinical Research Office of the Endourology Society-Urothelial Carcinomas of the Upper Tract (CROES-UTUC) Registry included 1134 UTUC patients with or without concurrent bladder tumor treated between 2014 and 2019. Results: In 218 (19.2%) cases, concurrent bladder tumor was present, while in 916 (80.8%) patients, no bladder cancer was found. In the multivariable Cox regression analysis, concomitant bladder tumor (hazard ratio (HR) 1.562, 95% confidence interval (CI) 0.954-2.560, p = 0.076) indicated a trend associated with recurrence-free survival for UTUC. Further data dissection confirmed that concomitant bladder tumor is a risk factor of bladder recurrence (HR 1.874, 95% CI 1.104-3.183, p = 0.020) but not UTUC recurrence (HR 0.876, 95% CI 0.292-2.625, p = 0.812). Kidney-sparing surgery (KSS) (HR 3.940, 95% CI 1.352-11.486, p = 0.012), pathological T staging >= pT2 (HR 2.840, 95% 1.039-7.763, p = 0.042) were significantly associated with UTUC recurrence. KSS does not affect bladder recurrence (HR 0.619, 95% CI 0.242-1.580, p = 0.315). A limitation is the retrospective nature of the present study analysis. Conclusions: The presence of concomitant bladder tumor does not increase risk of UTUC recurrence, but it results in an increased risk of bladder recurrence. KSS does not affect bladder recurrence and can still be considered in patients with concomitant bladder tumor.Öğe Impact of adjuvant gemcitabine containing chemotherapy following radical nephroureterectomy for patients with upper tract urothelial carcinoma: Results from a propensity-score matched cohort study(IOS Press BV, 2023) Hongda, Zhao; Kang, Liu; Ng, Chi-Fai; de la Rosette, Jean J. M. C. H.; del Pilar Laguna Pes, Maria; Gontero, Paolo; Baard, Joyce; Yıldız, Özcan; Teoh, Jeremy Yuen-ChunBACKGROUND: The evidence regarding perioperative adjuvant chemotherapy and personalized surveillance strategies for upper tract urothelial carcinoma is limited. OBJECTIVE: To evaluate whether adjuvant gemcitabine containing chemotherapy affects the oncological outcomes of advanced upper tract urothelial carcinoma (UTUC). METHODS: The CROES-UTUC registry is an observational, international, multi-center study on patients diagnosed with UTUC. Patient and disease characteristics from 2380 patients with UTUC were collected, and finally 738 patients were included in this analysis. The primary outcome of this study was recurrence-free survival. Propensity score matching was performed. Kaplan-Meier and multivariate Cox regression analyses were performed by stratifying patients according to the treatment of adjuvant chemotherapy. RESULTS: A total of 738 patients were included in this analysis, and 59 patients received adjuvant chemotherapy (AC), including 50 patients who received gemcitabine. A propensity score matching was performed, including 50 patients who received gemcitabine containing treatment and 50 patients without adjuvant chemotherapy. Disease recurrence occurred in 34.0% of patients. The recurrence rate in the AC group was 22.0%, which was significantly lower than the non-AC group (46.0%). Kaplan-Meier analyses also showed that AC was associated with a lower likelihood of tumor recurrence (p = 0.047). However, AC was not significantly associated with a higher overall survival (OS) (p = 0.908) and cancer-specific survival (CSS) (p = 0.979). Upon multivariate Cox regression analysis, AC was associated with a lower risk of tumor recurrence (HR = 0.297, p = 0.028). CONCLUSION: The present study confirms that adjuvant gemcitabine containing chemotherapy could decrease the risk of tumor recurrence in patients with locally advanced UTUC following nephroureterectomy. However, more studies are need to draw a clearer image of the value of this treatment method.Öğe Radical nephroureterectomy for UTUC conferred survival benefits irrespective of age and comorbidities(Springer, 2022) Teoh, Jeremy Yuen-Chun; Ng, Chi-Fai; Eto, Masatoshi; Chiruvella, Mallikarjuna; Capitanio, Umberto; Esen, Tarık; Zeng, Guohua; Lechevallier, Eric; Andonian, Sero; de la Rosette, Jean J. M. C. H.Purpose We investigated the effects of age, American Society of Anesthesiologists Physical Status Classification (ASA) grading and Charlson Comorbidity Index (CCI) on the survival outcomes of upper tract urothelial carcinoma (UTUC). Methods The CROES-UTUC registry was an international, multicenter study on patients with UTUC. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Kaplan-Meier and multivariate Cox regression analyses were performed by stratifying patients according to their age (<= 70 and > 70 years old) and ASA grade (I-II and III-V)/CCI (0-1 and >= 2). Results A total of 2352 patients were included in this study. Patients aged <= 70 years with ASA grading of I-II (p = 0.002), and patients aged <= 70 years with a CCI of 0-1 (p = 0.002) had the best OS. Upon multivariate analysis, both in patients aged <= 70 and > 70 years, ASA grading and CCI were not significantly associated with OS. Patients aged <= 70 years with ASA grading of III-IV (p = 0.024) had the best DFS. When stratified according to age and CCI, no significant difference in DFS was noted. Upon multivariate analysis, radical nephroureterectomy (RNU) was significantly associated with better DFS in patients aged <= 70 and > 70 years; CCI of >= 3 was significantly associated with worse DFS in patients <= 70 years; ASA grading was not associated with DFS in patients aged <= 70 and > 70 years. Conclusions A high ASA grading and CCI should not be considered contraindications for RNU. RNU should be considered even in elderly patients when it is deemed feasible and achievable after a geriatric assessment.Öğe Radiomics in urolithiasis: Systematic review of current applications, limitations, and future directions(MDPI (Multidisipliner Digital Publishing Institute), 2022) Lim, Ee Jean; Castellani, Daniele; So, Wei Zheng; Fong, Khi Yung; Li, Jing Qiu; Tiong, Ho Yee; Gadzhiev, Nariman; Heng, Chin Tiong; Teoh, Jeremy Yuen-Chun; Naik, Nithesh; Ghani, Khurshid; Sarıca, Kemal; de la Rosette, Jean J. M. C. H.; Somani, Bhaskar; Gauhar, VineetRadiomics is increasingly applied to the diagnosis, management, and outcome prediction of various urological conditions. Urolithiasis is a common benign condition with a high incidence and recurrence rate. The purpose of this scoping review is to evaluate the current evidence of the application of radiomics in urolithiasis, especially its utility in diagnostics and therapeutics. An electronic literature search on radiomics in the setting of urolithiasis was conducted on PubMed, EMBASE, and Scopus from inception to 21 March 2022. A total of 7 studies were included. Radiomics has been successfully applied in the field of urolithiasis to differentiate phleboliths from calculi and classify stone types and composition pre-operatively. More importantly, it has also been utilized to predict outcomes and complications after endourological procedures. Although radiomics in urolithiasis is still in its infancy, it has the potential for large-scale implementation. Its greatest potential lies in the correlation with conventional established diagnostic and therapeutic factors.Öğe The prognostic role of body mass index on oncological outcomes of upper tract urothelial carcinoma(Multidisciplinary Digital Publishing Institute (MDPI), 2023) Liu, Kang; Zhao, Hongda; Ng, Chi-Fai; Teoh, Jeremy Yuen-Chun; del Pilar Laguna Pes, Maria; Gontero, Paolo; Saltirov, Iliya; de la Rosette, Jean J. M. C. H.Simple Summary In patients with upper tract urothelial carcinoma, the impact of body mass index on oncological outcomes is still a matter of debate. We use the Clinical Research Office of the Endourology Society Urothelial Carcinomas of the Upper Tract Registry to compare the overall survival, cancer-specific survival, and recurrence-free survival between normal weight, overweight and obese patients. After balancing the clinicopathological features by propensity score matching, being overweight/obese (body mass index >= 25.0 kg/m2) was associated with a decreased risk of recurrence in upper tract urothelial carcinoma patients but not overall survival or cancer-specific survival.Abstract (1) Objective: The aim of this study was to evaluate whether overweight and obese upper urinary tract carcinoma (UTUC) patients have better or worse survival outcomes. (2) Methods: The Clinical Research Office of the Endourology Society Urothelial Carcinomas of the Upper Tract (CROES-UTUC) Registry was used to extract the data of normal-weight or overweight/obese UTUC patients between 2014 and 2019. Patients with a BMI between 18.5 and 24.9 kg/m2 were defined as normal weight, while those with a BMI >= 25.0 kg/m2 were considered as overweight/obese group. We compared baseline characteristics among groups categorized by different BMIs. The Kaplan-Meier plots with the log-rank test were used to explore the overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). Propensity score matching was performed to eliminate the differences in clinicopathologic features. The Declaration of Helsinki was followed during this study. (3) Results: Of 1196 UTUC patients, 486 patients (40.6%) were normal weight, while 710 patients (59.4%) presented with a BMI >= 25.0 kg/m2. After propensity score matching, all baseline characteristics were balanced. For normal weight and overweight/obese patients, 2-year overall survival rates were 77.8% and 87.2%, 2-year cancer-specific survival rates were 85.2% and 92.7%, and 2-year recurrence rates were 50.6% and 73.0%, respectively. The overweight patients obtained a better RFS (p = 0.003, HR 0.548, 95% CI 0.368-0.916) while their OS (p = 0.373, HR 0.761, 95% CI 0.416-1.390) and CSS (p = 0.272, HR 0.640, 95% CI 0.287-1.427) were similar to normal weight patients. (4) Conclusions: Being overweight/obese (BMI >= 25.0 kg/m2) was associated with a decreased risk of recurrence in UTUC patients but not overall survival or cancer-specific survival.Öğe Will "Hybrid" meetings replace face-to-face meetings post COVID-19 era? Perceptions and views from the urological community(Elsevier Science Inc, 2021) Hameed, B. M. Zeeshan; Tanıdır, Yılören; Naik, Nithesh; Teoh, Jeremy Yuen-Chun; Shah, Milap; Wroclawski, Marcelo Langer; Castellani, Daniele; İbrahim, Sufyan; da Silva, Rodrigo Donalisio; Rai, Bhavan; de la Rosette, Jean J. M. C. H.; Rajeev, T. P.; Gauhar, Vineet; Somani, BhaskarOBJECTIVE To understand the preference and role of 'hybrid' urological meetings compared to face-to-face and online meetings during and after COVID-19 pandemic. The secondary outcome was finding out the most preferable webinar setting. METHODS An online global survey was done between June 06 and July 05, 2020, using SurveyMonkey. The target participants were urology healthcare providers. The survey was disseminated via mailing lists and the Twitter platform. RESULTS A total of 526 urology providers from 56 countries responded to the survey and it was completed by 73.3%. Participants' overall experience was better in a face-to-face meeting, followed by a hybrid and webinar only meeting. While opportunities for networking was identified as high in face-to-face meeting, online webinars were more cost effective, and learning opportunity and reach of audience was higher for hybrid meetings. For online webinar format, Zoom platform was used by 73% and majority (69%) saw it on their laptop or desktop. The preference was for a 1-hour webinar in the evenings with 3-5 speakers. Urology residents rated face-to-face meetings to have better cost-effectiveness when compared to consultants. Post COVID-19, more than half of all respondents would prefer hybrid meetings compared to the other formats. CONCLUSION While there will be a place for face-to-face meetings, COVID-19 situation has led to a preference towards hybrid meetings which is ideal for a global reach in the future. It is plausible that most urological associations will move towards a hybrid model for their meetings.Öğe Worldwide distribution, risk factors, and temporal trends of testicular cancer incidence and mortality: A global analysis(NLM (Medline), 2022) Huang, Junjie; Chan, Sze Chai; Tin, Man Sing; Liu, Xianjing; Lok, Veeleah Ting-Ting; Ngai, Chun Ho; Zhang, Lin; Lucero-Prisno, Don Eliseo; Xu, Wanghong; Zheng, Zhi-Jie; Chiu, Peter Ka-Fung; Ng, Anthony Chi-Fai; Enikeev, Dmitry; Nicol, David; Spiess, Philippe E.; del Pilar Laguna Pes, Maria; Teoh, Jeremy Yuen-Chun; Wong, Martin C SBACKGROUND: Testicular cancer is a common malignancy among young males in western countries. OBJECTIVE: To examine the global disease burden and trends of testicular cancer incidence and mortality by age and country, and their associations with human development index (HDI), gross domestic product (GDP), lifestyle habits, and metabolic risk factors. DESIGN, SETTING, AND PARTICIPANTS: We retrieved the Global Cancer Observatory database for the testicular cancer incidence and mortality in 2020; the World Bank for GDP per capita; the United Nations for HDI; the WHO Global Health Observatory for prevalence of smoking and alcohol drinking; and the Cancer Incidence in Five Continents, WHO mortality database, Surveillance, Epidemiology, and End Results programme and Nordic Cancer Registries (NORDCAN) for trend analysis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We presented the testicular cancer incidence and mortality using age-standardised rates. We examined their associations with HDI, GDP, smoking, alcohol drinking, physical inactivity, overweight, obesity, and medical conditions including diabetes, hypertension, and hypercholesterolaemia by linear regression. We estimated the 10-yr trend of incidence and mortality by joinpoint regression with average annual percentage change with 95% confidence intervals in different age groups. RESULTS AND LIMITATIONS: There was a wide variation in the testicular cancer burden with the highest mortality found in low-income countries, and the regions of Central America and South America, while the highest incidence was observed in high-income countries, especially in Western and Northern Europe. We found a positive association for HDI, GDP, alcohol drinking, inactivity, overweight, obesity, and hypercholesterolaemia with testicular cancer incidence, while a negative correlation was observed between GDP and mortality of testicular cancer. Globally, there was an overall increasing incidence trend of testicular cancer for the past decade, particularly in younger males; the mortality trends of testicular cancer were relatively stable. However, we did not analyse the trend of different stages and subtypes of testicular cancer due to data unavailability. CONCLUSIONS: There was a global variation in the testicular cancer burden associated with HDI, GDP, alcohol drinking, inactivity, overweight, obesity, and hypercholesterolaemia. Testicular cancer had an increasing incidence but decreasing mortality. The increasing testicular cancer incidence in the younger population is of concern and calls for early detection and preventive interventions. PATIENT SUMMARY: Globally, testicular cancer incidence had been increasing particularly in the younger population, although its deaths rates had been decreasing. Socioeconomic indices, alcohol drinking, inactivity, overweight, obesity, and high plasma lipid levels are associated with testicular cancer incidence and mortality.
