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Öğe A clinical evaluation of the new digital single-use flexible ureteroscope (UscopePU3022): An international prospective multicentered study(Polish Urological Association, 2018) Johnston, Thomas James; Baard, Joyce; de la Rosette, Jean J. M. C. H.; Doizi, Steeve; Giusti, Guido; Knoll, Thomas; Proietti, Silvia; Brehmer, Marianne; Emiliani, Esteban; Perez-Fentes, Daniel; Osther, Palle Jorn Sloth; Seitz, Christian; Neal, Naomi; Turney, Ben; Hasan, Mudhar; Traxer, Olivier; Wiseman, OliverIntroduction We assessed the clinical performance of a new digital single-use flexible ureteroscope (UscopePU3022). Material and methods A prospective cohort study was carried out across 11 centers (July-Oct. 2017). The UscopePU3022 was assessed regarding ease of insertion; deflection, image quality, maneuverability and overall performance using either a visual analog* or Likert scale. Results A total of 56 procedures were performed in 11 centers (16 surgeons) with the indication being renal stones in 83%. The median score for ease of scope insertion was 10 (3-10). Intraoperative maneuverability was rated as 'good' in 38% and 'very good' in 52%. Visual quality was rated as 'poor or bad' in 18%, 'fair' in 37% and 'good very good' in 43%. Two scopes failed intraoperatively (4%). Preoperative and postoperative median upward and downward deflection was 270 degrees. Compared to standard flexible ureteroscopy (f-URS) maneuverability was rated as 'equivalent' in 30% and 'better' in 60%; visual quality was 'worse' in 38% and 'equivalent or better' in 62%; limb fatigue scores were 'better' in 86%; and overall performance was 'worse' in 55% and 'equivalent or better' in 45%. Conclusions UscopeTM3022 performed well with regards to maneuverability, deflection and limb fatigue and appears to be at least non-inferior to standard f-URS with regards to these parameters. Poor image quality is a concern for UscopePU3022 with it receiving a low overall performance rating when compared to standard f-URS. Despite this it scored highly when investigators were asked if they would use it in their practice if it was cost-effective to do so.Öğe A multi-center international study to evaluate the safety, functional and oncological outcomes of irreversible electroporation for the ablation of prostate cancer(2024) Zhang, Kai; Stricker, Phillip; Löhr, Martin; Stehling, Michael; Suberville, Michel; Cussenot, Olivier; Lunelli, Luca; Ng, Chi Fai; Teoh, Jeremy; del Pilar Laguna Pes, Maria; de la Rosette, Jean J. M. C. H.Background: Irreversible electroporation (IRE) is a novel technique to treat localized prostate cancer with the aim of achieving oncological control while reducing related side effects. We present the outcomes of localized prostate cancer treated with IRE from a multi-center prospective registry. Methods: Men with histologically confirmed prostate cancer were recruited to receive IRE. All the patients were proposed for prostate biopsy at 1-year post-IRE ablation. The functional outcomes were measured by the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5) questionnaires. The safety of IRE was graded by the treatment-related adverse events (AEs) according to the Common Terminology Criteria for Adverse Events (CTCAE). Results: 411 patients were recruited in this study from July 2015 to April 2020. The median follow-up time was 24 months (IQR 15–36). 116 patients underwent repeat prostate biopsy during 12–18 months after IRE. Clinically significant prostate cancer (Gleason ? 3 + 4) was detected in 24.1% (28/116) of the patients; any grade prostate cancers were found in 59.5% (69/116) of the patients. The IPSS score increased significantly from 7.1 to 8.2 (p = 0.015) at 3 months but decreased to 6.1 at 6 months (p = 0.017). Afterwards, the IPSS level remained stable during follow-up. The IIEF-5 score decreased at 3 months from 16.0 to 12.1 (p < 0.001) and then maintained equable afterwards. The rate of AEs was 1.8% at 3 months and then dropped to less than 1% at 6 months and remained stable until 48 months after IRE. Major AEs (Grade 3 or above) were rare. Conclusion: For men with localized prostate cancer, IRE could achieve good urinary and sexual function outcomes and a reasonable oncological result. The real-world data are consistent with earlier studies, including recently published randomized controlled studies. The long-term oncological results need further investigation and follow-up.Öğe A multicenter, randomized, single-blind, 2-arm intervention study evaluating the adverse events and quality of life after irreversible electroporation for the ablation of localized low-intermediate risk prostate cancer(NLM (Medline), 2023) de la Rosette, Jean J. M. C. H.; Dominguez-Escrig, Jose; Zhang, Kai; Teoh, Jeremy; Barret, Eric; Ramon-Borja, Juan Casanova; Muir, Gordon; Bohr, Julia; de Reijke, Theo; Ng, Chi-Fai; Leung, Chi-Ho; Sanchez-Salas, Rafael; del Pilar Laguna Pes, MariaPURPOSE: Our goal was to evaluate the effect of focal vs extended irreversible electroporation on side effects, patient-reported quality of life, and early oncologic control for localized low-intermediate risk prostate cancer patients. MATERIALS AND METHODS: Men with localized low-intermediate risk prostate cancer were randomized to receive focal or extended irreversible electroporation ablation. Quality of life was measured by International Index of Erectile Function, Expanded Prostate Cancer Index Composite questionnaire, and International Prostate Symptom Score. RESULTS: A total of 51 and 55 patients underwent focal and extended irreversible electroporation, respectively. The median follow-up time was 30 months. Rates of erectile dysfunction and rates of adverse events were similar between the 2 groups at 3 months. The focal ablation group seemed to have better International Index of Erectile Function scores at 3 months; it also had a better Expanded Prostate Cancer Index Composite-sexual function score than the extended ablation group across time that was close to statistical significance (mean difference 1.4; 95% CI -0.13 to 2.9, P = .073). There were no significant differences between the 2 groups in other quality-of-life measures. Upon prostate biopsy at 6 months, the rate of residual clinically significant prostate cancer (Gleason ?3 + 4) was 18.8% and 13.2% in the focal and extended irreversible electroporation groups, respectively, without significant differences. CONCLUSIONS: Focal and extended irreversible electroporation ablation had similar safety profile, urinary function, and oncologic outcomes in men with localized low-intermediate risk prostate cancer. In addition, focal ablation demonstrated superior erectile function outcome over extended irreversible electroporation in the first 3-6 months.Öğe A multicenter, randomized, single-blind, 2-arm intervention study evaluating the adverse events and quality of life after irreversible electroporation for the ablation of localized low-intermediate risk prostate cancer(Lippincott Williams & Wilkins, 2023) de la Rosette, Jean J. M. C. H.; Dominguez-Escrig, Jose; Zhang, Kai; Teoh, Jeremy; Barret, Eric; Ramon-Borja, Juan Casanova; Muir, Gordon; Bohr, Julia; de Reijke, Theo; Ng, Chi-Fai; Leung, Chi-Ho; Sanchez-Salas, Rafael; del Pilar Laguna Pes, MariaPurpose: Our goal was to evaluate the effect of focal vs extended irreversible electroporation on side effects, patient-reported quality of life, and early oncologic control for localized low- intermediate risk prostate cancer patients. Materials and Methods: Men with localized low-intermediate risk prostate cancer were randomized to receive focal or extended irreversible electroporation ablation. Quality of life was measured by International Index of Erectile Function, Expanded Prostate Cancer Index Composite questionnaire, and International Prostate Symptom Score. Results: A total of 51 and 55 patients underwent focal and extended irreversible electroporation, respectively. The median follow-up time was 30 months. Rates of erectile dysfunction and rates of adverse events were similar between the 2 groups at 3 months. The focal ablation group seemed to have better International Index of Erectile Function scores at 3 months; it also had a better Expanded Prostate Cancer Index Composite-sexual function score than the extended ablation group across time that was close to statistical significance (mean difference 1.4; 95% CI -0.13 to 2.9, P [.073). There were no significant differences between the 2 groups in other quality-of-life measures. Upon prostate biopsy at 6 months, the rate of residual clinically significant prostate cancer (Gleason >= 3 D 4) was 18.8% and 13.2% in the focal and extended irreversible electroporation groups, respectively, without significant differences. Conclusions: Focal and extended irreversible electroporation ablation had similar safety profile, urinary function, and oncologic outcomes in men with localized low-intermediate risk prostate cancer. In addition, focal ablation demonstrated superior erectile function outcome over extended irreversible electroporation in the first 3-6 months.Öğe A multicenter, randomized, single-blind, 2-arm intervention study evaluating the adverse events and quality of life after irreversible electroporation for the ablation of localized low-intermediate risk prostate cancer. Reply.(Wolters Kluwer Health, 2023) Zhang, Kai; Teoh, Jeremy; del Pilar Laguna Pes, Maria; Ng, Chi-Fai; de la Rosette, Jean J. M. C. H.To the Editor: We appreciate this opportunity toaddress the concerns in the comment by Jin et al on ourarticle,1evaluating the adverse events and quality of lifeafter irreversible electroporation (IRE) for the ablationof localized low-intermediate risk prostate cancer.Öğe A randomized trial investigating clinical outcomes and stent-related symptoms after placement of a complete intra-ureteric stent on a string versus conventional stent placement(Wiley, 2022) Shah, Milap; Pillai, Sunil; Chawla, Arun; de la Rosette, Jean J. M. C. H.; del Pilar Laguna Pes, Maria; Jayadeva Reddy, Suraj; Taori, Ravi; Hegde, Padmaraj; Mummalaneni, SitaramObjective: To compare stent-related symptoms (SRS) associated with conventional ureteric JJ stent (CUS) placement and SRS associated with placement of a modified complete intra-ureteric stent (CIUS) with extraction suture, designed to minimize SRS, using the validated Ureteral Stent Symptom Questionnaire (USSQ). Materials and Methods: We randomized 124 patients who had undergone uncomplicated ureteroscopic lithotripsy into a CIUS and a CUS placement group. USSQ scores were evaluated on postoperative days 1 and 7 (just before stent removal) and 4 weeks after stent removal (control values). Pain scores on a visual analogue scale (VAS) after stent removal were also recorded. Subdomain analysis of all SRS and stent-related complications were also compared. Results: No significant intergroup differences were found in the domain scores for urinary symptoms (P = 0.74), pain (P = 0.32), general health (P = 0.27), work (P = 0.24), or additional problems (P = 0.29). However, a statistically significant difference was noted in VAS scores (P = 0.015). Analysis of subdomains of USSQ item scores showed the CIUS group had significantly better scores for urge incontinence (1.21 vs 1.00; P ? 0.001), discomfort on voiding (2.07 vs 1.50; P ? 0.001), difficulties with respect to light physical activity (1.131 vs 1.00; P ? 0.001), fatigue (1.84 vs 1.57; P = 0.002), feeling comfortable (3.68 vs 3.16; P = 0.003), need for extra help (1.96 vs 1.00; P ? 0.001), and change in duration of work (4.27 vs 1.86; P ? 0.001). However, the patients in the CIUS group were sexually inactive for the time during which the stent was indwelling (mean: 7.34 days). There was no difference in complication rates between the two groups. Conclusion: The use of a CIUS with strings after Ureteroscopy decreases SRS.Öğe Adherence to guideline recommendations in the management of upper tract urothelial carcinoma: An analysis of the CROES-UTUC registry(Springer, 2022) Baard, Joyce; Shariat, Shahrokh F.; Roupret, Morgan; Yoshida, Takashi; Saita, Alberto; Saltirov, Iliya; Burgos, Javier Revilla; Çelik, Orçun; de la Rosette, Jean J. M. C. H.; del Pilar Laguna Pes, MariaBackground: The European Association of Urology provides Clinical Practice Guideline on upper tract urothelial carcinoma (UTUC). Due to the rarity of UTUC, guidelines are necessary to help guide decision-making based on the highest quality of care evidence available. Objectives: To evaluate guideline adherence in the management of UTUC by assessing recommendations on diagnostics needed for risk classification and subsequent treatment selection; to assess predictors for the latter. Participants: Data from the Clinical Research Office of the Endo Urology Society UTUC-registry were included for analysis. Statistical analysis: Overall compliance were evaluated by cross-tables, differences in risk groups characteristics and treatment selection were assessed by Chi-square tests, predictors for treatment selection by logistic regression analysis. Results: Data from 2380 patients were included. Imaging by CT-scan had highest adherence (85%) but was low for other diagnostics (17.7–49.7%). Multivariable regression analysis showed higher odds of receiving radical nephroureterectomy in patients with large tumours (OR 5.45, 95% CI 3.77–7.87, p < 0.001), signs of invasion (OR 3.07,CI 2.11–4.46, p < 0.001), high tumour grade (OR 2.05, CI 1.38–3.05, p < 0.001) and multifocality (OR 1.76,CI 1.05–2.97, p =0.032). Conclusions: CT-imaging is the most used and most impactful decision tool for risk-stratification and treatment selection in UTUC. Due to the low compliance in most of the diagnostic recommendations, proper risk stratification is not possible in a significant group of patients raising the question whether current stratification is deemed applicable in daily practice. Established prognostic factors on survival guides decision-making regarding radical versus kidney-sparing surgery. Tumour size was the most influencing factor on treatment decision. Clinical trial registration: The study was registered at ClinicalTrials.gov (ClinicalTrials.gov NCT02281188; https://clinicaltrials.gov/ct2/show/NCT02281188).Öğe Advanced ultrasound in the diagnosis of prostate cancer(Springer, 2021) Correas, Jean-Michel; Halpern, Ethan J.; Barr, Richard G.; Ghai, Sangeet; Walz, Jochen; Bodard, Sylvain; Dariane, Charles; de la Rosette, Jean J. M. C. H.The diagnosis of prostate cancer (PCa) can be challenging due to the limited performance of current diagnostic tests, including PSA, digital rectal examination and transrectal conventional US. Multiparametric MRI has improved PCa diagnosis and is recommended prior to biopsy; however, mp-MRI does miss a substantial number of PCa. Advanced US modalities include transrectal prostate elastography and contrast-enhanced US, as well as improved B-mode, micro-US and micro-Doppler techniques. These techniques can be combined to define a novel US approach, multiparametric US (mp-US). Mp-US improves PCa diagnosis but is not sufficiently accurate to obviate the utility of mp-MRI. Mp-US using advanced techniques and mp-MRI provide complementary information which will become even more important in the era of focal therapy, where precise identification of PCa location is needed.Öğe Association of diabetes, hypertension, and their combination with basal symptoms and treatment responses in overactive bladder patients(Frontiers Media S.A., 2023) Müderrisoğlu, A. Elif; Sakul, Ayse A.; Murgas, Sandra; de la Rosette, Jean J. M. C. H.; Michel, Martin C.Introduction: Pelvic hypoperfusion caused by atherosclerosis has been proposed as a cause of lower urinary tract dysfunction including overactive bladder syndrome (OAB). Limited data indicate that OAB patients with concomitant diabetes or hypertension, known risk factors of atherosclerosis, may exhibit greater baseline OAB symptoms and slightly smaller therapeutic responses to treatment, but the impact of a combined presence of diabetes and hypertension has not been reported. Therefore, we have explored whether the combined presence of both comorbidities is associated with greater baseline OAB symptoms than that of either comorbidity alone. Secondary questions were exploration of the impact of either comorbidity on baseline symptoms, and of the impact of either comorbidity alone and their combination on therapeutic responses. Methods: Data from two non-interventional studies applying treatment with propiverine ER 30 or 45 mg/d for 12 weeks were analyzed. Results: Number of urgency episodes in the combination group was greater than with each comorbidity alone. The impact of comorbidities on baseline intensity of incontinence, frequency or nocturia or Patient Perception of Bladder Condition was less consistent or absent. Either comorbidity alone was associated with a smaller % improvement of symptoms, and their combination had a greater effect than either alone. However, all attenuations associated with comorbidity were small relative to the overall improvement. Conclusions: We conclude that comorbidities of diabetes and hypertension have detectable effects on OAB symptoms and treatment responses, but the small magnitude of these alterations does not justify changing existing paradigms for the clinical management of OAB.Öğe Available evidence on HIFU for focal treatment of prostate cancer: A systematic review(NLM (Medline), 2022) Bakavicius, A.; Marra, G.; Macek, P.; Robertson, C.; Abreu, A. L.; George, A. K.; Malavaud, B.; Coloby, P.; Rischmann, P.; Moschini, M.; Rastinehad, A. R.; Sidana, A.; Stabile, A.; Tourinho-Barbosa, R.; de la Rosette, Jean J. M. C. H.; Ahmed, H.; Polascik, T.; Cathelineau, X.; Sanchez-Salas, R.PURPOSE: Prostate cancer (PCa) is the second most common oncologic disease among men. Radical treatment with curative intent provides good oncological results for PCa survivors, although definitive therapy is associated with significant number of serious side-effects. In modern-era of medicine tissue-sparing techniques, such as focal HIFU, have been proposed for PCa patients in order to provide cancer control equivalent to the standard-of-care procedures while reducing morbidities and complications. The aim of this systematic review was to summarise the available evidence about focal HIFU therapy as a primary treatment for localized PCa. MATERIAL AND METHODS: We conducted a comprehensive literature review of focal HIFU therapy in the MEDLINE database (PROSPERO: CRD42021235581). Articles published in the English language between 2010 and 2020 with more than 50 patients were included. RESULTS: Clinically significant in-field recurrence and out-of-field progression were detected to 22% and 29% PCa patients, respectively. Higher ISUP grade group, more positive cores at biopsy and bilateral disease were identified as the main risk factors for disease recurrence. The most common strategy for recurrence management was definitive therapy. Six months after focal HIFU therapy 98% of patients were totally continent and 80% of patients retained sufficient erections for sexual intercourse. The majority of complications presented in the early postoperative period and were classified as low-grade. CONCLUSIONS: This review highlights that focal HIFU therapy appears to be a safe procedure, while short-term cancer control rate is encouraging. Though, second-line treatment or active surveillance seems to be necessary in a significant number of patients.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 Chronic renal impairment predicts oncological outcomes in utuc patients undergoing rnu(2024) Wong, Chris Ho Ming; Sabuncu, Kubilay; Horuz, Rahim; Albayrak, Selami; del Pilar Laguna Pes, Maria; de la Rosette, Jean J. M. C. H.; Teoh, Jeremy Yuen ChunObjective: This study aims to explore the relationship between pre-existing renal impairment and oncological outcomes in upper tract urothelial carcinoma (UTUC) patients treated with radical nephroureterectomy (RNU) using data from a multicentre international registry. Patients and methods: Data on non-metastatic UTUC patients who underwent RNU were obtained from the Clinical Research Office of the Endourology Society Urothelial Carcinomas of the Upper Tract (CROES-UTUC) Registry. Patients were categorised into normal pre-operative renal function and chronic renal impairment (CKD) groups, with CKD defined as an estimated glomerular filtration rate below 60 mL/kg/1.73 m². Kaplan–Meier survival analysis was employed to investigate disease-free survival (DFS) and overall survival (OS). Multivariable Cox regression analysis was conducted to identify confounding variables. Results: A total of 1393 patients diagnosed with UTUC who underwent RNU between 2014 and 2019 were analysed. 875 patients (62.4%) had normal renal function, whilst 528 patients (37.6%) had CKD prior to RNU. The two groups had similar proportions of bladder cancer history, comparable cardiovascular comorbidity, similar tumour stage, and comparable proportions receiving laparoscopic or robotic-assisted RNU. In multivariable cox regression analysis, CKD was found to be associated with inferior DFS (HR = 1.419; 95%CI = 1.060–1.898; p = 0.019). Upon multivariable analysis, pre-existing renal impairment and higher T stage (HR = 4.613; 95%CI = 1.829–4.712; p < 0.001) and the use of adjuvant chemotherapy (HR = 1.858; 95%CI = 1.229–2.807; p = 0.003) were also found to associate with worse DFS. Significant cardiovascular disease and higher T stage were associated with worse OS. Existing renal impairment at baseline did not have any significant associated with OS. Conclusion: In this multicentre registry, preoperative chronic renal impairment was identified as an independent predictor of inferior DFS in patients undergoing RNU for non-metastatic UTUC. Preoperative CKD could serve as a clinical predictor of poorer oncological outcomes.Öğe Classification and standardized reporting of percutaneous nephrolithotomy (PCNL): International alliance of urolithiasis (IAU) consensus statements(2022) Choong, Simon; de la Rosette, Jean J. M. C. H.; Denstedt, John; Zeng, Guohua; Sarıca, Kemal; Mazzon, Giorgio; Saltirov, Iliya; Pal, Shashi Kumar; Agrawal, Madhu; Desai, Janak; Petrik, Aleš; Buchholz, Noor; Maroclo, Marcus V.; Gordon, Stephen; Sridhar, AshwinBackground: To reach a consensus in the classification and standardized reporting for the different types of PCNLs. Methods: The RAND/UCLA appropriateness methodology was used to reach a consensus. Thirty-two statements were formulated reviewing the literature on guidelines and consensus on PCNLs, and included procedure specific details, outcome measurements and a classification for PCNLs. Experts were invited to two rounds of input, the first enabled independent modifications of the proposed statements and provided the option to add statements. The second round facilitated scoring of all statements. Each statement was discussed in the third round to decide which statements to include. Any suggestion or disagreement was debated and discussed to reach a consensual agreement. Results: Twenty-five recommendations were identified to provide standardised reporting of procedure and outcomes. Consensual scoring above 80% were strongly agreed upon by the panel. The top treatment related outcomes were size of sheath used (99.1%) and position for PCNL (93.5%). The highest ranked Outcome Measures included definition of post-operative hospital length of stay (94.4%) and estimated blood loss (93.5%). Conclusions: The consensus statements will be useful to clarify operative technique, in the design of clinical trials and standardized reporting, and presentation of results to compare outcomes of different types of PCNLs.Öğe Colorectal cancer and associated genetic, lifestyle, cigarette, nargileh-hookah use and alcohol consumption risk factors: a comprehensive case-control study(2024) Bener, Abdulbari; Öztürk, Ahmet Emin; Daşdelen, Muhammed Furkan; Barışık, Cem Cahit; Daşdelen, Zehra Betül; Ağan, Ahmet Faruk; de la Rosette, Jean J. M. C. H.; Day, Andrew S.Aim: This study aimed to investigate the causes and risk factors of colorectal cancer (CRC) in a Turkish population, focusing on various modifiable and non-modifiable risk factors. Methods: A hospital-based case-control design was employed to compare individuals with CRC (cases) to individuals without CRC (controls). Male and female participants were recruited from the surgery, internal medicine, and out-patient departments. The study encompassed socio-demographic data, clinical information, radiological diagnoses, and biochemical measurements. Univariable and multivariable logistic regressions were used to determine associated risk factors of CRC. Results: The study included 704 individuals with CRC and 704 controls. Significant socio-demographic disparities were observed between the groups, with over 30% of the cases having lower levels of education and income compared to the controls. Lifestyle factors such as obesity, higher rates of smoking (cigarettes and hookah) and alcohol consumption were more prevalent among cases than controls. Further significant associations were identified with intestinal inflammation, obesity, processed food consumption, and symptoms such as abdominal pain, cramps, diarrhea, constipation, blood in stool, bloating, irritable bowel syndrome, nausea/vomiting, anemia, stress, fatigue, weakness, and weight loss. Diet analysis revealed that individuals with CRC consumed more red meat, processed and fast foods along with less pulses and vegetables. Genetic predispositions and exposure to chemicals also correlated strongly with increased CRC risk. Multivariable regression analysis identified, nausea/vomiting, constipation, intestinal disease, genetics factor, hookah-nargileh use, history of any cancer, family history of bowel cancer, constipation, cigarette smoking, stress, milk-yogurt consumption, obesity and red meat consumption as significant determinants for CRC. Conclusion: CRC risk is influenced by dietary, lifestyle, and genetic factors. Awareness of hereditary risk and participation in screening are crucial. Lifestyle changes, such as avoiding smoking, hookah, and alcohol use, and adopting a healthy diet, are essential for prevention.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 Confocal laser endomicroscopy and optical coherence tomography for the diagnosis of prostate cancer: A needle-based, in vivo feasibility study protocol (Ideal phase 2a)(JMIR Publications, Inc, 2018) Swaan, Abel; Mannaerts, Christophe K.; Scheltema, Matthijs J. V.; Nieuwenhuijzen, Jakko A.; Savcı-Heijink, C. Dilara; de la Rosette, Jean J. M. C. H.; Van Moorselaar, R. Jeroen A.; Van Leeuwen, Ton G.; De Reijke, Theo M.; De Bruin, Daniel MartijnBackground: Focal therapy for prostate cancer has been proposed as an alternative treatment to whole-gland therapies in selected men to diminish side effects in localized prostate cancer. As nowadays imaging cannot offer complete prostate cancer disease characterization, multicore systematic biopsies are recommended (transrectal or transperineal). Optical imaging techniques such as confocal laser endomicroscopy and optical coherence tomography allow in vivo, high-resolution imaging. Moreover, they can provide real-time visualization and analysis of tissue and have the potential to offer additive diagnostic information. Objective: This study has 2 separate primary objectives. The first is to assess the technical feasibility and safety of in vivo focal imaging with confocal laser endomicroscopy and optical coherence tomography. The second is to identify and define characteristics of prostate cancer and normal prostate tissue in confocal laser endomicroscopy and optical coherence tomography imaging by comparing these images with the corresponding histopathology. Methods: In this prospective, in vivo feasibility study, needle-based confocal laser endomicroscopy and optical coherence tomography imaging will be performed before transperineal template mapping biopsy or radical prostatectomy. First, confocal laser endomicroscopy and optical coherence tomography will be performed in 4 patients (2 for each imaging modality) undergoing transperineal template mapping biopsy to assess the feasibility and safety of confocal laser endomicroscopy and optical coherence tomography. If proven to be safe and feasible, confocal laser endomicroscopy and optical coherence tomography will be performed in 10 patients (5 for each imaging modality) undergoing radical prostatectomy. Confocal laser endomicroscopy and optical coherence tomography images will be analyzed by independent, blinded observers. Confocal laser endomicroscopy-and optical coherence tomography-based qualitative and quantitative characteristics and histopathology will be compared. The study complies with the IDEAL (Idea, Development, Exploration, Assessment, Long-term study) stage2a recommendations. Results: At present, the study is enrolling patients and results and outcomes are expected in 2019. Conclusions: Confocal laser endomicroscopy and optical coherence tomography are promising optical imaging techniques that can visualize and analyze tissue structure, possible tumor grade, and architecture in real time. They can potentially provide real-time, high-resolution microscopic imaging and tissue characteristics of prostate cancer in conjunction with magnetic resonance imaging or transrectal ultrasound fusion-guided biopsy procedures. This study will provide insight into the feasibility and tissue-specific characteristics of confocal laser endomicroscopy and optical coherence tomography for real-time optical analysis of prostate cancer.Öğe Confocal laser endomicroscopy for upper tract urothelial carcinoma: Validation of the proposed criteria and proposal of a scoring system for real-time tumor grading(Springer Verlag, 2019) Freund, Jan Erik; Liem, Esmee I.M.L.; Savcı-Heijink, Cemile Dilara; Baard, Joyce; Kamphuis, Guido Maarten; de la Rosette, Jean J. M. C. H.; de Bruin, Daniël MartijnPurpose: Confocal laser endomicroscopy (CLE) is a fluorescence-based fiber-optic imaging technique with the potential for intraoperative grading of upper tract urothelial carcinoma (UTUC). This study aims to (1) investigate the prevalence of the previously proposed CLE criteria for bladder cancer in papillary UTUC, (2) estimate the diagnostic value of CLE for UTUC grading and (3) propose a scoring system for a more quantifiable approach of CLE-based grading of UTUC. Materials and methods: Ureteroscopic CLE was performed in patients with UTUC. Following CLE imaging, co-localized biopsies were taken for histopathologic comparison. Postoperatively, two blinded raters assessed the CLE images. Results: Fifty-three papillary UTUCs (34 low grade and 19 high grade) were imaged with CLE in 36 patients. All the previously described CLE criteria were identifiable in varying proportions. After excluding 10 non-diagnostic recordings (5 low grade and 5 high grade) due to insufficient image quality, the histopathologic grade was correctly identified with CLE in 26 low-grade UTUCs (90%) and in 12 high-grade UTUCs (86%). The most prevalent CLE criteria with the highest diagnostic potential were cellular organization, morphology and cohesiveness of cells. A scoring system was proposed with these criteria, which yielded similar diagnostic accuracies. Conclusions: Based on the previously proposed criteria, CLE enables accurate grading of papillary UTUC at a non-diagnostic rate of 19%. The most prevalent CLE criteria with the highest diagnostic potential for grading of papillary UTUC are cellular organization, morphology and cohesiveness of cells. The proposed scoring system may simplify the assessment of CLE images for UTUC grading but external validation is required.Öğe Consensus and diversity in the management of varicocele for male infertility: Results of a global practice survey and comparison with guidelines and recommendations(Korean Society for Sexual Medicine and Andrology, 2022) Shah, Rupin; Agarwal, Ashok; Kavoussi, Parviz; Rambhatla, Amarnath; Saleh, Ramadan; Cannarella, Rossella; Harraz, Ahmed M.; Boitrelle, Florence; Kuroda, Shinnosuke; Hamoda, Taha Abo-Almagd Abdel-Meguid; Zini, Armand; Ko, Edmund; Çalık, Gökhan; Toprak, Tuncay; Kandil, Hussein; Gül, Murat; Bakırcıoğlu, Mustafa Emre; Parekh, Neel; Russo, Giorgio Ivan; Tadros, Nicholas; Kadıoğlu, Ateş; Arafa, Mohamed; Chung, Eric; Rajmil, Osvaldo; Dimitriadis, Fotios; Malhotra, Vineet; Salvio, Gianmaria; Henkel, Ralf; Le, Tan V.; Sogutdelen, Emrullah; Vij, Sarah; Alarbid, Abdullah; Güdeloğlu, Ahmet; Tsujimura, Akira; Calogero, Aldo E.; El Meliegy, Amr; Crafa, Andrea; Kalkanlı, Arif; Baser, Aykut; Hazır, Berk; Giulioni, Carlo; Cho, Chak-Lam; Ho, Christopher C.K.; Salzano, Ciro; Zylbersztejn, Daniel Suslik; Tien, Dung Mai Ba; Pescatori, Edoardo; Borges, Edson; Saïs-Hamza, Eminej; Huyghe, Eric; Ceyhan, Erman; Caroppo, Ettore; Castiglioni, Fabrizio; Bahar, Fahmi; Gökalp, Fatih; Lombardo, Francesco; Gadda, Franco; Duarsa, Gede Wirya Kusuma; Pinggera, Germar-Michael; Busetto, Gian Maria; Balercia, Giancarlo; Cito, Gianmartin; Blecher, Gideon; Franco, Giorgio; Liguori, Giovanni; Elbardisi, Haitham; Keskin, Hakan; Lin, Haocheng; Taniguchi, Hisanori; Park, Hyun Jun; Ziouziou, Imad; de la Rosette, Jean J. M. C. H.; Hotaling, Jim; Ramsay, Jonathan; Molina, Juan Manuel Corral; Lo, Ka Lun; Böcü, Kadir; Khalafalla, Kareim; Bowa, Kasonde; Okada, Keisuke; Nagao, Koichi; Chiba, Koji; Hakim, Lukman; Makarounis, Konstantinos; Hehemann, Marah; Peña, Marcelo Rodriguez; Falcone, Marco; Bendayan, Marion; Martinez, Marlon; Timpano, Massimiliano; Altan, Mesut; Fode, Mikkel; Al-Marhoon, Mohamed S.; Gilani, Mohammad Ali Sadighi; Soebadi, Mohammad Ayodhia; Gherabi, Nazim; Sofikitis, Nikolaos; Kahraman, Oğuzhan; Birowo, Ponco; Kothari, Priyank; Sindhwani, Puneet; Javed, Qaisar; Ambar, Rafael F.; Kosgi, Raghavender; Ghayda, Ramy Abou; Adriansjah, Ricky; Condorelli, Rosita Angela; La Vignera, Sandro; Micic, Sava; Kim, Shannon Hee Kyung; Fukuhara, Shinichiro; Ahn, Sun Tae; Mostafa, Taymour; Ong, Teng Aik; Takeshima, Teppei; Amano, Toshiyasu; Barrett, Trenton; Arslan, Umut; Karthikeyan, Vilvapathy Senguttuvan; Atmoko, Widi; Yumura, Yasushi; Yuan, Yiming; Kato, Yuki; Jezek, Davor; Cheng, Bryan Kwun-Chung; Hatzichristodoulou, Georgios; Dy, Jun; Castañé, Eduard Ruiz; El-Sakka, Ahmed I.; Nguyen, Quang; Sarıkaya, Selçuk; Boeri, Luca; Tan, Ronny; Moussa, Mohamad A.; El-Assmy, Ahmed; Alali, Hamed; Alhathal, Naif; Osman, Yasser; Perovic, Dragoljub; Sajadi, Hesamoddin; Akhavizadegan, Hamed; Vu?ini?, Miroslav; Kattan, Said; Kattan, Mohamed S.; Mogharabian, Nasser; Phuoc, Nguyen Ho Vinh; Ngoo, Kay Seong; Alkandari, Mohammad H.; Alsuhaibani, Shaheed; Sokolakis, Ioannis; Babaei, Mehdi; King, Mak Siu; Diemer, Thorsten; Gava, Marcelo M.; Henrique, Raphael; Spinola e Silva, Rodrigo; Paul, Gustavo Marquesine; Mierzwa, Tiago Cesar; Glina, Sidney; Siddiqi, Kashif; Wu, Han; Wurzacher, Jana; Farkouh, Ala'a; Son, Hwancheol; Minhas, Suks; Lee, Joe; Magsanoc, Nikko; Capogrosso, Paolo; Capogrosso, Paolo; Albano, German Jose; Lewis, Sheena E.M.; Jayasena, Channa N.; Alvarez, Juan G.; Teo, Colin; Smith, Ryan P.; Chua, Jo Ben M.; Jensen, Christian Fuglesang S.; Parekattil, Sijo; Finelli, Renata; Durairajanayagam, Damayanthi; Karna, Keshab Kumar; Ahmed, Abdelkareem; Evenson, Don; Umemoto, Yukihiro; Puigvert, Ana; Çeker, Gökhan; Colpi, Giovanni M.; Rolitsky, Sarah; Bouzouita, Abderrazak; Shokeir, Ahmed; Aşçı, Ahmet; Bouker, Amin; Adamyan, Aram; Avoyan, Armen E.; Palani, Ayad; Aghamajidi, Azin; Eze, Balantine; Noegroho, Bambang Sasongko; Purnomo, Basuki; Erkan, Bircan Kolbaşı; Zilaitiene, Birute; Kulaksız, Deniz; Kafetzis, Dimitrios; Lee, Dong Sup; Stember, Doron; Evgeni, Evangelini; Alhajeri, Faisal; Finocchi, Federica; Colombo, Fulvio; Tsangaris, George; Sallam, Hassan N.; Acosta, Herik; Rosas, Israel Maldonado; Kirkman-Brown, Jackson; Shin, Jae Il; Sonksen, Jens; Dong, Jie; Marmar, Joel; Moreno-Sepulveda, Jose; Seo, Ju Tae; Aydos, Kaan; Kesari, Kavindra Kumar; Trost, Landon; Jenkins, Lawrence; Rocco, Lucia; Darbandi, Mahsa; Simopoulou, Mara; Alves, Marco; Sabbaghian, Marjan; Tavalaee, Marziyeh; Razi, Mazdak; Duran, Mesut Berkan; Nago, Mitsuru; Elkhouly, Mohamed; Khalili, Mohamed; Nasr-Esfahani, Mohammad Hossein; Kamath, Mohan S.; Uğur, Muhammet Raşit; Park, Nam Cheol; Cruz, Natalio; Garrido, Nicolas; Sodeifi, Niloofar; Al Khalidi, Noora; Shoshany, Ohad; Satyagraha, Paksi; Drakopoulos, Panagiotos; Vogiatzi, Paraskevi; Dolati, Parisa; Das, Partha; Chiu, Peter Ka-Fung; Tsioulou, Petroula A.; Patel, Premal; Singh, Rajender; Kaiyal, Raneen Sawaid; Santos, Ferreira; Dada, Rima; Brodjonegoro, Sakti; Banihani, Saleem Ali; Schon, Samantha; Darbandi, Sara; Güneş, Sezgin; Homa, Sheryl; Mutambirwa, Shingai; Roychoudhury, Shubhadeep; Diaz, Sofia Ines Leonardi; Gopalakrishnan, Sreelatha; Krawetz, Stephen; Jindal, Sunil; Avidor-Reiss, Tomer; Lin, Tsung Yen; Kumar, Vijay; Ibrahim, Wael; Kerkeni, Walid; Woo, Wongi; Morimoto, Yoshiharu; Cheng, Yu-ShengPurpose: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. Materials and Methods: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological Association [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. Results: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.Öğe Contemporary patterns of presentation, diagnostics and management of upper tract urothelial cancer in 101 centres: The Clinical Research Office of the Endourological Society Global upper tract urothelial carcinoma registry(NLM (Medline), 2021) Baard, Joyce; Cormio, Luigi; Cavadas, Vítor; Alcaraz, Antonio; Shariat, Shahrokh F.; de la Rosette, Jean J. M. C. H.; Laguna, María PilarPURPOSE OF REVIEW: To assess patterns of presentation, diagnostics and treatment in patients with upper tract urothelial carcinoma (UTUC), a multicentre registry was launched. Clinical data of UTUC patients were prospectively collected over a 5-year period. RECENT FINDINGS: Data from 2380 patients were included from 2014 to 2019 (101 centres in 29 countries). Patients were predominantly male (70.5%) and 53.3% were past or present smokers. The majority of patients (58.1%) were evaluated because of symptoms, mainly macroscopic hematuria. Computed tomography (CT) was the most common performed imaging modality (90.5%). A ureteroscopy (URS) was part of the diagnostic process in 1184 (49.7%) patients and 488 (20.5%) patients were treated endoscopically. In total, 1430 patients (60.1%) were treated by a radical nephroureterectomy, 59% without a prior diagnostic URS. Eighty-two patients (3.4%) underwent a segmental resection, 19 patients (0.8%) were treated by a percutaneous tumour resection. SUMMARY: Our data is in line with the known epidemiologic characteristics of UTUC. CT imaging is the preferred imaging modality as also recommended by guidelines. Diagnostic URS gained a stronger position, however, in almost half of patients a definitive treatment decision was made without complete endoscopic information. Only one-third of patients with UTUC are currently treated with kidney sparing surgery.
