Journal of Clinical Medicine

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Open AccessEditorial

Special Issue ‘Minimally Invasive Urological Procedures and Related Technological Developments’

by Bhaskar Somani

J. Clin. Med. 2021, 10(18), 4225; https://doi.org/10.3390/jcm10184225 - 17 Sep 2021

Viewed by 1335

Abstract

The landscape of minimally invasive urological intervention is changing [...] Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments)

Research

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10 pages, 928 KiB

Open AccessArticle

A Machine Learning Predictive Model for Post-Ureteroscopy Urosepsis Needing Intensive Care Unit Admission: A Case–Control YAU Endourology Study from Nine European Centres

by Amelia Pietropaolo, Robert M. Geraghty, Rajan Veeratterapillay, Alistair Rogers, Panagiotis Kallidonis, Luca Villa, Luca Boeri, Emanuele Montanari, Gokhan Atis, Esteban Emiliani, Tarik Emre Sener, Feras Al Jaafari, John Fitzpatrick, Matthew Shaw, Chris Harding and Bhaskar K. Somani

J. Clin. Med. 2021, 10(17), 3888; https://doi.org/10.3390/jcm10173888 - 29 Aug 2021

Cited by 21 | Viewed by 2298

Abstract

Introduction: With the rise in the use of ureteroscopy and laser stone lithotripsy (URSL), a proportionate increase in the risk of post-procedural urosepsis has also been observed. The aims of our paper were to analyse the predictors for severe urosepsis using a machine [...] Read more.

Introduction: With the rise in the use of ureteroscopy and laser stone lithotripsy (URSL), a proportionate increase in the risk of post-procedural urosepsis has also been observed. The aims of our paper were to analyse the predictors for severe urosepsis using a machine learning model (ML) in patients that needed intensive care unit (ICU) admission and to make comparisons with a matched cohort. Methods: A retrospective study was conducted across nine high-volume endourology European centres for all patients who underwent URSL and subsequently needed ICU admission for urosepsis (Group A). This was matched by patients with URSL without urosepsis (Group B). Statistical analysis was performed with ‘R statistical software’ using the ‘randomforests’ package. The data were segregated at random into a 70% training set and a 30% test set using the ‘sample’ command. A random forests ML model was then built with n = 300 trees, with the test set used for internal validation. Diagnostic accuracy statistics were generated using the ‘caret’ package. Results: A total of 114 patients were included (57 in each group) with a mean age of 60 ± 16 years and a male:female ratio of 1:1.19. The ML model correctly predicted risk of sepsis in 14/17 (82%) cases (Group A) and predicted those without urosepsis for 12/15 (80%) controls (Group B), whilst overall it also discriminated between the two groups predicting both those with and without sepsis. Our model accuracy was 81.3% (95%, CI: 63.7–92.8%), sensitivity = 0.80, specificity = 0.82 and area under the curve = 0.89. Predictive values most commonly accounting for nodal points in the trees were a large proximal stone location, long stent time, large stone size and long operative time. Conclusion: Urosepsis after endourological procedures remains one of the main reasons for ICU admission. Risk factors for urosepsis are reasonably accurately predicted by our innovative ML model. Focusing on these risk factors can allow one to create predictive strategies to minimise post-operative morbidity. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments)

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13 pages, 1624 KiB

Open AccessArticle

Extracorporeal Shockwave Therapy (ESWT) Alleviates Pain, Enhances Erectile Function and Improves Quality of Life in Patients with Chronic Prostatitis/Chronic Pelvic Pain Syndrome

by Wen-Ling Wu, Oluwaseun Adebayo Bamodu, Yuan-Hung Wang, Su-Wei Hu, Kai-Yi Tzou, Chi-Tai Yeh and Chia-Chang Wu

J. Clin. Med. 2021, 10(16), 3602; https://doi.org/10.3390/jcm10163602 - 16 Aug 2021

Cited by 10 | Viewed by 3503

Abstract

Purpose: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), affecting over 90% of patients with symptomatic prostatitis, remains a therapeutic challenge and adversely affects patients’ quality of life (QoL). This study probed for likely beneficial effects of ESWT, evaluating its extent and durability. Patients and [...] Read more.

Purpose: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), affecting over 90% of patients with symptomatic prostatitis, remains a therapeutic challenge and adversely affects patients’ quality of life (QoL). This study probed for likely beneficial effects of ESWT, evaluating its extent and durability. Patients and methods: Standardized indices, namely the pain, urinary, and QoL domains and total score of NIH-CPSI, IIEF-5, EHS, IPSS, and AUA QoL_US were employed in this study of patients with CP/CPPS who had been refractory to other prior treatments (n = 215; age range: 32–82 years; median age: 57.5 ± 12.4 years; modal age: 41 years). Results: For CP symptoms, the mean pre-ESWT NIH-CPSI total score of 27.1 ± 6.8 decreased by 31.3–53.6% over 12 months after ESWT. The mean pre-ESWT NIH-CPSI pain (12.5 ± 3.3), urinary (4.98 ± 2.7), and QoL (9.62 ± 2.1) domain scores improved by 2.3-fold, 2.2-fold, and 2.0-fold, respectively, by month 12 post-ESWT. Compared with the baseline IPSS of 13.9 ± 8.41, we recorded 27.1–50.9% amelioration of urinary symptoms during the 12 months post-ESWT. For erectile function, compared to pre-ESWT values, the IIEF-5 also improved by ~1.3-fold by month 12 after ESWT. This was corroborated by EHS of 3.11 ± 0.99, 3.37 ± 0.65, 3.42 ± 0.58, 3.75 ± 0.45, and 3.32 ± 0.85 at baseline, 1, 2, 6, and 12 months post-ESWT. Compared to the mean pre-ESWT QoL score (4.29 ± 1.54), the mean QoL values were 3.26 ± 1.93, 3.45 ± 2.34, 3.25 ± 1.69, and 2.6 ± 1.56 for months 1, 2, 6, and 12 after ESWT, respectively. Conclusions: This study shows ESWT, an outpatient and easy-to-perform, minimally invasive procedure, effectively alleviates pain, improves erectile function, and ameliorates quality of life in patients with refractory CP/CPPS. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments)

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8 pages, 1439 KiB

Open AccessArticle

Comparison of Holmium:YAG and Thulium Fiber Lasers on the Risk of Laser Fiber Fracture

by Audrey Uzan, Paul Chiron, Frédéric Panthier, Mattieu Haddad, Laurent Berthe, Olivier Traxer and Steeve Doizi

J. Clin. Med. 2021, 10(13), 2960; https://doi.org/10.3390/jcm10132960 - 30 Jun 2021

Cited by 15 | Viewed by 2143

Abstract

Objectives: To compare the risk of laser fiber fracture between Ho:YAG laser and Thulium Fiber Laser (TFL) with different laser fiber diameters, laser settings, and fiber bending radii. METHODS: Lengths of 200, 272, and 365 μm single use fibers were used with a [...] Read more.

Objectives: To compare the risk of laser fiber fracture between Ho:YAG laser and Thulium Fiber Laser (TFL) with different laser fiber diameters, laser settings, and fiber bending radii. METHODS: Lengths of 200, 272, and 365 μm single use fibers were used with a 30 W Ho:YAG laser and a 50 W Super Pulsed TFL. Laser fibers of 150 µm length were also tested with the TFL only. Five different increasingly smaller bend radii were tested: 1, 0.9, 0.75, 0.6, and 0.45 cm. A total of 13 different laser settings were tested for the Ho:YAG laser: six fragmentation settings with a short pulse duration, and seven dusting settings with a long pulse duration. A total of 33 different laser settings were tested for the TFL. Three laser settings were common two both lasers: 0.5 J × 12 Hz, 0.8 J × 8 Hz, 2 J × 3 Hz. The laser was activated for 5 min or until fiber fracture. Each measurement was performed ten times. Results: While fiber failures occurred with all fiber diameters with Ho:YAG laser, none were reported with TFL. Identified risk factors of fiber fracture with the Ho:YAG laser were short pulse and high energy for the 365 µm fibers (p = 0.041), but not for the 200 and 272 µm fibers (p = 1 and p = 0.43, respectively). High frequency was not a risk factor of fiber fracture. Fiber diameter also seemed to be a risk factor of fracture. The 200 µm fibers broke more frequently than the 272 and 365 µm ones (p = 0.039). There was a trend for a higher number of fractures with the 365 µm fibers compared to the 272 µm ones, these occurring at a larger bend radius, but this difference was not significant. Conclusion: TFL appears to be a safer laser regarding the risk of fiber fracture than Ho:YAG when used with fibers in a deflected position. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments)

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13 pages, 1015 KiB

Open AccessArticle

Global Variations in the Mineral Content of Bottled Still and Sparkling Water and a Description of the Possible Impact on Nephrological and Urological Diseases

by Simone J. M. Stoots, Guido M. Kamphuis, Rob Geraghty, Liffert Vogt, Michaël M. E. L. Henderickx, B. M. Zeeshan Hameed, Sufyan Ibrahim, Amelia Pietropaolo, Enakshee Jamnadass, Sahar M. Aljumaiah, Saeed B. Hamri, Eugenio Ventimiglia, Olivier Traxer, Vineet Gauhar, Etienne X. Keller, Vincent De Coninck, Otas Durutovic, Nariman K. Gadzhiev, Laurian B. Dragos, Tarik Emre Sener, Nick Rukin, Michele Talso, Panagiotis Kallidonis, Esteban Emiliani, Ewa Bres-Niewada, Kymora B. Scotland, Naeem Bhojani, Athanasios Vagionis, Angela Piccirilli and Bhaskar K. Somani Show full author list Hide full author list

J. Clin. Med. 2021, 10(13), 2807; https://doi.org/10.3390/jcm10132807 - 27 Jun 2021

Cited by 6 | Viewed by 6018

Abstract

Kidney stone disease (KSD) is a complex disease. Besides the high risk of recurrence, its association with systemic disorders contributes to the burden of disease. Sufficient water intake is crucial for prevention of KSD, however, the mineral content of water might influence stone [...] Read more.

Kidney stone disease (KSD) is a complex disease. Besides the high risk of recurrence, its association with systemic disorders contributes to the burden of disease. Sufficient water intake is crucial for prevention of KSD, however, the mineral content of water might influence stone formation, bone health and cardiovascular (CVD) risk. This study aims to analyse the variations in mineral content of bottled drinking water worldwide to evaluate the differences and describes the possible impact on nephrological and urological diseases. The information regarding mineral composition (mg/L) on calcium, bicarbonate, magnesium, sodium and sulphates was read from the ingredients label on water bottles by visiting the supermarket or consulting the online shop. The bottled waters in two main supermarkets in 21 countries were included. The evaluation shows that on a global level the mineral composition of bottled drinkable water varies enormously. Median bicarbonate levels varied by factors of 12.6 and 57.3 for still and sparkling water, respectively. Median calcium levels varied by factors of 18.7 and 7.4 for still and sparkling water, respectively. As the mineral content of bottled drinking water varies enormously worldwide and mineral intake through water might influence stone formation, bone health and CVD risk, urologists and nephrologists should counsel their patients on an individual level regarding water intake. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments)

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6 pages, 207 KiB

Open AccessArticle

Outcomes of Ureteroscopy and Laser Stone Fragmentation (URSL) for Kidney Stone Disease (KSD): Comparative Cohort Study Using MOSES Technology 60 W Laser System versus Regular Holmium 20 W Laser

by Amelia Pietropaolo, Thomas Hughes, Mriganka Mani and Bhaskar Somani

J. Clin. Med. 2021, 10(13), 2742; https://doi.org/10.3390/jcm10132742 - 22 Jun 2021

Cited by 27 | Viewed by 3032

Abstract

Background: For ureteroscopy and laser stone fragmentation (URSL), the use of laser technology has shifted from low power to higher power lasers and the addition of Moses technology, that allows for ‘fragmentation, dusting and pop-dusting’ of stones. We wanted to compare the outcomes [...] Read more.

Background: For ureteroscopy and laser stone fragmentation (URSL), the use of laser technology has shifted from low power to higher power lasers and the addition of Moses technology, that allows for ‘fragmentation, dusting and pop-dusting’ of stones. We wanted to compare the outcomes of URSL for Moses technology 60 W laser system versus matched regular Holmium 20 W laser cases. Methods: Prospective data were collected for patients who underwent URSL using a Moses 60 W laser (Group A) and matched to historical control data using a regular Holmium 20 W laser (Group B), performed by a single surgeon. Data were collected for patient demographics, stone location, size, pre- and post-operative stent, operative time, length of stay, complications and stone free rate (SFR). Results: A total of 38 patients in each group underwent the URSL procedure. The stones were matched for their location (17 renal and 11 ureteric stones). The mean single and cumulative stone sizes (mm) were 10.9 ± 4.4 and 15.5 ± 9.9, and 11.8 ± 4.0 and 16.5 ± 11.3 for groups A and B, respectively. The mean operative time (min) was 51.6 ± 17.1 and 82.1 ± 27.0 (p ≤ 0.0001) for groups A and B. The initial SFR was 97.3% and 81.6% for groups A and B, respectively (p = 0.05), with 1 and 7 patients in each group needing a second procedure (p = 0.05), for a final SFR of 100% and 97.3%. While there were 2 and 5 Clavien I/II complications for groups A and B, none of the patients in group A had any infection related complication. Conclusions: Use of Moses technology with higher power was significantly faster for stone lithotripsy and reduced operative time and the number of patients who needed a second procedure to achieve a stone free status. It seems that the use of Moses technology with a mid-power laser is likely to set a new benchmark for treating complex stones, without the need for secondary procedures in most patients. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments)

9 pages, 392 KiB

Open AccessArticle

Acute Kidney Injury Post-Percutaneous Nephrolithotomy (PNL): Prospective Outcomes from a University Teaching Hospital

by Sunil Pillai, Akshay Kriplani, Arun Chawla, Bhaskar Somani, Akhilesh Pandey, Ravindra Prabhu, Anupam Choudhury, Shruti Pandit, Ravi Taori and Padmaraj Hegde

J. Clin. Med. 2021, 10(7), 1373; https://doi.org/10.3390/jcm10071373 - 29 Mar 2021

Cited by 6 | Viewed by 2607

Abstract

Acute Kidney Injury (AKI) after percutaneous nephrolithotomy (PNL) is a significant complication, but evidence on its incidence is bereft in the literature. The objective of this prospective observational study was to analyze the incidence of post-PNL AKI and the potential risk factors and [...] Read more.

Acute Kidney Injury (AKI) after percutaneous nephrolithotomy (PNL) is a significant complication, but evidence on its incidence is bereft in the literature. The objective of this prospective observational study was to analyze the incidence of post-PNL AKI and the potential risk factors and outcomes. Demographic data collected included age, gender, body mass index (BMI), comorbidities (hypertension, diabetes mellitus), and drug history—particularly angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers and beta blockers. Laboratory data included serial serum creatinine measured pre- and postoperation (12, 24, and 48 h), hemoglobin (Hb), total leucocyte count (TLC), Prothrombin time (PT), serum uric acid and urine culture. Stone factors were assessed by noncontrast computerized tomography of kidneys, ureter and bladder (NCCT KUB) and included stone burden, location and Hounsfield values. Intraoperative factors assessed were puncture site, tract size, tract number, operative time, the need for blood transfusion and stone clearance. Postoperative complications were documented using the modified Clavien–Dindo grading system and patients with postoperative AKI were followed up with serial creatinine measurements up to 1 year. Among the 509 patients analyzed, 47 (9.23%) developed postoperative AKI. Older patients, with associated hypertension and diabetes mellitus, those receiving ACE inhibitors and with lower preoperative hemoglobin and higher serum uric acid, had higher incidence of AKI. Higher stone volume and density, staghorn stones, multiple punctures and longer operative time were significantly associated with postoperative AKI. Patients with AKI had an increased length of hospital stay and 17% patients progressed to chronic kidney disease (CKD). Cut-off values for patient age (39.5 years), serum uric acid (4.05 mg/dL) and stone volume (673.06 mm³) were assessed by receiver operating characteristic (ROC) curve analysis. Highlighting the strong predictors of post-PNL AKI allows early identification, proper counseling and postoperative planning and management in an attempt to avoid further insult to the kidney. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments)

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9 pages, 1048 KiB

Open AccessArticle

Risk of Metabolic Syndrome in Kidney Stone Formers: A Comparative Cohort Study with a Median Follow-Up of 19 Years

by Robert M. Geraghty, Paul Cook, Paul Roderick and Bhaskar Somani

J. Clin. Med. 2021, 10(5), 978; https://doi.org/10.3390/jcm10050978 - 2 Mar 2021

Cited by 10 | Viewed by 1932

Abstract

Background: Kidney stone formers (SF) are more likely to develop diabetes mellitus (DM), but there is no study examining risk of metabolic syndrome (MetS) in this population. We aimed to describe the risk of MetS in SF compared to non-SF. Methods and Materials: [...] Read more.

Background: Kidney stone formers (SF) are more likely to develop diabetes mellitus (DM), but there is no study examining risk of metabolic syndrome (MetS) in this population. We aimed to describe the risk of MetS in SF compared to non-SF. Methods and Materials: SF referred to a tertiary referral metabolic centre in Southern England from 1990 to 2007, comparator patients were age, sex, and period (first stone) matched with 3:1 ratio from the same primary care database. SF with no documentation or previous MetS were excluded. Ethical approval was obtained and MetS was defined using the modified Association of American Clinical Endocrinologists (AACE) criteria. Analysis with cox proportional hazard regression. Results: In total, 828 SF were included after 1000 records were screened for inclusion, with 2484 age and sex matched non-SF comparators. Median follow-up was 19 years (interquartile range—IQR: 15–22) for both stone formers and stone-free comparators. SF were at significantly increased risk of developing MetS (hazard ratio—HR: 1.77; 95% confidence interval—CI: 1.55–2.03, p < 0.001). This effect was robust to adjustment for pre-existing components (HR: 1.91; 95% CI: 1.66–2.19, p < 0.001). Conclusions: Kidney stone formers are at increased risk of developing metabolic syndrome. Given the pathophysiological mechanism, the stone is likely a ‘symptom’ of an underlying metabolic abnormality, whether covert or overt. This has implications the risk of further stone events and cardiovascular disease. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments)

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11 pages, 1104 KiB

Open AccessArticle

Quality Assessment of CEUS in Individuals with Small Renal Masses—Which Individual Factors Are Associated with High Image Quality?

by Paul Spiesecke, Thomas Fischer, Frank Friedersdorff, Bernd Hamm and Markus Herbert Lerchbaumer

J. Clin. Med. 2020, 9(12), 4081; https://doi.org/10.3390/jcm9124081 - 17 Dec 2020

Cited by 6 | Viewed by 1608

Abstract

Obesity and bowel gas are known to impair image quality in abdominal ultrasound (US). The present study aims at identifying individual factors in B-mode US that influence contrast-enhanced US (CEUS) image quality to optimize further imaging workup of incidentally detected focal renal masses. [...] Read more.

Obesity and bowel gas are known to impair image quality in abdominal ultrasound (US). The present study aims at identifying individual factors in B-mode US that influence contrast-enhanced US (CEUS) image quality to optimize further imaging workup of incidentally detected focal renal masses. We retrospectively analyzed renal CEUS of focal renal masses ≤ 4 cm performed at our center in 143 patients between 2016 and 2020. Patient and lesion characteristics were tested for their influence on focal and overall image quality assessed by two experienced radiologists using Likert scales. Effects of significant variables were quantified by receiver operating characteristics (ROC) curve analysis with area under the curve (AUC), and combined effects were assessed by binary logistic regression. Shrunken kidney, kidney depth, lesion depth, lesion size, and exophytic lesion growth were found to influence focal renal lesion image quality, and all factors except lesion size also influenced overall image quality. Combination of all parameters except kidney depth best predicted good CEUS image quality showing an AUC of 0.91 (p < 0.001, 95%-CI 0.863–0.958). The B-mode US parameters investigated can identify patients expected to have good CEUS image quality and thus help select the most suitable contrast-enhanced imaging strategy for workup of renal lesions. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments)

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10 pages, 1275 KiB

Open AccessArticle

Single-Site Sutureless Partial Nephrectomy for Small Exophytic Renal Tumors

by Ching-Chia Li, Tsu-Ming Chien, Shu-Pin Huang, Hsin-Chih Yeh, Hsiang-Ying Lee, Hung-Lung Ke, Sheng-Chen Wen, Wei-Che Chang, Yung-Shun Juan, Yii-Her Chou and Wen-Jeng Wu

J. Clin. Med. 2020, 9(11), 3658; https://doi.org/10.3390/jcm9113658 - 13 Nov 2020

Cited by 7 | Viewed by 2621

Abstract

Partial nephrectomy (PN) is the standard procedure for most patients with localized renal cancer. Laparoscopy has become the preferred surgical approach to target this cancer, but the steep learning curve with laparoscopic PN (LPN) remains a concern. In LPN intracorporeal suturing, the operation [...] Read more.

Partial nephrectomy (PN) is the standard procedure for most patients with localized renal cancer. Laparoscopy has become the preferred surgical approach to target this cancer, but the steep learning curve with laparoscopic PN (LPN) remains a concern. In LPN intracorporeal suturing, the operation time is further extended even under robot assistance, a step which prolongs warm ischemic time. Herein, we shared our experience to reduce the warm ischemia time, which allows surgeons to perform LPN more easily by using a combination of hemostatic agents to safely control parenchymal bleeding. Between 2015 and 2018, we enrolled 52 patients who underwent LPN in our hospital. Single-site sutureless LPN and traditional suture methods were performed in 33 and 19 patients, respectively. Preoperative, intra-operative, and postoperative variables were recorded. Renal function was evaluated by estimated glomerular filtration rate (eGFR) pre- and postoperatively. The average warm ischemia time (sutureless vs. suture group; 11.8 ± 3.9 vs. 21.2 ± 7.2 min, p < 0.001) and the operation time (167.9 ± 37.5 vs. 193.7 ± 42.5 min, p = 0.035) were significantly shorter in the sutureless group. In the sutureless group, only 2 patients suffered from massive urinary leakage (>200 mL/day) from the Jackson Pratt drainage tube, but the leakage spontaneously decreased within 7 days after surgery. eGFR and serum hemoglobin were not found to be significantly different pre- and postoperatively. All tumors were removed without a positive surgical margin. All patients were alive without recurrent tumors at mean postoperative follow-ups of 29.3 ± 12.2 months. Single-site sutureless LPN is a feasible surgical method for most patients with small exophytic renal cancer with excellent cosmetic results without affecting oncological results. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments)

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Review

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14 pages, 810 KiB

Open AccessReview

by Francesca J. New, Sally J. Deverill and Bhaskar K. Somani

J. Clin. Med. 2021, 10(11), 2354; https://doi.org/10.3390/jcm10112354 - 27 May 2021

Cited by 13 | Viewed by 4720

Abstract

Background: Malignant ureteric obstruction occurs in a variety of cancers and has been typically associated with a poor prognosis. Percutaneous nephrostomy (PCN) can potentially help increase patient longevity by establishing urinary drainage and treating renal failure. Our aim was to look at the [...] Read more.

Background: Malignant ureteric obstruction occurs in a variety of cancers and has been typically associated with a poor prognosis. Percutaneous nephrostomy (PCN) can potentially help increase patient longevity by establishing urinary drainage and treating renal failure. Our aim was to look at the outcomes of PCN in patients with advanced cancer and the impact on the patients’ lifespan and quality of life. Materials and Methods: A literature review was carried out for articles from 2000 to 2020 on PCN in patients with advanced malignancies, using MEDLINE, EMBASE, Scopus, CINAHL, Cochrane Library, clinicaltrials.gov, and Google Scholar. All English-language articles reporting on a minimum of 20 patients who underwent PCN for malignancy-associated ureteric obstruction were included. Results: A total of 21 articles (1674 patients) met the inclusion criteria with a mean of 60.2 years (range: 21–102 years). PCN was performed for ureteric obstruction secondary to urological malignancies (n = −633, 37.8%), gynaecological malignancies (n = 437, 26.1%), colorectal and GI malignancies (n = 216, 12.9%), and other specified malignancies (n = 205, 12.2%). The reported mean survival times varied from 2 to 8.5 months post PCN insertion, with an average survival time of 5.6 months, which depended on the cancer type, stage, and previous treatment. Conclusions: Patients with advanced malignancies who need PCN tend to have a survival rate under 12 months and spend a large proportion of this time in the hospital. Although the advent of newer chemotherapy and immunotherapy options has changed the landscape of managing advanced cancer, decisions on nephrostomy must be balanced with their survival and quality of life, which must be discussed with the patient. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments)

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19 pages, 22924 KiB

Open AccessReview

Artificial Intelligence and Its Impact on Urological Diseases and Management: A Comprehensive Review of the Literature

by B. M. Zeeshan Hameed, Aiswarya V. L. S. Dhavileswarapu, Syed Zahid Raza, Hadis Karimi, Harneet Singh Khanuja, Dasharathraj K. Shetty, Sufyan Ibrahim, Milap J. Shah, Nithesh Naik, Rahul Paul, Bhavan Prasad Rai and Bhaskar K. Somani

J. Clin. Med. 2021, 10(9), 1864; https://doi.org/10.3390/jcm10091864 - 26 Apr 2021

Cited by 43 | Viewed by 6029

Abstract

Recent advances in artificial intelligence (AI) have certainly had a significant impact on the healthcare industry. In urology, AI has been widely adopted to deal with numerous disorders, irrespective of their severity, extending from conditions such as benign prostate hyperplasia to critical illnesses [...] Read more.

Recent advances in artificial intelligence (AI) have certainly had a significant impact on the healthcare industry. In urology, AI has been widely adopted to deal with numerous disorders, irrespective of their severity, extending from conditions such as benign prostate hyperplasia to critical illnesses such as urothelial and prostate cancer. In this article, we aim to discuss how algorithms and techniques of artificial intelligence are equipped in the field of urology to detect, treat, and estimate the outcomes of urological diseases. Furthermore, we explain the advantages that come from using AI over any existing traditional methods. Full article

(This article belongs to the Special Issue Minimally Invasive Urological Procedures and Related Technological Developments)

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