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Uro, Volume 3, Issue 4 (December 2023) – 4 articles

Cover Story (view full-size image): The management of penile cancer patients has its grey zones. In particular, no strong evidence or recommendations exist regarding the timing of prophylactic lymphadenectomy. Here, we aim to review the impact that the timing of inguinal and pelvic prophylactic lymph node dissection has on patient outcomes. Four clinical trials, all focusing on the role of inguinal lymph node dissection, are included. Despite the lack of randomized and controlled trials, this review suggests that lymph node dissection should be performed as soon as possible after diagnosis, with 3 months suggested as a realistic cut-off. The survival of penile cancer patients is strictly related to the timing of prophylactic pelvic lymph node dissection. All patients at high risk of nodal metastasis should be offered lymph node dissection within three months of diagnosis until new prediction tools are validated. View this paper
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11 pages, 914 KiB  
Article
Understanding Renal Failure Mortality Trends and Determinants in the US (1999–2020): Impacts of the Affordable Care Act, Advancements, Disparities, and Challenges
by Oscar Salichs, Sishir Doddi, Taryn Hibshman, Jama Hersi and Puneet Sindhwani
Uro 2023, 3(4), 271-281; https://doi.org/10.3390/uro3040027 - 18 Dec 2023
Viewed by 859
Abstract
Introduction: Renal failure, encompassing both acute and chronic forms, stands as a formidable public health challenge with far-reaching consequences for individual well-being and healthcare systems. This study delves into the mortality rates of renal failure in the United States over two transformative decades, [...] Read more.
Introduction: Renal failure, encompassing both acute and chronic forms, stands as a formidable public health challenge with far-reaching consequences for individual well-being and healthcare systems. This study delves into the mortality rates of renal failure in the United States over two transformative decades, from 1999 to 2020. Renal failure’s significance arises from its escalating prevalence, substantial healthcare costs, and the imperative to understand the multifaceted factors that influence its outcomes. Objectives: The primary objectives of this research are to analyze temporal trends in renal failure mortality rates, explore the impact of the Affordable Care Act (ACA) and advancements in renal care practices on mortality rates, and assess demographic disparities in mortality outcomes. Methods: Utilizing CDC WONDER’s multi-cause mortality data, we assessed mortality due to renal failure (ICD-10 Codes: N17–N19). Age-adjusted mortality rates (AAMRs) were collected and stratified by sex and race. The Joinpoint Regression Program analyzed trends, calculating annual percent change (APC) and significant average annual percent change (AAPC) from 1999 to 2020. Segmented line regression models were employed for parallel pairwise comparisons. Results: Renal failure mortality rates decreased for both sexes during the late 2000s. The ACA’s enactment in 2010 coincided with improved access to healthcare, possibly contributing to the decline. Demographic disparities highlighted variations in mortality rates across racial and gender groups. Advancements in renal care practices were evident, which were driven by innovations in treatment modalities and disease management. Significant temporal trends were observed by race, with varying periods of decrease or uptrend. Conclusions: The decline in renal failure mortality rates during the late 2000s was potentially influenced by the ACA and advances in renal care practices. Demographic disparities emphasize the need for equitable healthcare access and interventions. These findings underscore the significance of healthcare policies and medical advancements in reducing renal failure mortality rates and addressing disparities. Persistent efforts to mitigate challenges such as healthcare access, cost barriers, and disparities remain crucial to enhancing renal failure outcomes. Full article
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9 pages, 2091 KiB  
Brief Report
Efficacy of Fosfomycin against Extended Spectrum Beta-Lactamase-Producing Escherichia coli Isolated from Patient Urinary Cultures in the General Reference Hospital of Niamey, Niger
by Alassane Halawen Mohamed, René Dembélé, Alio Mahamadou Fody, Alix Bénédicte Kagambèga, Hiliassa Coulibaly, Frédéric François Bado, Chaibou Salaou, Laouali Boubou, Alkassoum Ibrahim, Eric Adehossi Omar and Nicolas Barro
Uro 2023, 3(4), 262-270; https://doi.org/10.3390/uro3040026 - 04 Dec 2023
Viewed by 1035
Abstract
Urinary tract infection (UTI) is a common patient infection and a major public health problem today. The rapid spread of antibiotic resistance genes in Enterobacterales, particularly in Extended-spectrum beta-lactamases producing Escherichia coli (ESBL-E. coli), is compromising treatment with the [...] Read more.
Urinary tract infection (UTI) is a common patient infection and a major public health problem today. The rapid spread of antibiotic resistance genes in Enterobacterales, particularly in Extended-spectrum beta-lactamases producing Escherichia coli (ESBL-E. coli), is compromising treatment with the antibiotics that are normally used. The aim of this study was to evaluate the level of susceptibility of uropathogenic ESBL-producing E. coli to fosfomycin as an alternative treatment. A total of 3369 samples of urine were received and processed in the Bacteriology Laboratory of the Niamey General Reference Hospital (NGRH) throughout 2021. Synergy testing was performed for phenotypic detection of ESBLs, and fosfomycin sensibility of ESBLs-producing uropathogenic E. coli isolates were determined using the Viteck-2 system. Of the 280 enterobacteria identified in the urine samples, 104 Escherichia coli isolates were positive to the synergy test. The average age of the patients was 54 ± 17. The age range of 46–65 years was the most affected by these infections. The female patients predominated over the male ones, with a prevalence of 51.90%, a sex ratio of 1.08. The ESBL-producing E. coli isolates were 0.97% resistant to fosfomycin. Fosfomycin is highly effective against uropathogenic ESBL-producing E. coli isolates. It could be used as an alternative treatment for both uncomplicated and complicated urinary tract infections. Full article
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11 pages, 2391 KiB  
Review
Prophylactic Lymphadenectomy in Patients with Penile Cancer: Is Sooner Better?
by Tommaso Cai, Marco Capece, Maria Grazia Zorzi, Alessandro Palmieri, Gabriella Nesi, Mattia Barbareschi and Truls E. Bjerklund Johansen
Uro 2023, 3(4), 251-261; https://doi.org/10.3390/uro3040025 - 09 Nov 2023
Viewed by 723
Abstract
Background: Management of penile cancer patients has its grey zones. In particular, no strong evidence or recommendations exist regarding the timing of prophylactic lymphadenectomy. Here, we aim to review the impact that the timing of inguinal and pelvic prophylactic lymph node dissection [...] Read more.
Background: Management of penile cancer patients has its grey zones. In particular, no strong evidence or recommendations exist regarding the timing of prophylactic lymphadenectomy. Here, we aim to review the impact that the timing of inguinal and pelvic prophylactic lymph node dissection has on patient outcome. Methods: All relevant databases were searched following the preferred reporting items for systematic reviews and meta-analysis guidelines. A narrative review of indications for lymph node dissection and pathological considerations precede a systematic review of the impact of prophylactic lymph node dissection timing on prognosis. The primary endpoint is disease-free and overall survival in patients undergoing early or late lymph node dissection after penile cancer diagnosis. Results: Four clinical trials, all focusing on the role of inguinal lymph node dissection, are included. Despite the lack of randomized and controlled trials, this review suggests that lymph node dissection should be performed as soon as possible after diagnosis, with 3 months as a realistic cut-off. Conclusions: Survival of penile cancer patients is strictly related to the timing of prophylactic pelvic lymph node dissection. All patients at high risk of nodal metastasis should be offered lymph node dissection within three months of diagnosis, until new predicting tools are validated. Full article
(This article belongs to the Special Issue Andrology and Reproductive Health)
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12 pages, 285 KiB  
Review
Fertility Preservation Options for Transgender Patients: An Overview
by Natalie Mainland, Dana A. Ohl, Ahmed R. Assaly, Nabila Azeem, Amber Cooper, Angie Beltsos, Puneet Sindhwani and Tariq A. Shah
Uro 2023, 3(4), 239-250; https://doi.org/10.3390/uro3040024 - 08 Oct 2023
Viewed by 805
Abstract
Fertility preservation technologies have existed for decades, and the field is rapidly advancing; limited data exist regarding the use of these technologies by transgender patients. Many options are available for transgender patients who wish to preserve fertility before transitioning. These options include the [...] Read more.
Fertility preservation technologies have existed for decades, and the field is rapidly advancing; limited data exist regarding the use of these technologies by transgender patients. Many options are available for transgender patients who wish to preserve fertility before transitioning. These options include the cryopreservation of gametes, embryos, or ovarian tissue. Currently, ejaculated, or testicular sperm, immature oocytes, and ovarian tissue can be preserved for later use, but no such use option exists for immature testicular tissue. Many financial, sociological, and legal barriers and a lack of awareness among physicians and patients also hinders the utilization of these fertility preservation services. While options are abundant, usage rates are relatively low. The initial data regarding the successful use of preserved tissues appears promising, with birth rates not dissimilar to non-transgender patients. Further investigations into this area are needed. In addition, counseling regarding fertility preservation options should become a significant part of the provider-patient conversation before transitioning therapies. Full article
(This article belongs to the Special Issue Andrology and Reproductive Health)
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