Nevin Manimala

J Robot Surg. 2025 Jul 6;19(1):353. doi: 10.1007/s11701-025-02528-6.

ABSTRACT

To compare the therapeutic efficacy of conventional laparoscopic pyeloplasty (LP) and robot-assisted single-port laparoscopic pyeloplasty (RSLP) for ureteropelvic junction obstruction (UPJO) in infants and to summarize the preliminary experience and advantage of RSLP. The clinical data of UPJO infants (≤ 12 months) who received LP and RSLP in our center from October 2018 to October 2024 were analyzed retrospectively. A total of 51 patients with UPJO were included, with 11 cases receiving RSLP (8 with left UPJO; 3 with right UPJO) and 40 receiving LP (29 with left UPJO; 11 with right UPJO). In the RSLP group, the median age was 3 months (range: 1-9 months). In the LP group, the median age was 2.5 months (range: 1-11 months). The mean operative time was 217.45 ± 20.77 min for the RSLP group and 258.57 ± 52.56 min for the LP group. The mean time of ureteropelvic anastomosis in the RSLP group was shorter than that in the LP group (79.36 ± 17.74 vs. 99.35 ± 21.03). The mean hospital stay was 6.27 ± 2.53 days for the RSLP group and 6.32 ± 2.71 days for the LP group. The mean postoperative hospital stay was 1.9 ± 0.94 days for the RSLP group and 2.67 ± 2.37 days for the LP group. The mean hospital costs were 57,950.63 ± 1,165.68 yuan for the RSLP group and 30,396.30 ± 5214.06 yuan for the LP group. Significant improvements in the hydronephrosis grading, anterior-posterior renal pelvic diameters, and renal parenchymal thickness were observed in both groups after surgery. RSLP is a safe and effective method for the treatment of UPJO in infants. Compared with LP, RSLP has the advantages of precise suturing, short anastomosis time, and short operation duration, making it an attractive and safe option. However, it faces the disadvantages of higher cost of hospitalization.

PMID:40618311 | DOI:10.1007/s11701-025-02528-6

Calcif Tissue Int. 2025 Jul 6;116(1):94. doi: 10.1007/s00223-025-01404-7.

ABSTRACT

The present study aimed to determine the influence of different degrees of energy restriction (ER) on the bones in young female rats. Forty female Sprague-Dawley rats (n = 40; age, 6 weeks) were randomly divided into the following five experimental groups after a 1-week acclimatization period: 0% ER, 10% ER, 20% ER, 30% ER, and 40% ER groups. The experimental period was 10.5 weeks. Statistical analysis was conducted using one-way analysis of variance, Tukey’s post hoc comparison tests, and simple linear regression analysis. The body weight and fat weight showed significantly lower values above 20% ER. The bone mineral content and bone mineral density of the tibia in the 30% ER group were significantly lower than those in the 10% and 20% ER groups, and those in the 40% ER group was significantly lower than those in the 0%, 10%, and 20% ER groups. The trabecular thickness, cortical bone volume, and cortical total volume in the 40% ER group were significantly lower than those in the 0% ER group. The serum levels of parathyroid hormone, bone-specific alkaline phosphatase, and tartrate-resistant acid phosphatase significantly increased with increasing degree of ER. However, the serum levels of leptin, carboxylated osteocalcin, and carboxylated osteocalcin / uncarboxylated osteocalcin significantly decreased with increasing degree of ER. Our findings showed that 30% or 40% ER resulted in lower bone mass and 40% ER impaired bone microstructure in young female rats. However, 10% or 20% ER did not affect these parameters.

PMID:40618303 | DOI:10.1007/s00223-025-01404-7

Dig Dis Sci. 2025 Jul 6. doi: 10.1007/s10620-025-09181-x. Online ahead of print.

ABSTRACT

PURPOSE: Intestinal ultrasound (IUS) is increasingly being used to evaluate induction efficacy in both clinical practice and clinical trials. We aimed to quantify the rates of induction IUS transmural (TM) remission and response across advanced therapies (AT) in Crohn’s disease (CD).

METHODS: Single-center retrospective review of patients with CD initiating AT with IUS pre- and post-induction. Primary outcome was induction TM segmental response (> 25% decrease in bowel wall thickness (BWT), absolute BWT decrease > 2 mm, or absolute BWT decrease > 1 mm with ≥ 1-point improvement in Modified Limberg Score (MLS) for bowel wall hyperemia of 0-3). Secondary outcomes were segmental and complete (all segments) TM remission (BWT ≤ 3.0 mm and MLS 0). Descriptive statistics summarized data (median [IQR]): univariate and multivariate tested associations.

RESULTS: 101 patients (53% female, age 17.4 years [15.0-21.1]); disease duration 0.80 years [0.17-3.96]. IUS performed 78 [56-102] days on AT (44% anti-TNF, 53% AT naïve). Segmental TM induction response and remission across all AT were 63% and 36%, respectively. Complete TM remission was 35% and was independently associated with infliximab (aOR 12.9 [2.1-79.8]), upadacitinib (aOR 10.4[1.4-75.4]), as well baseline MLS 3 (aOR 0.20[0.049-0.79]) and loss of bowel wall stratification on baseline IUS (aOR 0.21[0.056-0.77]).

CONCLUSIONS: Transmural induction outcomes are achievable across multiple advanced therapies, with 2/3 of patients achieving a response and 1/3 of patients achieving complete remission. These data, combined with the high correlation between IUS and endoscopy, suggest that IUS response could be considered as a clinical trial endpoint.

PMID:40618289 | DOI:10.1007/s10620-025-09181-x

Clin Cardiol. 2025 Jul;48(7):e70173. doi: 10.1002/clc.70173.

ABSTRACT

BACKGROUND: Educational attainment and economic status are important socioeconomic characteristics and are associated with metabolic diseases and premature death risk. However, their relative importance and contributions to premature death remain unclear.

METHODS: Data were collected from ten survey waves of the National Health and Nutrition Examination Survey from 1999 to 2018. Deaths before age 75 from all-cause and cause-specific mortality were ascertained from linkage to the National Death Index with follow-up through 2019. Weighted Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CI) for death by educational attainment and income level. Population-attributable fractions (PAFs) were calculated to quantify the proportional contributions of low income and low educational attainment to mortality.

RESULTS: Over an average of 10.1 years of follow-up, 4310 premature deaths were confirmed from 43 637 participants. Low income and low educational attainment were associated with increased risks of all-cause and cause-specific mortality, respectively. The associations between low educational attainment and mortality risk disappeared after mutual adjusting for income and education. However, among those with high school education or above, the adjusted HRs of middle income and low income were 1.81 (95% CI, 1.48-2.21) and 2.88 (95% CI, 2.31-3.59) for all-cause mortality. The PAF showed that low educational attainment did not contribute to mortality, while 33.0% of premature deaths were attributable to low income.

CONCLUSIONS: Income had a greater impact on mortality risk than education. The disparities in mortality risk could be reduced by narrowing the income differentials.

PMID:40618234 | DOI:10.1002/clc.70173

Womens Health (Lond). 2025 Jan-Dec;21:17455057251351410. doi: 10.1177/17455057251351410. Epub 2025 Jul 6.

ABSTRACT

BACKGROUND: Intimate partner violence (IPV) is the most prevalent form of violence against women globally and is linked to depressive symptoms and other mental health disorders. Socioeconomic status is associated with both IPV and depressive symptoms, yet few studies have explored household wealth as a potential modifier of this relationship.

OBJECTIVES: To analyze the association between IPV and depressive symptoms according to household wealth levels among Peruvian women in 2023.

DESIGN: Cross-sectional study.

METHODS: A secondary analysis of the 2023 Demographic and Family Health Survey (ENDES) in Peru was conducted, including 10,161 women of reproductive age in the final analysis. The exposure variable was IPV, and the outcome variable was depressive symptoms. Household wealth levels were classified into quintiles ranging from Q1 (poorest) to Q5 (wealthiest). A multivariate regression analysis was performed.

RESULTS: The association between IPV and depressive symptoms decreased as household wealth increased: poorest (adjusted prevalence ratio (aPR): 2.42, 95% confidence interval (CI): 2.07-2.83), poor (aPR: 2.02, 95% CI: 1.64-2.5), and middle-income (aPR: 1.89, 95% CI: 1.47-2.43); however, no associations were found in wealthy households (aPR: 1.37, 95% CI: 0.96-1.94). In the wealthiest households, the association between IPV and depressive symptoms was significant again (aPR: 2.71, 95% CI: 1.69-4.34). Emotional and physical violence showed similar trends in relation to household wealth levels. In wealthy households, no type of IPV (emotional, sexual, or physical) was associated with depressive symptoms.

CONCLUSION: We found that the association between IPV and depressive symptoms is unequal and not present at all household wealth levels in Peru. A moderate level of wealth may weaken the association between IPV and depressive symptoms among Peruvian women of reproductive age. Moreover, in the wealthiest households, the association is even stronger than in poorer households, which has implications for the implementation of universal and inclusive public policies that address women and families across all socioeconomic sectors.

PMID:40618231 | DOI:10.1177/17455057251351410

Ann Pharmacother. 2025 Jul 6:10600280251355619. doi: 10.1177/10600280251355619. Online ahead of print.

ABSTRACT

BACKGROUND: In patients with septic shock, intravenous (IV) hydrocortisone is recommended when there is an ongoing vasopressor requirement. Guidelines recommend IV hydrocortisone 200 mg/day administered as a continuous infusion or 50 mg every 6 hours. To prevent waste during a hydrocortisone shortage and reduce cost, our institution implemented a dosing regimen of 100 mg every 12 hours.

OBJECTIVES: The primary objective of this study was to compare the impact of hydrocortisone 100 mg IV every 12 hours vs 50 mg IV every 6 hours on clinical outcomes in patients with septic shock.

METHODS: This was a retrospective, multicenter study that evaluated patients admitted from April 2022 to September 2023 to a Greater Charlotte Atrium Health facility. Adult patients diagnosed via the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes with sepsis, severe sepsis, or septic shock receiving ≥15 mcg/min of norepinephrine equivalents requiring ≥ 24 hours of hydrocortisone were included. The primary outcome was time to shock reversal. Secondary outcomes included in-hospital mortality, hospital and intensive care unit (ICU) length of stay, and hyperglycemia.

RESULTS: Of 446 screened patients, 111 were included. Median Sequential Organ Failure Assessment scores and Charlson Comorbidity Index were similar among groups. The median time to shock reversal was 56 [34-81] hours in the every 12 hours group compared to 65 [39-101] hours in the every 6 hours group (P = 0.21). In-hospital mortality was comparable between the every 6 hours group and the every 12 hours group (51.9% vs 45.6%, P = 0.51). There was no difference in hospital or ICU length of stay nor in incidence of hyperglycemic episodes between groups.

CONCLUSION AND RELEVANCE: There was no difference in the primary outcome of time to shock reversal or any secondary outcome between hydrocortisone groups. This alternative hydrocortisone dosing strategy may warrant further evaluation in large, prospective studies.

PMID:40618220 | DOI:10.1177/10600280251355619

Investig Clin Urol. 2025 Jul;66(4):344-351. doi: 10.4111/icu.20250060.

ABSTRACT

PURPOSE: Intravesical bacillus Calmette-Guerin (BCG) instillation is a cornerstone treatment for non-muscle-invasive bladder cancer (NMIBC) but is frequently associated with significant local and systemic adverse effects. This study aimed to investigate the effects of Uro-Vaxom (UVX) on BCG-related infectious adverse events and oncologic outcomes in patients with NMIBC.

MATERIALS AND METHODS: This retrospective cohort study included 251 NMIBC patients who underwent BCG induction therapy following transurethral resection of bladder tumors at a single institution. Patients were stratified into two groups: those not receiving UVX (non-UVX group, n=142) and those receiving UVX (UVX group, n=109). Clinical and oncologic parameters, including the frequency of antibiotic use, treatment discontinuation rates, and early recurrence rates following BCG therapy, were compared between the groups.

RESULTS: Antibiotic use during BCG treatment was significantly lower in the UVX group compared to the non-UVX group (p<0.001). Furthermore, BCG discontinuation due to urinary tract infection (UTI) was observed exclusively in the non-UVX group (p=0.003). Although tumor recurrence rates within one year were lower in the UVX group, this difference did not reach statistical significance (p=0.212). Multivariate analysis did not identify UVX use as a significant predictor of early recurrence or bacteriuria.

CONCLUSIONS: The administration of UVX during BCG therapy in NMIBC patients was associated with reduced antibiotic use and a lower BCG discontinuation rate due to UTI, thereby improving treatment adherence. These findings highlight the potential role of UVX as a valuable adjunct to BCG therapy to optimize patient outcomes.

PMID:40618210 | DOI:10.4111/icu.20250060

Investig Clin Urol. 2025 Jul;66(4):336-343. doi: 10.4111/icu.20250067.

ABSTRACT

PURPOSE: With the introduction of the AUA Quality Registry (AQUA), physician practice styles and adherence to clinical guidelines are under closer scrutiny. While adherence is critical for optimal healthcare, it has not been studied in men’s health. This survey-based study assessed adherence to American Urological Association (AUA) clinical guidelines on erectile dysfunction (ED), Peyronie’s disease, priapism, infertility, and ejaculatory disorders among members of the New York section of the AUA.

MATERIALS AND METHODS: An anonymous questionnaire was emailed to members, covering five non-oncologic men’s health guideline categories. Each category included two to four specific guidelines, with responses recorded on a Likert scale. Respondents could provide rationale for their answers or omit questions if they did not treat a specific condition.

RESULTS: Among 82 urologists, most treated ED and ejaculatory dysfunction but less commonly treated Peyronie’s, priapism, and infertility. Some guidelines were frequently not followed. For instance, 57% never prescribed tramadol or α1-adrenoreceptor antagonists for premature ejaculation after first-line therapy failure. Half never performed in-office intracavernosal injection tests for Peyronie’s. For priapism, 52% never used ultrasound in initial evaluations, and 45% rarely referred men with ED to mental health professionals.

CONCLUSIONS: This pilot study highlights generally high adherence to AUA guidelines but identifies gaps in areas driven by expert opinion. Findings suggest a need for targeted educational initiatives, particularly in Peyronie’s diagnosis and mental health integration for ED, to enhance patient care and outcomes. Such initiatives are crucial in refining the approach to men’s health, ultimately enhancing patient care and outcomes.

PMID:40618209 | DOI:10.4111/icu.20250067

Investig Clin Urol. 2025 Jul;66(4):329-335. doi: 10.4111/icu.20250011.

ABSTRACT

PURPOSE: To propose a novel surgical approach for managing inflammatory adhesions of the tunica vaginalis (TV) during vasoepididymostomy (VE), and to report surgical outcomes.

MATERIALS AND METHODS: A T-shaped incision of the TV was used to expose the epididymis and vas deferens in cases with adhesions between the TV and the testis. We retrospectively analyzed data from five patients who underwent microsurgical VE for obstructive azoospermia (OA) secondary to epididymal obstruction. Operative time, postoperative patency rate and semen analysis, and natural pregnancy rates were recorded. For comparison, 50 patients who underwent conventional longitudinal TV incision were included to assess operative time, while 46 and 36 of these patients were used to compare patency and pregnancy rates, respectively, with the T-shaped incision group.

RESULTS: The T-shaped incision involves a longitudinal incision of the TV at the epididymal-testicular junction followed by an incision (T) in the direction towards the epididymis and vas deferens area. Among the five patients who underwent this approach, four (80.0%) had sperm detected in semen two months postoperatively, and their partners achieved natural pregnancy (4/5, 80.0%) within one year after VE. No postoperative wound infections occurred. No statistically significant differences were observed in mean operative time, patency rates, or pregnancy rates between the T-shaped and longitudinal incision groups.

CONCLUSIONS: The T-shaped TV incision is a feasible approach for VE in OA patients with inflammatory TV-testis adhesions, providing adequate epididymal access without compromising operative time or surgical outcomes.

PMID:40618208 | DOI:10.4111/icu.20250011

Investig Clin Urol. 2025 Jul;66(4):302-310. doi: 10.4111/icu.20240362.

ABSTRACT

PURPOSE: Transurethral resection of bladder tumors (TUR-BT) requires follow-up evaluation by cystoscopy. We sought to evaluate the prognosis of non-muscle-invasive bladder cancer (NMIBC) patients within 6 months of surgery to identify the optimal timing for the first cystoscopy after TUR-BT.

MATERIALS AND METHODS: In this retrospective analysis, patients newly diagnosed with NMIBC were divided into two groups according to whether they underwent cystoscopy within 6 months after TUR-BT. We considered four outcomes: recurrence, progression, cancer-specific mortality, and all-cause mortality. Inverse probability treatment weighting (IPTW)-adjusted Kaplan-Meier analysis was performed to identify the difference in survival for each outcome stratified by cystoscopy status within 6 months after the first TUR-BT. We employed Cox regression models with IPTW to estimate the hazard ratios (HRs) of each outcome according to cystoscopy status.

RESULTS: Among 40,678 patients, 11,940 (29.4%) did not undergo cystoscopy within 6 months. The risk of recurrence was higher for patients who underwent cystoscopy than those who did not (HR 1.32, 95% confidence interval [CI] 1.26-1.38, p<0.001). By contrast, the cystoscopy group had a lower risk of progression compared to the non-cystoscopy group (HR 0.70, 95% CI 0.65-0.76, p<0.001), with lower cancer-specific mortality (HR 0.62, 95% CI 0.56-0.68, p<0.001) and all-cause mortality (HR 0.58, 95% CI 0.56-0.60, p<0.001).

CONCLUSIONS: Cystoscopy within 6 months was associated with a higher risk of recurrence but a lower risk of progression and death. Therefore, regular cystoscopy after the first TUR-BT for NMIBC is essential to ensure favorable survival outcomes.

PMID:40618205 | DOI:10.4111/icu.20240362