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1دورية أكاديمية
المصدر: The World Journal of Men's Health, Vol 36, Iss 2, Pp 103-109 (2018)
مصطلحات موضوعية: Androgens, Hypogonadism, Prostate-specific antigen, Prostatic neoplasm, Testosterone, Medicine, Diseases of the genitourinary system. Urology, RC870-923
الوصف: Historically, testosterone and prostate cancer have been demonstrated to have a positive association leading providers to forgo testosterone replacement therapy (TRT) in men with concurrent histories of hypogonadism and prostate cancer. This paradigm has been gradually shifting with our evolving understanding of the relationship between testosterone and prostate cancer and the gaining popularity of the saturation model. Newer data suggests improved quality of life for men with hypo-gonadism after TRT leading to a more tempered view of the effects of this treatment and its risk in prostate cancer. As more reports emerge of TRT in men who have either undergone definitive treatment for prostate cancer or are on active surveil-lance, some providers see a role for TRT in these patients despite non-consensus in clinical guidelines. It is critical that we examine evidence currently available, while we await more rigorous data to emerge.
وصف الملف: electronic resource
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2دورية أكاديمية
المؤلفون: Arnav Srivastava, Gregory Joice, Madeline Manka, Nikolai Sopko, Edward Wright
المصدر: Journal of Clinical and Translational Science, Vol 1, Pp 83-83 (2017)
مصطلحات موضوعية: Medicine
الوصف: OBJECTIVES/SPECIFIC AIMS: Perineal urethral sling placement is an option for men with mild to moderate post-prostatectomy stress urinary incontinence (SUI). However, men with persistent incontinence after sling placement often require secondary artificial urinary sphincter (AUS) placement, made difficult by the sling occupying the proximal bulbar urethra. This proximal section has a thicker corpus spongiosum which may mitigate cuff-induced ischemia and subsequent urethral atrophy. The authors report a series of AUS placements after failed sling, using sling revision or removal to access the proximal urethra. METHODS/STUDY POPULATION: Cutting the sling arms during urethral cuff placement increased urethral exposure and mobility. If feasible, completely removing the sling allowed the most proximal cuff site; but if dissection was felt unsafe, the mesh was left in situ and the cuff placed distally. This study is a retrospective cohort design of patients with SUI who underwent AUS placement after failed sling from 2010 to 2016. Variables included baseline patient characteristics, SUI severity, intraoperative variables, and postoperative outcomes. AUS failure, defined as infection, erosion or urethral atrophy, was analyzed at 12 and 96 months using univariate and multivariable logistic regression. RESULTS/ANTICIPATED RESULTS: Over the study period, 29 patients underwent AUS placement after failed sling. At the time of AUS placement, mean urethral circumference was 6.2 cm and 68% of patients had a 4.5 cm cuff placed; no cases required a 3.5 cm cuff. Seventy-three percent of cases were after transobturator sling placement (27% bone-anchored) and 45% of slings were explanted. AUS failure rate at 12 and 96 months was 17.8% and 45%, respectively; atrophy was the most common indication. Prior transobturator sling placement had lower rates of both 12 month (9.1% vs. 57%, p=0.006) and 96 month (36% vs. 71%, p=0.11) failure, though the latter was not statistically significant. Sling explant was not a significant predictor of 12 month (p=0.12) or 96 month failure (p=0.17). DISCUSSION/SIGNIFICANCE OF IMPACT: Sling revision during AUS placement helps expose the wider proximal urethra, allowing larger cuff size placement. This procedure appears safe, with low rates of erosion and short-term failure—albeit with high rates of long-term urethral atrophy possibly due to more significant dissection causing devascularization. However, sling removal was not a significant predictor of failure. The transobturator sling’s smaller profile may result in less trauma to urethra—possibly explaining the improved outcomes.
وصف الملف: electronic resource
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المؤلفون: Connie Wang, Daniel Schoenfeld, Joseph Marte, Gregory Joice
المصدر: Journal of Urology. 209
مصطلحات موضوعية: Urology
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المؤلفون: Justin Lee, Jacob McLean, Jason Zucker, Steven Brandes, Gregory Joice
المصدر: Journal of Urology. 209
مصطلحات موضوعية: Urology
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المؤلفون: Sarah C. Sanders, Allen F. Morey, Linley Diao, Claus G. Roehrborn, Avery R. Wolfe, Steven J. Hudak, Raj Bhanvadia, Gregory Joice, Benjamin M. Dropkin
المصدر: Urology. 158:162-168
مصطلحات موضوعية: medicine.medical_specialty, Urinary Incontinence, Stress, Urology, medicine.medical_treatment, Pilot Projects, Body Mass Index, Artificial urinary sphincter, Weight loss, Weight Loss, Prosthetic surgery, medicine, Humans, Aged, Retrospective Studies, Prostatectomy, business.industry, Middle Aged, Single surgeon, Cohort, Urinary Sphincter, Artificial, medicine.symptom, business, Weight gain, Body mass index
الوصف: Objectives To examine association between post-prostatectomy incontinence (PPI) severity and weight changes before and after restoration of continence via artificial urinary sphincter (AUS). Methods Single surgeon, retrospective review of urologic prosthetic surgery (UPS) after radical prostatectomy (RP). A cohort of post-RP inflatable penile prosthesis (IPP) patients served as a surgical control. Body Mass Index (BMI) and total body weight were assessed pre and post-UPS. Multivariable linear regression was utilized to assess BMI changes post-UPS. Results 187 AUS and 63 IPP patients met selection criteria. Greater PPI severity was associated with faster BMI gain after RP (coeff. 0.14 kg/m2, P = 0.03, per pad used) and magnitude of incontinence improvement (mean reduction in daily pad use) after AUS insertion was associated with greater BMI reduction at 12 months post-UPS (coeff. - 0.13 kg/m2, P = 0.04). On multivariable regression, AUS insertion was associated with a decrease in BMI by - 2.83 kg/m2 12 months post-UPS (P = 0.02). Twelve months post-UPS, men with AUS exhibited a mean BMI reduction of -1.0 kg/m2 compared to a mean BMI increase in the IPP cohort of 0.4 kg/m2 (P 5% body weight) at 12 months post-UPS (31.8% vs 8.3%, P Conclusion Severe PPI appears to be associated with weight gain and correction of PPI via AUS insertion with weight loss.
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المؤلفون: Sam Kusin, Shervin Badkhshan, Samantha Nealon, Gregory Joice, Sarah Sanders, Steven Hudak, Allen Morey
المصدر: Journal of Urology. 207
مصطلحات موضوعية: Urology
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المؤلفون: Michael A. Gorin, Michael H. Johnson, Zeyad Schwen, Misop Han, Trinity J. Bivalacqua, Hiten D. Patel, Mohamad E. Allaf, Alan W. Partin, H. Ballentine Carter, Farzana A. Faisal, Phillip M. Pierorazio, Christian P. Pavlovich, Gregory Joice, Bruce J. Trock
المصدر: European Urology. 78:360-368
مصطلحات موضوعية: Male, medicine.medical_specialty, Injections, Subcutaneous, Urology, medicine.medical_treatment, 030232 urology & nephrology, Chemoprevention, law.invention, 03 medical and health sciences, Lymphocele, Postoperative Complications, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Humans, Prospective Studies, cardiovascular diseases, Aged, Prostatectomy, Venous Thrombosis, Heparin, business.industry, Anticoagulants, Venous Thromboembolism, Perioperative, Middle Aged, medicine.disease, Interim analysis, Pulmonary embolism, Venous thrombosis, 030220 oncology & carcinogenesis, Relative risk, Preoperative Period, Pulmonary Embolism, business
الوصف: Background Direct high-quality evidence is lacking evaluating perioperative pharmacologic prophylaxis (PP) after radical prostatectomy (RP) to prevent venous thromboembolism (VTE) leading to significant practice variation. Objective To study the impact of in-hospital PP on symptomatic VTE incidence and adverse events after RP at 30 d, with the secondary objective of evaluating overall VTE in a screening subcohort. Design, setting, and participants A prospective, phase 4, single-center, randomized trial of men with prostate cancer undergoing open or robotic-assisted laparoscopic RP was conducted (July 2017–November 2018). Intervention PP (subcutaneous heparin) plus routine care versus routine care alone. The screening subcohort was offered lower extremity duplex ultrasound at 30 d. Outcomes measurements and statistical analysis The primary efficacy outcome was symptomatic VTE incidence (pulmonary embolism [PE] or deep venous thrombosis [DVT]). Primary safety outcomes included the incidence of symptomatic lymphocele, hematoma, or bleeding after surgery. Secondary outcomes were overall VTE, estimated blood loss, total surgical drain output, complications, and surveillance imaging bias. Fisher’s exact test and modified Poisson regression were performed. Results and limitations A total of 501 patients (75% robotic) were randomized and >99% (500/501) completed follow-up. At second interim analysis (N = 445), the symptomatic VTE rate was 2.3% (four PE + DVT and one DVT) for routine care versus 0.9% (one PE + DVT and one DVT) for PP (relative risk 0.40 [95% confidence interval 0.08–2.03], p = 0.3) meeting a futility threshold for early stopping. In the screening subcohort, the overall VTE rate was 3.3% versus 2.4% (p = 0.7). Results were similar at the final analysis (symptomatic VTE: 2.0% vs 0.8%, p = 0.3; overall VTE: 2.9% vs 2.8%, p = 1). No differences were observed in safety or secondary outcomes. All VTE events (seven symptomatic and three asymptomatic) occurred in patients undergoing pelvic lymph node dissection. Conclusions This study was not able to demonstrate a statistically significant reduction in symptomatic VTE associated with PP. There was no increase in the development of symptomatic lymphoceles, bleeding, or other adverse events. Given that the event rate was lower than powered for, further research is needed among high-risk patients (Caprini score ≥8) or patients receiving pelvic lymph node dissection. Patient summary In this report, we randomized patients undergoing radical prostatectomy to perioperative pharmacologic prophylaxis or routine care alone. We found that pharmacologic prophylaxis did not reduce postoperative symptomatic venous thromboembolism significantly for men at routine risk. Importantly, pharmacologic prophylaxis did not increase adverse events, such as formation of lymphoceles or bleeding, and can safely be implemented when indicated for patients with risk factors undergoing radical prostatectomy.
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المؤلفون: Christine Yu, Trinity J. Bivalacqua, Jiuru Li, Harrison Jeong, Shivang Sharma, Gregory Joice, Anirudha Singh, Chen Hao Fang
المصدر: ACS applied bio materials. 3(3)
مصطلحات موضوعية: Biomaterials, Collagen type, Natural rubber, Chain (algebraic topology), Chemistry, visual_art, Biochemistry (medical), Biomedical Engineering, visual_art.visual_art_medium, General Chemistry, Elastomer, Biomedical engineering
الوصف: Collagen type I is one of the most suitable natural biomaterials for constructing tissue-engineering scaffolds. Despite their biocompositional similarities to physiological tissues, these scaffolds lack host specific and matching mechanical properties. While it is possible to enhance their stiffness by cross-linking, it often compromises their abilities to expand or strain under minimal stress, that is, compliance (inverse of stiffness). Here, we report a simple, inexpensive, cross-linking- and elastin-free collagen-based material composition for developing elastomeric scaffolds that are highly compliant, soft yet strong, and suturable, therefore, clinically attractive. Our strategy utilizes room-temperature modification of collagen type I scaffolds with linear aliphatic chains of various lengths (C7-C18). In particular, dodecenylsuccinic anhydride (size: C12, DDSA) modified scaffolds elongated up to 400% of its initial length compared to only ∼20% for collagen-control within the applied tensile stress of 0.2 MPa without breaking. Furthermore, the suture retention strength value increased to 60 g-force from 30 g-force for collagen control. We confirmed that the C12-modified material remained structurally stable at the physiological temperature (37 °C) with a tan δ value of ∼0.3, similar to collagen control; however, tan δ increased sharply for C12-modified collagen above 42 °C, compared to 59 °C for collagen control. To understand the mechanism of hyperextensibility, we studied the morphology of the resultant material by transmission electron microscopy (TEM), which showed an altered microstructure of C12-modified collagen scaffolds. While the partially C12-modified sample had a mixture of typical collagen type I triple helix and diffused gelatinized random coil-like configuration, the fully modified samples showed thick wrinkled and entangled ribbon-like microstructures, which was different than that of thermally denatured gelatin. We further confirmed that the resultant material allowed cell growth
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المؤلفون: James Liu, M. Katayoon Rezaei, Marie-Lisa Eich, William R. Bishai, Phuoc T. Tran, Kara Lombardo, David J. McConkey, Charles G. Drake, Andres Matoso, Aleksandar Obradovic, Max Kates, Alok Kumar Singh, Gregory Joice, Trinity J. Bivalacqua, Alcides Chaux, George J. Netto
المصدر: J Pathol
مصطلحات موضوعية: Myeloid, medicine.medical_treatment, T-Lymphocytes, Antineoplastic Agents, Radiation Dosage, Article, Pathology and Forensic Medicine, Immune system, Lymphocytes, Tumor-Infiltrating, Interferon, Tumor-Associated Macrophages, medicine, Tumor Microenvironment, Animals, Humans, Bladder cancer, Innate immune system, business.industry, Membrane Proteins, Immunosuppression, medicine.disease, eye diseases, Immunity, Innate, Radiation therapy, Mice, Inbred C57BL, Sting, medicine.anatomical_structure, Administration, Intravesical, Urinary Bladder Neoplasms, Cancer research, BCG Vaccine, Female, Immunotherapy, Inflammation Mediators, Urothelium, business, medicine.drug
الوصف: Radiation and Bacillus Calmette-Guerin (BCG) instillations are used clinically for treatment of urothelial carcinoma, but the precise mechanisms by which they activate an immune response remain elusive. The role of the cGAS-STING pathway has been implicated in both BCG and radiation-induced immune response however comparison of STING-pathway molecules and immune landscape following treatment in urothelial carcinoma has not be performed. We therefore comprehensively analyzed the local immune response in the bladder tumor microenvironment following radiotherapy and BCG instillations in a well-established spontaneous murine model of urothelial carcinoma to provide insight into activation of STING-mediated immune response. Mice were exposed to the oral carcinogen, BBN, for 12 weeks prior to treatment with a single 15Gy dose of radiation or 3 intravesical instillations of BCG (1x108 CFU). At sacrifice, tumors were staged by a urologic pathologist and effects of therapy on the immune microenvironment were measured using the NanoString Myeloid Innate Immunity Panel and immunohistochemistry. Clinical relevance was established by measuring immune biomarker expression of cGAS and STING on a human tissue microarray consisting of BCG-treated non-muscle invasive urothelial carcinomas. BCG instillations in the murine model elevated STING and downstream STING-induced interferon and pro-inflammatory molecules, intratumoral M1 macrophage and T-cell accumulation, and complete tumor eradication. In contrast, radiotherapy caused no changes in STING pathway or innate immune gene expression; rather, it induced M2 macrophage accumulation and elevated FoxP3 expression characteristic of immunosuppression. In human non-muscle invasive bladder cancer, STING protein expression was elevated at baseline in patients who responded to BCG therapy and increased further after BCG therapy. Overall, these results show that STING pathway activation plays a key role in effective BCG-induced immune response and strongly indicate that the effects of BCG on the bladder cancer immune microenvironment are more beneficial than those induced by radiation. This article is protected by copyright. All rights reserved.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::82ba05ad75bfaa1ef99067a5a4dd6e5d
https://europepmc.org/articles/PMC8738146/ -
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المؤلفون: Nikolai A. Sopko, E. James Wright, Madeleine G. Manka, Arnav Srivastava, Gregory Joice, Hiten D. Patel
المصدر: European Urology Focus. 5:887-893
مصطلحات موضوعية: Male, Reoperation, medicine.medical_specialty, Urology, Urinary system, 030232 urology & nephrology, Surgical Revision, Balloon, Artificial urinary sphincter, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Device failure, Aged, Retrospective Studies, business.industry, Middle Aged, Prosthesis Failure, Surgery, Urinary Incontinence, Sample size determination, 030220 oncology & carcinogenesis, Cuff, Cohort, Urinary Sphincter, Artificial, business
الوصف: Background Up to 50% of patients receiving an artificial urinary sphincter (AUS) require surgical revision after initial placement. However, the literature is heterogeneous regarding the leading causes of AUS failure and appropriate surgical management. Objective To inform a revision approach by tabulating the causes of AUS failure, assessing AUS component survival, and examining the single-component revision efficacy. Design, setting, and participants We retrospectively reviewed 168 patients receiving AUS placements carried out by a single surgeon from 2008 to 2016 at a high-volume academic institution. The median follow-up from initial placement was 2.7 yr, with 37.5% experiencing recurrent incontinence. The cuff size ranged from 4.0 to 5.5cm, with median size of 4.5cm. Intervention Patients without infection or erosion underwent systematic device interrogation and revision, starting with the pressure-regulating balloon (PRB) and then, if necessary, the urethral cuff. Device revision involved either PRB-only correction or cuff and PRB revision. Outcome measurements and statistical analysis We used bootstrapped intervals to estimate the mean time to failure for individual AUS components. Kaplan-Meier estimates were used to compare survival for individual components and for revised devices by revision technique. Results and limitations PRB malfunction most commonly caused device failure, while cuff or pump malfunction was rare. Among patients undergoing surgical revision, those with PRB-only correction had similar outcomes to those with more extensive device correction (cuff and PRB exchange; p =0.46). This study, while systematic and detailed, is limited by sample size, follow-up length, and its retrospective nature. Conclusions PRB malfunction most commonly caused AUS failure in our cohort. PRB-only correction may satisfactorily restore AUS function in select patients. Consequently, initial interrogation of the PRB may avoid a second incision and urethral exposure for many patients requiring AUS revision. Patient summary Artificial urinary sphincters remain prone to failure over time. In many instances, correcting only the pressure-regulating balloon may effectively restore device function, allowing for a less invasive revision.
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