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in category urology

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1: ACE2 Expression in Kidney and Testis May Cause Kidney and Testis Damage After 2019-nCoV Infection
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Posted 13 Feb 2020

ACE2 Expression in Kidney and Testis May Cause Kidney and Testis Damage After 2019-nCoV Infection
124,553 downloads medRxiv urology

Caibin Fan, Kai Li, Yanhong Ding, Wei Lu, Jianqing Wang

In December 2019 and January 2020, novel coronavirus (2019-nCoV) - infected pneumonia (NCIP) occurred in Wuhan, and has already posed a serious threat to public health. ACE2 (Angiotensin Converting Enzyme 2) has been shown to be one of the major receptors that mediate the entry of 2019-nCoV into human cells, which also happens in severe acute respiratory syndrome coronavirus (SARS). Several researches have indicated that some patients have abnormal renal function or even kidney damage in addition to injury in respiratory system, and the related mechanism is unknown. This arouses our interest in whether coronavirus infection will affect the urinary and male reproductive systems. Here in this study, we used the online datasets to analyze ACE2 expression in different human organs. The results indicate that ACE2 highly expresses in renal tubular cells, Leydig cells and cells in seminiferous ducts in testis. Therefore, virus might directly bind to such ACE2 positive cells and damage the kidney and testicular tissue of patients. Our results indicate that renal function evaluation and special care should be performed in 2019-nCoV patients during clinical work, because of the kidney damage caused by virus and antiviral drugs with certain renal toxicity. In addition, due to the potential pathogenicity of the virus to testicular tissues, clinicians should pay attention to the risk of testicular lesions in patients during hospitalization and later clinical follow-up, especially the assessment and appropriate intervention in young patients fertility.

2: Urinalysis, but not blood biochemistry, detects the early renal-impairment in patients with COVID-19
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Posted 06 Apr 2020

Urinalysis, but not blood biochemistry, detects the early renal-impairment in patients with COVID-19
2,680 downloads medRxiv urology

Haifeng Zhou, Zili Zhang, Heng Fan, Junyi Li, Mingyue Li, Yalan Dong, Weina Guo, Lan Lin, Zhenyu Kang, Ting Yu, Chunxia Tian, Yang Gui, Renjie Qin, Haijun Wang, Shanshan Luo, Desheng Hu

BackgroundIn December 2019, a novel coronavirus (SARS-CoV-2) caused infectious disease, termed COVID-19, outbroke in Wuhan, China. COVID-19 patients manifested as lung injury with complications in other organs, such as liver, heart, gastrointestinal tract, especially for severe cases. However, whether COVID-19 causes significant acute kidney injury (AKI) remained controversial. MethodsWe retrospectively analyzed the clinical characteristics, urine and blood routine tests and other laboratory parameters of hospitalized COVID-19 patients in Wuhan Union Hospital. Findings178 patients, admitted to Wuhan Union hospital from February 02 to February 29, 2020, were included in this study. No patient (0 [0%]) presented increased serum creatinine (Scr), and 5 (2.8%) patients showed increased blood urea nitrogen (BUN), indicating few cases with "kidney dysfunction". However,for patients (83) with no history of kidney disease who received routine urine test upon hospitalization, 45 (54.2%) patients displayed abnormality in urinalysis, such as proteinuria, hematuria and leukocyturia, while none of the patients was recorded to have acute kidney injury (AKI) throughout the study. Meanwhile, the patients with abnormal urinalysis usually had worse disease progression reflecting by laboratory parameters presentations, including markers of liver injury, inflammation, and coagulation. ConclusionMany patients manifested by abnormal urinalysis on admission, including proteinuria or hematuria. Our results revealed that urinalysis is better in unveiling potential kidney impairment of COVID-19 patients than blood chemistry test and urinalysis could be used to reflect and predict the disease severity. We therefore recommend pay more attention in urinalysis and kidney impairment in COVID-19 patients.

3: Intermittent gross hematuria after lithotripsy: ureteral stent or residual stone?
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Posted 17 Feb 2020

Intermittent gross hematuria after lithotripsy: ureteral stent or residual stone?
2,477 downloads medRxiv urology

Linjie Peng, Junjun Wen, Wen Zhong

PurposeTo explore the role of stone fragment and ureteric stent in process of intermittent gross hematuria (IGH), discuss the definition of ureteral stent related symptoms (USS) in a setting of lithotripsy and clinical outcomes of IGH. MethodsBetween January 2018 and July 2019, patients with completed one month follow up after lithotripsy were collected. Based on whether occurrence of IGH, demographics, stent information and clinical outcomes were mainly analyzed. ResultsA total of 258 consecutive patients were eventually analyzed, among which 97 patients (37.6%) suffered from IGH. Compared to patients without symptom of IGH, preoperative potassium level (3.89{+/-}0.43mmol/L vs. 4.02{+/-}0.42mmol/L, p=0.01), initial stone free rate (SFR, 50.52% vs. 68.32%, p=0.007) and potassium citrate application (11.34% vs. 4.55%, p=0.04) were found statistically different in univariate analysis. In multivariate logistic analysis, preoperative potassium level (OR: 0.39, CI: 0.19-0.76, p=0.007), potassium citrate (OR: 2.96, CI: 1.07-8.73, p=0.04), initial SFR (OR: 0.42, CI: 0.24-0.74, p<0.001), and hospital stay (OR: 0.94, CI: 0.89-0.99, p=0.045) were independent risk factors, rather than stent size and stent position. Hemoglobin change, stone area reduction and SFR in one-month follow-up were similar between groups, but more outpatient consultations were found in hematuria group (20 vs. 3, p<0.001), among which 2 patients were readmitted for severe ongoing hematuria. ConclusionsStone fragment, rather the size or length of ureteral stent, is the independent risk factors of IGH. Definition of USS is not suitable for IGH after lithotripsy, and a comprehensive inform and enough rest would reduce the unnecessary medical consultations.

4: No SARS-CoV-2 in expressed prostatic secretion of patients with coronavirus disease 2019: a descriptive multicentre study in China
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Posted 30 Mar 2020

No SARS-CoV-2 in expressed prostatic secretion of patients with coronavirus disease 2019: a descriptive multicentre study in China
2,318 downloads medRxiv urology

Weihe Quan, Jun Chen, Zhigang Liu, Jinfei Tian, Xiangqiu Chen, Tao Wu, Ziliang Ji, Jinqi Tang, Hao Chu, Haijia Xu, Yong Zhao, Qingyou Zheng

PurposeThe aim of the present study was to assess whether SARS-CoV-2 can be detected in the expressed prostatic secretion (EPS) of patients with corona virus disease 2019 (COVID-19). Methods18 cases of COVID-19, and 5 suspected cases, were selected from three medical centers to detect the RNA expression of SARS-CoV-2 in their EPS with RT-PCR. ResultsResults were negative in all EPS samples for SARS-CoV-2 of suspected and confirmed patients. ConclusionsNo SARS-CoV-2 was expressed in EPS of patients with COVID-19.

5: Acute kidney injury at early stage as a negative prognostic indicator of patients with COVID-19: a hospital-based retrospective analysis
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Posted 26 Mar 2020

Acute kidney injury at early stage as a negative prognostic indicator of patients with COVID-19: a hospital-based retrospective analysis
1,984 downloads medRxiv urology

Shen Xu, Lin Fu, Jun Fei, Hui-Xian Xiang, Ying Xiang, Zhu-Xia Tan, Meng-Die Li, Fang-Fang Liu, Ying Li, Ming-Feng Han, Xiu-Yong Li, De-Xin Yu, Hui Zhao, De-Xiang Xu

Coronavirus disease 2019 (COVID-19) is a newly emerged infection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and has been pandemic all over the world. This study described acute kidney injury (AKI) at early stage of COVID-19 and its clinical significance. Three-hundred and fifty-five COVID-19 patients with were recruited and clinical data were collected from electronic medical records. Patients prognosis was tracked and risk factors of AKI was analyzed. Of 355 COVID-19 patients, common, severe and critical ill cases accounted for 63.1%, 16.9% and 20.0%, respectively. On admission, 56 (15.8%) patients were with AKI. Although AKI was more common in critical ill patients with COVID-19, there was no significant association between oxygenation index and renal functional indices among COVID-19 patients with AKI. By multivariate logistic regression, male, older age and comorbidity with diabetes were three important independent risk factors predicting AKI among COVID-19 patients. Among 56 COVID-19 patients with AKI, 33.9% were died on mean 10.9 day after hospitalization. Fatality rate was obviously higher among COVID-+19 patients with AKI than those without AKI (RR=7.08, P<0.001). In conclusion, male elderly COVID-19 patients with diabetes are more susceptible to AKI. AKI at early stage may be a negative prognostic indicator for COVID-19.

6: An integrated multi-omics analysis identifies clinically relevant molecular subtypes of non-muscle-invasive bladder cancer
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Posted 22 Jun 2020

An integrated multi-omics analysis identifies clinically relevant molecular subtypes of non-muscle-invasive bladder cancer
1,961 downloads medRxiv urology

Sia V Lindskrog, Frederik F Prip, Philippe Lamy, Ann Taber, Clarice S Groeneveld, Karin Birkenkamp-Demtroder, Jorgen B Jensen, Trine Strandgaard, Iver Nordentoft, Emil Christensen, Mateo Sokac, Nicolai J. Birkbak, Lasse Maretty, Gregers H Hermann, Astrid C Petersen, Veronika Weyerer, Marc-Oliver Grimm, Marcus Horstmann, Gottfrid Sjodahl, Mattias Hoglund, Torben Steiniche, Karin Mogensen, Aurelien de Reynies, Roman Nawroth, Brian Jordan, Xiaoqi Lin, Dejan Dragicevic, Douglas G. Ward, Anshita Goel, Carolyn D Hurst, Jay D Raman, Joshua I Warrick, Ulrika Segersten, Danijel Sikic, Kim E M van Kessel, Tobias Maurer, Joshua J Meeks, David J Degraff, Richard T Bryan, Margaret A Knowles, Tatjana Simic, Arndt Hartmann, Ellen C Zwarthoff, Per-Uno Malmstrom, Nuria Malats, Francisco X Real, Lars Dyrskjot

The molecular landscape in non-muscle-invasive bladder cancer (NMIBC) is characterized by large biological heterogeneity with variable clinical outcomes. Here, we performed a large integrative multi-omics analysis of patients diagnosed with NMIBC (n=834). Transcriptomic analysis identified four classes (1, 2a, 2b and 3) reflecting tumor biology and disease aggressiveness. Both transcriptome-based subtyping and the level of chromosomal instability provided independent prognostic value beyond established prognostic clinicopathological parameters. High chromosomal instability, p53-pathway disruption and APOBEC-related mutations were significantly associated with transcriptomic class 2a and poor outcome. RNA-derived immune cell infiltration was associated with chromosomally unstable tumors and enriched in class 2b. Spatial proteomics analysis confirmed the higher infiltration of class 2b tumors and demonstrated an association between higher immune cell infiltration and lower recurrence rates. Finally, a single-sample classification tool was built and the independent prognostic value of the transcriptomic classes was documented in 1306 validation samples. The classifier provides a framework for novel biomarker discovery and for optimizing treatment and surveillance in next-generation clinical trials.

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Posted 09 May 2020

1,484 downloads medRxiv urology

Caroline Santos Silva, Ueslei Menezes de Araujo Pereira, Mateus Andrade Alvaia, Katia Santana Freitas, Cristiano M Gomes, Jose de Bessa

OBJECTIVE: To validate a new simplified score for the assessment of men with LUTS (LUTS-V). METHODS: We made adjustments to the VPSS, resulting in a new simplified instrument (LUTS visual score - LUTS-V). In a pilot study, LUTS-V was administered to 50 men to identify interpretation issues. We used the International Prostate Symptom Score (IPSS) as the gold standard to validate the new tool in 306 men. The total IPSS and LUTS-V scores for each subject were evaluated and we used Bland-Altman analysis and Pearson's correlation plot to assess the agreement between the scores. A ROC curve was utilized to determine the diagnostic accuracy of LUTS-V and its diagnostic properties were described in terms of sensitivity, specificity, positive, and negative predictive values. RESULTS: Median age was 59 [52-67] years and, according to the IPSS, 26 (8.7%) patients had severe symptoms, while 99 (33%) had moderate symptoms, and 175 (58.3%) had mild symptoms. We found a positive correlation between the IPSS and LUTS-V (r = 0.72; p < 0.0001). The bland-Altman analysis showed good agreement between the two questionnaires. We found LUTS-V to have a diagnostic accuracy to detect more severe cases of 83% (95% CI: [78-87%]; p < 0.001), as estimated by the area under the ROC curve. The cut-off value of [&ge;] 4 points was the best threshold, with a sensitivity of 74% and a specificity of 78%, which resulted in a negative predictive value of 81% and a positive predictive value of 71% in this scenario. Median completion time was 0.51 [0.41-1.07] min for LUTS-V and 2.5 [2.2-3.4] min for the IPSS (p < 0.0001). Also, 91.5% of patients completed the questionnaires with no help, while the other 8.5% were interviewed. CONCLUSION: LUTS-V is a simple, self-administered tool with a significant discriminating power to identify patients with moderate to severe symptoms.

8: Public Perceptions of Artificial Intelligence and Robotics in Medicine
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Posted 19 Dec 2019

Public Perceptions of Artificial Intelligence and Robotics in Medicine
1,354 downloads medRxiv urology

Bethany Stai, Nick Heller, Sean McSweeney, Jack Rickman, Paul Blake, Ranveer Vasdev, Zach Edgerton, Resha Tejpaul, Matt Peterson, Arveen Kalapara, Subodh Regmi, Nikolaos Papanikolopoulos, Christopher Weight

ObjectiveTo understand better the public perception and comprehension with medical technology such as artificial intelligence and robotic surgery. Additionally, to identify sensitivity to, and comfort with, the use of AI and robotics in medicine a in order to ensure acceptability and quality of counseling and to guide future development. Subjects and MethodsA survey was conducted on a convenience sample of visitors to the Minnesota State Fair (n = 264). The survey investigated participant beliefs on the capabilities of AI and robotics in medicine and their comfort with such technology. Participants were randomized to receive one of two similar surveys. In the first a diagnosis was made by a physician and in the second by an AI application in order to compare confidence in human and computer-based diagnosis. ResultsThe median age of participants was 45 (IQR 28-59), 58% were female (n=154) vs. 42% male (n=110), 69% had completed at least a bachelors degree, 88% were Caucasian (n=233) vs. 12% ethnic minorities (n=31) and were from 12 states in the US with most from the Upper Midwest. Participants had nearly equal trust in AI vs. physician diagnoses, however, they were significantly more likely to trust an AI diagnosis of cancer over a doctors diagnosis when responding to the version of the survey that suggested an AI could make medical diagnosis (p = 9.32e-06). Though 55% of respondents (n=145) reported they were uncomfortable with automated robotic surgery the majority of the individuals surveyed (88%) mistakenly believed that partially autonomous surgery was already being performed. Almost all (94%) stated they would be willing to pay for an AI to review their medical imaging, if available. ConclusionMost participants express confidence in AI providing medical diagnoses, sometimes even over human physicians. Participants generally expressed concern with surgical AI, but mistakenly believe it is already happening. As AI applications make their way into medical practice, health care providers should be cognizant of patient misconceptions and the sensitivity that patients have to how such technology is represented.

9: Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists
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Posted 05 Jun 2020

Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists
1,036 downloads medRxiv urology

Cristiano M Gomes, Luciano Favorito, Joao Victor T Henriques, Alfredo F Canalini, Karin Anzolch, Roni Fernandes, Carlos Henrique Bellucci, Caroline Santos Silva, Marcelo L Wroclawski, Antonio Carlos L Pompeo, Jose de Bessa

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 [&ge;] 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of [&ge;] 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.

10: A Prospective Study of Outcomes After Tubularized Incised Plate (TIP) Urethroplasty: a Multivariate Analysis of Prognostic Factors in Children 1-3 Years Old
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Posted 18 Sep 2020

A Prospective Study of Outcomes After Tubularized Incised Plate (TIP) Urethroplasty: a Multivariate Analysis of Prognostic Factors in Children 1-3 Years Old
1,026 downloads medRxiv urology

M. Reza Roshandel, Fahimeh Kazemi Rashed, Tannaz Aghaei Badr, Samantha Salomon, Mohammad Seyyed Ghahestani, Fernando A. Ferrer

Background: Tubularized incised plate (TIP) urethroplasty as the most common hypospadias repair method, aims to achieve normal functioning of the penis along with cosmetic reconstruction. However, there are remaining questions toward anatomical prognostic factors affecting the results of surgery. Lack of age-matched controls or controlling for meatal location, employment of several surgical techniques or multiple surgeons, or age heterogeneity of the study population are the problems affected the results of the current body of literature. Objective: This prospective study aimed to evaluate the preoperative factors to predict future complications associated with hypospadias repair outcomes in males aged between 1-3 years and performed by a single surgeon with employing multivariate analysis. Patients and methods: A prospective cohort of 101 males aging from 1 to 3 years with distal to mid-shaft hypospadias were consecutively selected for TIP repair. The urethral plate dimensions in erect and flaccid states, penile length, glans diameter, and chordee were evaluated individually before reconstruction. After surgery and during follow-up visits, the subsequent transient and persistent complications were recorded. Results: Postoperatively, the acute transient events were observed in 42 cases (41.6%) and the persistent complications in 16 cases (15.8%). The uncomplicated group had a higher percentage of patients with distal meatal location than the complicated group (P=0.01%). Furthermore, fistula formation was notably higher in the group with acute surgical site infection (P<0.001). The analysis also showed the width of the urethral plate to be inversely associated with the development of complications (P=0.03). Conclusion: By performing TIP by a single surgeon on a homogenous study population and eliminating the impact of severe chordee as a potential cofounding variable, this study prospectively found that out of the anatomical specifications, pre- and postoperative factors, the urethral meatus location was the only significant and independent predictor of the development of complications in young children with midshaft to distal hypospadias. Finally based on the inverse association of width with the complications we hypostatized that a combination of urethral width and depth should be considered in the investigation of prognostic factors for hypospadias repair outcomes. (figure 1)

11: Antimicrobial Susceptibility Pattern and Detection of Extended-Spectrum Beta-Lactamase (blaCTX-M) Gene in Escherichia coli from Urinary Tract Infections at the University Teaching Hospital in Lusaka, Zambia
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Posted 18 May 2020

Antimicrobial Susceptibility Pattern and Detection of Extended-Spectrum Beta-Lactamase (blaCTX-M) Gene in Escherichia coli from Urinary Tract Infections at the University Teaching Hospital in Lusaka, Zambia
1,008 downloads medRxiv urology

Emmanuel Chirwa, Georgina Mulundu, Kunda Ndashe, Kalo Kanongesha, Kaziwe Simpokolwe, Wezi Kachinda, Bernard Mudenda Hangombe

Urinary tract infections caused by Extended Spectrum Beta-Lactamase producing Escherichia coli are increasing globally and yet treatment still remains a challenge due to antibiotic resistance of the causative agent. The aim of the study was to determine the antimicrobial susceptibility pattern and detect the presence of blaCTX-M gene in Escherichia coli isolated from urinary tract infection patients at the University Teaching Hospital, Lusaka, Zambia. This was a cross-sectional study that involved the collection of urine samples from patients who were diagnosed with urinary tract infections. The samples were cultured on MacConkey agar complemented with cefotaxime and Polymerase Chain Reaction was performed to confirm the Extended-Spectrum Beta-Lactamase producers by detecting the CTX-M gene. Antimicrobial susceptibility tests were conducted using standard methods. A total of 327 urine samples were cultured and 15 (4.6%) of these samples were positive ESBL producers. The isolates showed complete resistance to ampicillin and cotrimoxazole. Multi drug-resistant Extended Spectrum Beta-Lactamase producing Escherichia coli was detected in 4.6 % of UTI patients at the University Teaching Hospital.

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Posted 25 Apr 2020

968 downloads medRxiv urology

Anna Paloma Martins Rocha Ribeiro, Caroline Santos Silva, Jean Carlos Zambrano, Juliana Oliveira Freitas Miranda, Carlos Augisto Molina, Cristiano M Gomes, Eduardo de Paula Miranda, Jose de Bessa

Introduction: Sickle cell disease (SCD) is associated with the development of hypogonadism, but there is still controversy regarding its etiology and clinical implications. Objective: To evaluate the prevalence of hypogonadism in a population of men with SCD and characterize its etiology. Methods: We performed a cross-sectional study of 34 men with SCD aged > 18 years. Sociodemographic and clinical data, including anthropometric measurements (weight, height, and BMI), were obtained. Early morning blood samples were collected and total testosterone (TT), free testosterone (FT), luteinizing hormone (LH), follicle-stimulating hormone (FSH), a complete blood count, and hemoglobin electrophoresis were measured. Results: Median age was 33 [26-41] years, and SS genotype was the most frequent (73.5%). The prevalence of eugonadism, compensated, and secondary hypogonadism was 67.5%, 26.4%, and 5.88%, respectively. No men with primary hypogonadism were identified in our sample. Those with compensated hypogonadism had also higher FSH levels than individuals with eugonadism; p < 0.001). Conclusion: In our study population of men with SCD a high prevalence of compensated hypogonadism was identified, which is a controversial and distinct clinical entity that warrants monitoring and further research.

13: Improved Global Response Outcome After Intradetrusor Injection of Adult Muscle-Derived Cells for the Treatment of Underactive Bladder
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Posted 19 Jun 2020

Improved Global Response Outcome After Intradetrusor Injection of Adult Muscle-Derived Cells for the Treatment of Underactive Bladder
939 downloads medRxiv urology

Jason Gilleran, Ananias Diokno, Elijah Ward, Larry Sirls, Deborah Hasenau, Jennifer Giodano, Evelyn Shea, Sarah Bartolone, Laura Lamb, Michael B. Chancellor

We report on the first regulatory approved clinical trial of a prospective open-label physician-initiated study assessing the safety and efficacy of intradetrusor injected Autologous Muscle Derived Cells (AMDC) treatment for underactive bladder (UAB). 20 non-neurogenic UAB patients were treated. Approximately 50-250 mg of quadriceps femoris muscle was collected using a spirotome 8-gauge needle. The muscles biopsy samples were sent to Cook MyoSite (Pittsburgh, PA) for processing, isolation, and propagation of cells. Research patients received approximately 30 intradetrusor injections of 0.5 mL delivered to the bladder, for a total of 15 mL and 125 million AMDC, performed utilizing a flexible cystoscope under direct vision using topical local anesthesia. Follow-up assessments included adverse events and efficacy via voiding diary and urodynamic testing at 1, 3, 6 & 12-month post-injection. An optional second injection was offered at the end of the 6 months visit. 20 patients received the first injection and all 20 patients requested and received a second injection. Median patient age was 65 years old (range 41-82 years). There were 16 male (80%) and 4 female (20%) patients. Etiology included 7 men (35%) with persistent urinary retention after transurethral resection of the prostate for benign prostatic hyperplasia and 13 patients (65%) with idiopathic chronic urinary retention. At the primary outcome time point of 12 months, 11/19 patients (58%) reported a global response assessment (GRA) > 5, showing slight to marked improvement in their UAB symptoms, compared to 6/20 (30%) patients at 3-months post-injection. No serious procedure or treatment-related adverse events occurred. Noted improvements included: decreased post void residual urine volume, increased voiding efficiency, and decreased catheter use. Intradetrusor injected AMDC as a treatment for UAB was successfully completed in a 20-patient trial without serious adverse event and with signal of efficacy. Cellular therapy may be a promising novel treatment for catheter dependent chronic urinary retention. A multicenter controlled trial is needed to further assess the promise of regenerative medicine in the treatment of lower urinary tract dysfunction.

14: Immediate post-operative PDE5i Therapy improves early Erectile Function Outcomes after Robot Assisted Radical Prostatectomy (RARP)
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Posted 28 Sep 2020

Immediate post-operative PDE5i Therapy improves early Erectile Function Outcomes after Robot Assisted Radical Prostatectomy (RARP)
887 downloads medRxiv urology

Arjun Nathan, Shivani Shukla, Amil Sinha, Sailantra Sivathasan, Amir Rashid, Joseph Rassam, Sonny Smart, Keval Patel, Nimish Shah, Benjamin W Lamb

Objectives To assess whether the timing of post-operative Phosphodiesterase Inhibitor (PDE5i) therapy after Robot Assisted Radical Prostatectomy (RARP) is associated with a change in early erectile function outcomes. Additionally, to determine whether there are differences in continence or safety outcomes. Subjects/patients and methods Data was prospectively collected from a single surgeon in one tertiary centre and retrospectively evaluated. 158 patients were treated with PDE5i therapy post RARP over a two-year period. PDE5i therapy was started: immediately (day 1-2) post-op in 29%, early (day 3-14) post-op in 37% and late (after day 14) post-op in 34%. EPIC-26 Erectile Function (EF) scores were collected pre-op and post-op with a median follow-up time of 43 days. Results The median age was 64 and the median BMI was 27. 9% of the series had Charlson Co-Morbidities. There were no significant differences in pre-operative characteristics between the therapy groups. Patients that had bilateral nerve sparing had a mean drop in Erectile Function (EF) score by 5.4 compared to 8.8 in the unilateral group. Additionally, 34.9% of bilateral nerve sparing patients returned to baseline compared to 12.1% of unilateral. Drop in EF scores and percentage return to baseline for unilateral nerve sparing was respectively 9 and 11.1% of immediate therapy, 7 and 14.8% of early therapy and 9.7 and 9.5% of late therapy (p=0.9 and p=0.6). For bilateral nerve sparing this was respectively 3.5 and 42.9% immediate therapy, 5.5 and 35.5% early therapy and 7.3 and 25% late therapy (p=0.017 and p=0.045). Pad free and social continence was achieved in 54% and 37% of those receiving immediate therapy, 60% and 33% for early therapy and 26% and 54% for late therapy. There were no differences in compliance, complication or readmission outcomes. Conclusion In patients with bilateral nerve sparing RARP, immediate post-operative PDE5i therapy may protect EF. Early onset (3-14 days) may also provide a benefit compared to initiating PDE5i therapy later (after 14 days). Expediting therapy for patients undergoing unilateral nerve sparing may also provide a benefit; however, the differences are less pronounced. Immediate or early PDE5i therapy also improved early continence outcomes for patients with bilateral nerve sparing, compared to late therapy. There were no differences in compliance, complication or readmission rates between the groups. Therefore, immediate PDE5i therapy should be considered in patients following nerve sparing RARP in order to maximise functional outcomes, especially in those undergoing bilateral nerve spare.

15: Safety of hot and cold site admissions within a high volume urology department in the United Kingdom at the peak of the COVID-19 pandemic
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Posted 06 Aug 2020

Safety of hot and cold site admissions within a high volume urology department in the United Kingdom at the peak of the COVID-19 pandemic
880 downloads medRxiv urology

Luke Stroman, Beth Russell, Pinky Kotecha, Anastasia Kantarzi, Luis Ribeiro, Bethany Jackson, Vugar Ismaylov, Adeoye Oluwakanyinsola Debo-Aina, Findlay MacAskill, Francesca Kum, Meghana Kulkarni, Raveen Sandher, Anna Walsh, Ella Doerge, Katherine Guest, Yamini Kailash, Nick Simson, Cassandra R McDonald, Elsie Mensah, Li June Tay, Ramandeep Chalokia, Sharon Clovis, Elizabeth Eversden, Jane Cossins, Jonah Rusere, Grace Zisengwe, Louisa Fleure, Leslie Cooper, Kathryn Chatterton, Amelia Barber, Catherine Roberts, Thomasia Azavedo, Jeffrey Ritualo, Harold Omana, Liza Mills, Lily Studd, Oussama El Hage, Rajesh Nair, Sachin Malde, Arun Sahai, Archana Fernando, Claire Taylor, Ben Challacombe, Ramesh Thurairaja, Rick Popert, Jonathon Olsburgh, Paul Cathcart, Christian Brown, Marios Hadjipavlou, Ella Di Benedetto, Matthew Bultitude, Jonathon Glass, Tet Yap, Rhana Zakri, Majed Shabbir, Susan Willis, Kay Thomas, Tim O'Brien, Muhammad Shamim Khan, Prokar Dasgupta

Importance: Contracting COVID-19 peri-operatively has been associated with a mortality rate as high as 23%. Using hot and cold sites has led to a low rate of post-operative diagnosis of COVID-19 infection and allowed safe continuation of important emergency and cancer operations in our centre. Objective: The primary objective was to determine the safety of the continuation of surgical admissions and procedures during the height of the COVID-19 pandemic using hot and cold surgical sites. The secondary objective is to determine risk factors of contracting COVID-19 to help guide further prevention. Setting: A single surgical department at a tertiary care referral centre in London, United Kingdom. Participants: All consecutive patients admitted under the care of the urology team over a 3-month period from 1st March to 31st May 2020 over both hot acute admission sites and cold elective sites were included. Exposures: COVID-19 was prevalent in the community over the three months of the study at the height of the pandemic. The majority of elective surgery was carried out in a cold site requiring patients to have a negative COVID-19 swab 72 hours prior to admission and to self-isolate for 14 days pre-operatively, whilst all acute admissions were admitted to the hot site. Main outcomes and measures: COVID-19 was detected in 1.6% of post-operative patients. There was 1 (0.2%) post-operative mortality due to COVID-19. Results: A total of 611 patients, 451 (73.8%) male and 160 (26.2%) female, with a median age of 57 (interquartile range 44-70) were admitted under the surgical team. Of these, 101 (16.5%) were admitted on the cold site and 510 (83.5%) on the hot site. Surgical procedures were performed in 495 patients of which 8 (1.6%) contracted COVID-19 post-operatively with 1 (0.2%) post-operative mortality due to COVID-19. Overall, COVID-19 was detected in 20 (3.3%) patients with 2 (0.3%) deaths. On multivariate analysis, length of stay was associated with contracting COVID-19 in our cohort (OR 1.25, 95% CI 1.13-1.39). Conclusions and Relevance: Continuation of surgical procedures using hot and cold sites throughout the COVID-19 pandemic was safe practice, although the risk of COVID-19 remained and is underlined by a post-operative mortality. Reducing length of stay may be able to reduce contraction of COVID-19.

16: Intervention strategies for cystinuria: A systematic review
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Posted 18 Sep 2020

Intervention strategies for cystinuria: A systematic review
874 downloads medRxiv urology

Nirmal P Bhatt, Aniruddh V Deshpande, Bernadette Jones-Freeman, Simon H Jiang, Malcolm R Starkey

Purpose: This systematic review evaluates the current intervention strategies for cystinuria and assesses their quality and efficacy in order to determine the need to identify new and improved strategies for treatment. Materials and Methods: A literature search for interventions in cystinuria was conducted on key electronic databases for studies published between 1996 and 2019. Quality was assessed using Methodological Index for Non-Randomized Studies (MINORS). Studies meeting the inclusion criteria were assessed for study design, patient characteristics and outcomes of interventions, including urinary cystine levels, stone-free rate and stone recurrence rate. A qualitative and critical analysis was performed. Results: Common treatment strategies for cystinuria include hydration and diuresis, alkali therapy and thiol-based therapeutics. Conservative therapies such as adequate hydration and urinary alkalization effectively increased urinary pH, decreased urinary cystine levels and the formation of cystine stones. Second line agents reported included thiols such as Tiopronin, D-penicillamine and captopril. Non-invasive surgical procedures were found to reduce operative trauma and preserved renal function. Combined treatment approaches with hydration and thiols after surgical procedures were associated with less stones and reduced stone recurrence rates. Patient compliance to interventions was often poor and contributed to recurrent cystine stones. Conclusions: Despite existing pharmacological intervention strategies, cystinuria patients frequently require surgical procedures. A more detailed understanding of the mechanisms of pathogenesis of cystinuria as well as an evaluation of patients on an individual basis may be beneficial in reducing the severity of cystinuria, by reducing stone recurrence and associated renal complications.

17: What Specimen Urologists Should Be Most Concerned About ? A Systematic Review and Meta-Analysis
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Posted 13 Oct 2020

What Specimen Urologists Should Be Most Concerned About ? A Systematic Review and Meta-Analysis
869 downloads medRxiv urology

M. Reza Roshandel, Masoud Nateqi, Ramin Lak, Pooya Aavani, Reza Sari Motlagh, Tannaz Aghaei Badr, John Sfakianos, Steven A. Kaplan, Shahrokh F. Shariat, Ashutosh K Tewari

ObjectiveInvestigating the infectivity of body fluid can be useful for preventative measures in the community and ensuring safety in the operating rooms and on the laboratory practices. MethodsWe performed a literature search of clinical trials, cohorts, and case series using PubMed/MEDLINE, Google Scholar, and Cochrane library, and downloadable database of CDC. We excluded case reports and searched all-language articles for review and repeated until the final drafting. The search protocol was registered in the PROSPERO database. ResultsThirty studies with urinary sampling for viral shedding were included. A total number of 1,271 patients were enrolled initially, among which 569 patients had undergone urinary testing. Nine studies observed urinary viral shedding in urine from 41 patients. The total incidence of urinary SARS-CoV-2 shedding was 8%, compared to 21.3% and 39.5 % for blood and stool, respectively. The summarized risk ratio (RR) estimates for urine positive rates compared to the pharyngeal rate was 0.08. The pertaining RR urine compared to blood and stool positive rates were 0.20 and 0.33 respectively. ConclusionsOur review concludes that not only the SARS-CoV-2 can be excreted in the urine in eight percent of patients but also its incidence may have associations with the severity of the systemic disease, ICU admission, and fatality rates. Moreover, the findings in our review suggest that a larger population size may reveal more positive urinary cases possibly by minimizing biases. However, it is important to notice that it is the naso-pharyngeal specimens, stool, and serum that show more possibilities to became positive, respectively.

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Posted 29 Jun 2020

867 downloads medRxiv urology

Sarah Spencer-Bowdage, Jeannie Rigby, Jackie O'Kelly, Phil Kelly, Mark Page, Caroline Raw, Paula Allchorne, Peter Harper, Jeremy Crew, Roger Kockelbergh, Allen Knight, Richard T Bryan

The Covid-19 pandemic has placed unprecedented strain on healthcare systems worldwide. Within this context, UK cancer services have undergone significant disruption to create capacity for the National Health Service. As a charity that endeavours to support bladder cancer (BC) patients and improve outcomes, Action Bladder Cancer UK (ABCUK) designed and administered a SurveyMonkey survey to investigate the prevalence of such disruption for BC patients. From 22nd April to 18th June 2020, 142 BC patients responded. Across all patient groups, 46.8% of patients described disruption to their treatment or follow-up. For non-muscle-invasive BC (NMIBC) patients, disruptions included postponement of: initial transurethral resection of bladder tumour (TURBT) (33.3%), subsequent TURBT (40.0%), and surveillance cystoscopy (58.1%). For NMIBC patients undergoing intravesical therapy, 68.4% experienced treatment postponements or curtailments. For muscle-invasive BC patients, 57.1% had experienced postponement of cystectomy and 14.3% had been changed from cystectomy to radiotherapy. Half of patients undergoing systemic chemotherapy also experienced disruption. Despite the survey's limitations, we have demonstrated considerable disruption to the care of BC patients during the UK Covid-19 pandemic. To avoid a repeat, the UK BC community should define effective contingent ways of working ready for a possible second wave of Covid-19, or any other such threat.

19: Outcomes of ureteroscopy and internal ureteral stent for pregnancy with urolithiasis: a systematic review and meta-analysis
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Posted 23 Sep 2020

Outcomes of ureteroscopy and internal ureteral stent for pregnancy with urolithiasis: a systematic review and meta-analysis
844 downloads medRxiv urology

Xingwei Jin, Boke Liu, Yunqi Xiong, Weichao Tu, Yuan Shao, Lin Zhang, Dawei Wang

Objectives To investigate the outcomes of internal ureteral stent versus ureteroscopy (URS) treatments for pregnant women with urolithiasis. Design This is a systematic review and meta-analysis of observational studies that investigated the outcomes of internal ureteral stent and ureteroscopy for pregnancy with urolithiasis. This systematic review have been registered on the PROSPERO website (www.york.ac.uk/inst/crd, registration number: CRD42020195607). Data Sources Relevant studies published from January 1980 to April 2020 were identified through a systematic literature search in MEDLINE, EMBASE, Web of Science and the Cochrane Library. Data extraction and synthesis All pregnant women in their all pregnancy stages who were underwent double-J (D-J) stent insertion only or URS operation for lithotripsy/stone extraction/exploration were considered. The number of related participants in study more than 10 were included. Fertility outcome and complications of intervention were extracted as main outcomes, while other data such as operation success rate, stone free rate (SFR), patient characteristics, anaesthetic method, ureteral stone characteristics, detail of interventions were obtained as well. Complications were stratified according to Clavien-Dindo criteria. Two authors independently extracted data and assessed the quality of included studies. Study-specific prevalence rates were pooled using a random-effects model. We applied the Newcastle-Ottawa Scale quality assessment to evaluate the quality of the selected studies. Results A total of 25 studies were identified with 131 cases undergoing serial stenting and 789 cases undergoing URS operation. The age range was from 16 to 41, and urolithiasis occurred in the second trimester most. Ultrasound was the most commonly used diagnostic method. The most common site of calculi was distal ureter. The average stone size was between 6-17mm. There were 6 studies investigating D-J stent insertion only, while 23 studies involving URS operation. The most commonly used anesthesia for internal ureteral stent therapy was local anesthesia, and for URS treatments, general anesthesia and spinal anesthesia were widely used. The pooled operation success rate was 97% for D-J stent insertion, and 99% for URS. Serial D-J stenting was an effective methods for treating ureter obstruction and only a few patients passed stone spontaneously. Different common lithotripters were used in URS operations and the pooled SFR was about 91%. For internal ureteral stent therapy; the rate of normal fertility outcome was 99%, but the pooled incidence of complications was about 45%. For the URS treatment group, the rate of normal fertility outcome was 99% as well, and the pooled incidence of complications was about 1%. However, the pooled premature and abortion incidence rate of two group were the same as less than 1%, and the same as this in serious complication incidence rate. Conclusions Both ureteroscopy operation and internal ureteral stent were usually used for handing pregnancy with urolithiasis. Two treatments had less side effective on fertility outcome, but internal ureteral stent may cause more complications. Evidence suggests that URS therapy may have a greater advantage for pregnancy with urolithiasis when the conditions permit. As it is proved safe and effective, internal ureteral stent could be considered at emergency condition or preoperative preparations was lack.

20: Lactobacillus pentosus KCA1 Decreases Vaginal and Gut Microbiota Associated with Bacterial Vaginosis (BV), Down-regulates IL-1 beta in Women of Child-Bearing Age and Modulates Bacterial Genes Related to Metabolic Functions
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Posted 04 Apr 2020

Lactobacillus pentosus KCA1 Decreases Vaginal and Gut Microbiota Associated with Bacterial Vaginosis (BV), Down-regulates IL-1 beta in Women of Child-Bearing Age and Modulates Bacterial Genes Related to Metabolic Functions
843 downloads medRxiv urology

Kingsley C Anukam, Chinwe E Ejike, Nneka R Agbakoba, Charlotte B Oguejiofor

IntroductionBacterial vaginosis which affects 14-50% of reproductive-aged women in Nigeria is misdiagnosed and under-reported. Treatment option is antibiotics, which leads to recurrent infections. The objectives of this study are three folds, first to determine effects of oral feeding of Lactobacillus pentosus KCA1 on the vaginal and gut microbiota of women diagnosed with BV; to measure the level of two proinflammatory cytokines IL-1 beta, before and after KCA1 consumption and to determine the relative abundance of bacterial metabolic genes. MethodsSeven women diagnosed with BV by Nugent score (7-10) were recruited to provide vaginal and gut sample before and after 14 days oral intake of 3 grams of Lactobacillus pentosus KCA1. The DNA from the swabs were processed for 16S rRNA metagenomics using Illumina MiSeq platform. The paired-end sequence FASTQ reads were imported into Illumina Basespace pipeline for quality check (QC). In addition, EzBioCloud pipeline was use for alpha and beta diversity estimation using PKSSU4.0 version and open reference UCLUST_MC2 for OTUs picking at 97% cut-off. Blood samples were analyzed using ELISA technique. PICRUSt was used to predict the metabolic functions from the 16S rRNA gene dataset. ResultsOn average, there was no significant difference at p=0.05 in the alpha indices typified by Shannon index. The beta diversity showed different clustering positions with PCoA. However, at individual taxonomic categories, there was a significant decrease in the relative abundance of some genera associated with bacterial vaginosis after KCA1 feeding with a corresponding increase of Lactobacillus genera. Bacterial genes related to defence systems were up-regulated in the vagina. There was a 2-fold down-regulation of IL-1 beta after consumption of KCA1. ConclusionOur findings suggest that Lactobacillus pentosus KCA1 taken orally, lowers pro-inflammatory cytokine, IL-1 beta and decreases the relative abundance of BV-associated bacteria.

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