Tag: nevin manimala

Arch Esp Urol. 2022 Jun;75(5):435-440. doi: 10.56434/j.arch.esp.urol.20227505.63.

ABSTRACT

BACKGROUND: Meatal advancement with glanduloplasty (MAGPI) has been in the recent years one of the most frequently surgical techniques used for the correction of distal hypospadias. Multiple modifications have been described to improve the results ofthis technique. In 2004 we presented the initial results of the New Modern MAGPI or DUAGPI (distal urethral advancement and glanduloplasty) as a surgical alternative to the original MAGPI.

OBJETIVE: The objective of the present study is to evaluate the applicability, safety and the cosmetic results obtained with this technique, as well as the long-term complications.

MATERIALS AND METHODS: Retrospective and descriptive study of patients with distal hypospadias, corrected using the DUAPI technique, between 2002 and 2018.

SURGICAL TECHNIQUE: Initially, an artificial erection was performed, the absence of curvature in all patients is proven. A skin denudation was performed up to the base of the penis in those children with a bend greater than 30. Second, the distal urethral disconnection was performed at the posterior and lateral urethral level. A glandular triangular section is made to accommodate the distal urethra and to allow a conical appearance with a final glandular. Finally, the fixation of the distal urethral to the glandular tip and the anterior glandular closure is performed. We performed an annual follow-up of all patients. The analysis of all the variables collected during surgery and follow-up was done with SPSS 22 statistical package.

RESULTS: 90 patients meet inclusion criteria and were included in the study (32 glandular and 58 coronal). The mean surgical time was 47 minutes (Range: 37-71 minutes). The mean follow-up was 9.4 years (2.1-15 years). 2 patients had meatal stenosis after surgery, 4 mild glandular retraction, and 2 urethrocutaneous fistula. Six of the 8 patients with a complication were successfully reoperated. 92% of the patients and their families were satisfied with the cosmetic result obtained after surgery (83 patients).

CONCLUSION: DUAGPI technique is simple, reproducible and optimal for most distal hypospadias. It is a safe technique, with a low complication rate. The final aesthetic result is satisfactory in most cases, with a conical glans and a natural cosmetic appearance.

PMID:35983815 | DOI:10.56434/j.arch.esp.urol.20227505.63

Arch Esp Urol. 2022 Jun;75(5):430-434. doi: 10.56434/j.arch.esp.urol.20227505.62.

ABSTRACT

INTRODUCTION: Prostate cancer (PCa) can progress to the lethal phenotype of metastatic castration resistance (mCRPC), either from initially localized disease or de novo metastatic cancer. New drugs improving overall survival are now the cornerstone of treatment. Nevertheless, there are no defined sequences or established timing to initiate or discontinue treatments; besides, not all patients end in CRPC or reach this stage at the same time.

OBJECTIVE: To evaluate characteristics of patients who progress to mCRPC and establish an association with time to mCRPC diagnosis.

MATERIAL AND METHODS: Retrospective, descriptive and observational study of 35 mCRPC patients, performed from 2013 to 2017. Variables analyzed were age, Gleason score and prostate-specific antigen (PSA) at diagnosis, initial stage, response time to androgen deprivation therapy (ADT), PSA nadir on ADT and time until mCRPC progression. Statistical analysis comparing variables with time to mCRPC diagnosis was performed.

RESULTS: Average age at diagnosis was 68.9 years; PSA values were classified into 3 categories: <20 ng/ml, 20-50 and >50. Gleason score was 7 in 50%, and 8-9 in the rest. Tumor was initially localized in 46% of the patients and metastatic in the rest. PSA nadir on ADT was <1 ng/ml in 67%. Average time to androgen deprivation: 5.5 years, time to mCRPC diagnosis: 6.9 years. Significant associations between time to mCRPC and time of androgen deprivation, PSA nadir during ADT and stage at diagnosis were found.

CONCLUSION: Response time to ADT <1 year, PSA nadir value >5 ng/ml during treatment and metastatic stage at diagnosis were associated with earlier progression to mCRPC.

PMID:35983814 | DOI:10.56434/j.arch.esp.urol.20227505.62

Arch Esp Urol. 2022 Jun;75(5):416-422. doi: 10.56434/j.arch.esp.urol.20227505.60.

ABSTRACT

PURPOSE: Prostate cancer is the most commonly diagnosed cancer and the second most common reason for cancer-related mortality in men. The purpose of cancer screening is to detect the disease at an early stage to help effective treatment. This study aimed to investigate the effectiveness of MRI and PI-RADS in the diagnosis of prostate cancer and examine the relation between screening parameters with prostate cancer.

METHODS: The PACS system was analyzed and MRI images between September 2016 and April 2018 were listed. The state of patients regarding having pathology results were obtained. PSA values were listed. The prostate volume and the prostate density was calculated. PI-RADS assessment was used for each prostate lesion.

RESULTS: Data of 138 patients were included in the study. The mean age was 63±8.9. The mean prostate gland volume was 63.8±39.3ml, the mean PSA value was 12.51±25.22 and the mean PSA density was calculated as 0.319±0.945. A statistically significant difference was found between age and prostate volume and cancer. The age of the cancer cases was higher than those who did not have cancer (p<0.05). A negative correlation was found between prostate volume and cancer status. The prostate volume of non-cancer cases was higher compared to cancer cases (p=0.0001). 55 patients had no malignancy. It was observed that 56.4% of cancer patients had significant cancer. The frequency of using PI-RADS scores was 4% for P1, 36% for P2, 14% for P3, 28% for P4, and 18% for P5. Clinically significant cancer was present in 57.9% of patients with PI-RADS score4 and 69.6% of patients with PI-RADS score5. It was found that diagnostic values were significantly high for prostate cancer screening in patients with PI-RADS scores4 and 5 (Sensitivity 76.4%, Specificity 73.5%, Negative predictive value 82.4%, Positive predictive value 65.6%).

CONCLUSION: PI-RADS and MRI can be useful for the diagnosis of the clinically significant prostate cancer in patients at risk for prostate cancer. It is a non-invasive, repeatable method for prostate cancer screening and diagnosis. In prostate screening PSA reliability may be questioned. Additional methods are needed for the diagnosis. For this reason MRI and PI-RADSv2 is an effective predictor of prostate cancer in patients with high PSA levels.

PMID:35983812 | DOI:10.56434/j.arch.esp.urol.20227505.60

Arch Esp Urol. 2022 Jun;75(5):405-409. doi: 10.37554/en-j.arch.esp.urol-20210522-3503-23.

ABSTRACT

AIM: The presence of intraductal carcinoma of the prostate (IDC-P) in radical prostatectomy (RP) specimens correlates with adverse prognostic factors such as worse biochemical recurrence-free survival, higher grade and stage disease. This study aimed to investigate the effect of IDC-P in radical prostatectomy specimens on short-term oncological outcomes.

MATERIALS AND METHODS: Patients who underwent RP at our clinic for prostate cancer between May 2016 and November 2019 were included in the study. They were divided into two groups based on the presence of IDC-P in RP specimens. Their clinical, pathological, and oncologic data were evaluated retrospectively.

RESULTS: A total of 98 patients underwent RP with a mean age of 65.5 years (50-83) and a mean follow-up time of 31.2 months (6-52). Seventy and 28 patients were evaluated in the group without IDC-P and group with IDC-P, respectively. Surgical margin positivity (p=0.307) and lymph node metastasis (p=0.017) rates were higher in the group with IDC-P. Although there were no statistical differences between the groups, at follow-up biochemical recurrence rate (p=0.052) was higher, and mean time to biochemical recurrence rates were lower (p=0.057) in the group with IDC-P. The group with IDC-P was associated with a 3-fold increase in prostate cancer-specific mortality to the group without IDC-P (p=0.037).

CONCLUSIONS: Patients with IDC-P at RP specimens have more advanced disease, shorter biochemical recurrence-free, and cancerspecific survival than those without IDC-P. Defining the presence of IDC-P in RP specimens is critical in choosing the appropriate treatment strategy and predicting the prognosis.

PMID:35983810 | DOI:10.37554/en-j.arch.esp.urol-20210522-3503-23

Arch Esp Urol. 2022 Jun;75(5):400-404. doi: 10.37554/en-j.arch.esp.urol-20210704-3502-22.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Although erectile dysfunction is frequently seen in hemodialysis patients, little information is documented about the efficacy of phosphodiesterase type 5 (PDE5) inhibitors and almost all the articles evaluate sildenafil. We aimed to evaluate the efficacy of chronic low dose tadalafil in this group of patients.

MATERIALS AND METHODS: The International Index of Erectile Function (IIEF) questionairre was administered to patients under hemodialysis program. A total of 58 patients with ED (International Index of Erectile Function (IIEF) score < 26), each having a stable partner, between 18-60 years, receiving routine outpatient HD matched the inclusion criteria and divided into two equal groups; placebo and tadalafil 5 mg/3 days. Changes of the IIEF score was recorded after one month of treatment.

RESULTS: The mean age of the patients was 50.0±9.93 years. Duration of dialysis was 57.5(12-108) months. Hemoglobin (g/dl) and creatinin clearence (ml/Min) values of placebo and tadalafil groups were not significantly different; 10.9(8.8-14) vs 10.7(8.9-13) and 5.7±1.3 vs 6.0±1.4 respectively. There was a statistically significant increase for all subgroups related erectile dysfunction 9.28±4.17 vs 21.07±5.99 (p=0.037), intercourse satisfaction 8(3-9) vs 10(5-15) (p<0.001), orgasmic function 4(1-10) vs 8(4-10) (p<0.001), sexual desire 4(2-10) vs 7(3-9) (p<0.001) and general satisfaction 5(2-9) vs 6(2-9) (p<0.001) with low dose of tadalafil at the end of four weeks without any major side effects. There was only a significant increase in sexual desire 4(3-9) vs 6(4-10) (p<0.001),in placebo group with an insignificant change in all other IIEF domains. Total IIEF score of the placebo group was insignificantly increased from 21.13±7.73 to 21.99±7.04 (p=0.771) while there was a statistically significant increase in tadalafil group; from 20.87±8.84 to 30.75±7.04 (p<0.001).

CONCLUSIONS: Tadalafil 5 mg once in three days is appear to be efficacious and well tolerated for the treatment of ED in hemodialysis patients.

PMID:35983809 | DOI:10.37554/en-j.arch.esp.urol-20210704-3502-22

Arch Esp Urol. 2022 Jun;75(5):382-399. doi: 10.56434/j.arch.esp.urol.20227505.56.

ABSTRACT

INTRODUCTION AND OBJECTIVES: Post-finasteride syndrome (PFS) is a little known adverse effect of 5α-reductase inhibitor (5-ARI) drugs used in benign prostatic hyperplasia (BPH) and androgenetic alopecia. Five articles on the syndrome have been published in Spain, although no review has been published.The objectives of this article are to review the world literature, including the Spanish literature.

MATERIAL AND METHODS: A retrospective review on post-finasteride syndrome was performed between 2011 and 2020. The search for information in PubMed/Medline was performed using the English terms “post-finasteride, post-finasteride syndrome” and in Google with the Spanish “post-finasteride, síndrome post-finasteride”. The results of the variables studied were analyzed using descriptive statistics.

RESULTS: A total of 64 worldwide articles on post-finasteride syndrome were found, discarding 24 (37.5%) that did not deal with the symptoms of the syndrome, and 40 articles (62.5%) by 37 authors were included for study, corresponding to 29 publications on case series (72.5%) and 11 reviews (27.5%). Of the 40 articles, 37 referred to male post-finasteride syndrome (92.5%) and 3 to female (7.5%), the number of patients studied in the review was 87,887 corresponding to 87,224 men (99.2%) and 663 women (0.7%), with the number of articles on general symptoms being 23 (57.5%), male sexual symptoms 20 (50%) and female sexual symptoms 1 (2.5%). The articles came from 14 specialties, with Dermatology 14 publications (35%), Urology-Andrology 7 (17.5%) and Pharmacology 6 (15%). The countries with the highest number of publications were the USA 15 (37.5%), Italy 7 (17.5%) and Spain 5 (12.5%).

CONCLUSIONS: Finasteride is rarely associated with sexual and systemic adverse effects that constitute the so-called post-finasteride syndrome. There are still few studies on this syndrome in the world. This is the first review of this syndrome in Spain.

PMID:35983808 | DOI:10.56434/j.arch.esp.urol.20227505.56

Acupunct Med. 2022 Aug 19:9645284221108215. doi: 10.1177/09645284221108215. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify a comprehensive list of outcomes and explore the reporting rate of core outcome sets (COS) and related factors in systematic reviews (SRs) of acupuncture for osteoarthritis (OA).

STUDY DESIGN AND SETTING: Databases were searched for the relative SRs. Descriptive statistics were calculated as frequencies and percentages. Binary logistic regression was used to explore the factors affecting the reporting rate of COS.

RESULTS: We included 59 SRs. Outcome measures reported in the SRs were classified into 11 domains and 67 unique outcomes. No SR completely reported COS. In COS released in 2016, 75% of outcomes (6/8) were only reported by ⩽5% SRs. In COS released in 2019, the reporting rate was very low (from 0% to 17%) for 73.3% of outcomes (11/15). SRs published in the most recent 5 years had a significantly greater possibility of reporting COS (odds ratio (OR) = 4.74, 95% confidence interval (CI) = 1.33 to 16.88, p = 0.016).

CONCLUSION: Core outcomes were rarely reported in systematic reviews of acupuncture for OA, with considerable heterogeneity in the use of outcomes. The publication of COS in the COMET (Core Outcome Measures in Effectiveness Trials) database may help promote the reporting of COS. We encourage systematic reviewers to use relevant COS.

PMID:35983785 | DOI:10.1177/09645284221108215

Br J Nutr. 2022 Aug 19:1-22. doi: 10.1017/S0007114522002641. Online ahead of print.

ABSTRACT

Vitamin D (VD) deficiency [serum 25(OH)D concentration of <20 ng/ml], in endemic proportions, demands a supplementation strategy with optimal dosing regimens. A randomised parallel-group, active-controlled trial was conducted among apparently healthy, VD deficient subjects, age 18-60 years who received 600 IU/day (Group A), 1000 IU/day (Group B), 2000 IU/day (Group C) and 60,000 IU/month (Group D) of oral cholecalciferol. The intervention was carried in two phases (I&II) of 12 weeks each, with same dose, separated by a washout phase of 12 weeks. Serum 25(OH)D, iPTH, calcium (Ca), phosphorous (PO4), alkaline phosphatase (ALP), spot urine calcium/creatinine (Ca/Cr) was measured at baseline, 12, 24 and 36 weeks following the intervention and adverse events were recorded at each occurrence and at 12, 24 and 36 weeks. A statistically significant time-group interaction was found in serum 25(OH)D concentration (P<0.05). Serum 25(OH)D concentration increased significantly from baseline to 12 weeks (P<0.05) in all the groups with no change at 24 weeks but further increase at 36 weeks (P<0.05). At the end of study, group C had maximum increment in serum 25(OH)D concentration while as groups C and D (95%, and 90%) had higher proportion of subjects VD sufficient than groups A and B (65% and 78%) (Table 3) (P<0.05). No significant time-dose interactions were observed in serum iPTH, Ca, PO4 and ALP or Urine Ca/Cr ratio. Three subjects (two in group C and one in group D) developed transient hypercalciuria. Supplementation with daily 2000IU or monthly 60,000IU oral cholecalciferol among adults seems optimal and safe.

PMID:35983775 | DOI:10.1017/S0007114522002641

Euro Surveill. 2022 Aug;27(33). doi: 10.2807/1560-7917.ES.2022.27.33.2200070.

ABSTRACT

BackgroundAnalyses of diagnostic performance of SARS-CoV-2 antigen rapid diagnostic tests (AG-RDTs) based on long-term data, population subgroups and many AG-RDT types are scarce.AimWe aimed to analyse sensitivity and specificity of AG-RDTs for subgroups based on age, incidence, sample type, reason for test, symptoms, vaccination status and the AG-RDT’s presence on approved lists.MethodsWe included AG-RDT results registered in Czechia’s Information System for Infectious Diseases between August and November 2021. Subpopulations were analysed based on 346,000 test results for which a confirmatory PCR test was recorded ≤ 3 days after the AG-RDT; 38 AG-RDTs with more than 100 PCR-positive and 300 PCR-negative samples were individually evaluated.ResultsAverage sensitivity and specificity were 72.4% and 96.7%, respectively. We recorded lower sensitivity for age groups 0-12 (65.5%) and 13-18 years (65.3%). The sensitivity level rose with increasing SARS-CoV-2 incidence from 66.0% to 76.7%. Nasopharyngeal samples had the highest sensitivity and saliva the lowest. Sensitivity for preventive reasons was 63.6% vs 86.1% when testing for suspected infection. Sensitivity was 84.8% when one or more symptoms were reported compared with 57.1% for no symptoms. Vaccination was associated with a 4.2% higher sensitivity. Significantly higher sensitivity levels pertained to AG-RDTs on the World Health Organization Emergency Use List (WHO EUL), European Union Common List and the list of the United Kingdom’s Department of Health and Social Care.ConclusionAG-RDTs from approved lists should be considered, especially in situations associated with lower viral load. Results are limited to SARS-CoV-2 delta variant.

PMID:35983773 | DOI:10.2807/1560-7917.ES.2022.27.33.2200070

Elife. 2022 Aug 19;11:e72518. doi: 10.7554/eLife.72518.

ABSTRACT

Complex systems are challenging to understand, especially when they defy manipulative experiments for practical or ethical reasons. Several fields have developed parallel approaches to infer causal relations from observational time series. Yet, these methods are easy to misunderstand and often controversial. Here, we provide an accessible and critical review of three statistical causal discovery approaches (pairwise correlation, Granger causality, and state space reconstruction), using examples inspired by ecological processes. For each approach, we ask what it tests for, what causal statement it might imply, and when it could lead us astray. We devise new ways of visualizing key concepts, describe some novel pathologies of existing methods, and point out how so-called ‘model-free’ causality tests are not assumption-free. We hope that our synthesis will facilitate thoughtful application of methods, promote communication across different fields, and encourage explicit statements of assumptions. A video walkthrough is available (Video 1 or https://youtu.be/AIV0ttQrjK8).

PMID:35983746 | DOI:10.7554/eLife.72518