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Re: Continuous Normothermic Ex Vivo Kidney Perfusion is Superior to Brief Normothermic Perfusion following Static Cold Storage in Donation after Circulatory Death Pig Kidney Transplantation
J. M. Kaths, J. Y. Cen, Y. M. Chun, J. Echeverri, I. Linares, S. Ganesh, P. Yip, R. John, D. Bagli, I. Mucsi, A. Ghanekar, D. R. Grant, L. A. Robinson and M. Selzner
Re: Variation in the Use of Open Pyeloplasty, Minimally Invasive Pyeloplasty, and Endopyelotomy for the Treatment of Ureteropelvic Junction Obstruction in Adults
B. L. Jacobs, J. C. Lai, R. Seelam, J. M. Hanley, J. S. Wolf, Jr., B. K. Hollenbeck, J. M. Hollingsworth, A. W. Dick, C. M. Setodji and C. S. Saigal
The comment states that our “findings are interesting and have immense clinical application.” We would like to provide clarification about some of the concerns in the comment. In our work we did in fact explore the role of salt and protein consumption. We had previously examined salt and protein consumption individually but chose the DASH score because it already incorporates them. We also attempted to define kidney stone type in a large validation study (reference 7 in article). We reviewed medical records in a subgroup of participants who reported a kidney stone.
Using data on 3 large cohorts Ferraro et al report that several modifiable risk factors are associated with a lower risk of incident kidney stones, including fluid intake, BMI, DASH diet, dietary calcium intake and sugar sweetened beverages. These findings are interesting and have immense clinical application.
The above commentary nicely crystallizes the basic pathophysiological tenants of stricture formation and explains how increasing age is theorized to place patients at risk of poor outcomes. Our collective experience demonstrates that patients are often indiscriminately subjected to age bias when counseled on the various treatment options for urethral stricture disease. There appears to be a decidedly lower threshold to employ repetitive, even scheduled endoscopic treatments for older patients in an effort to avoid “major surgery.” Heyns et al analyzed pre-referral stricture management for patients who eventually underwent urethroplasty, noting that patients with 5-6 endoscopic interventions before referral had an average age of 60.2 years vs 46.6 years in those receiving 1-2 interventions.
Urethroplasty is the definitive surgical treatment for strictures with a success rate of 85-90% for simple procedures and about 80% for extremely complex repairs.1
In this editorial reviewing surgical options for benign prostatic hyperplasia Parsons concludes that holmium laser enucleation of the prostate (HoLEP) and robot-assisted simple prostatectomy (RASP) for large volume glands result in equivalent outcomes. We have concerns with use of the term “equivalent” in the absence of level 1 evidence supporting this assertion.
Electroacupuncture improved stress urinary incontinence - that's when a woman can experience an involuntary loss of urine such as when sneezing or coughing - but acupuncture did not increase the...
The primary aim was to evaluate the use of sexual dissatisfaction as a marker of poor overall health. Secondary objectives were to assess the effect of age on this measure and the utility of the Brief Sexual Symptom Checklist (BSSC) for general practitioners (GPs) and patients.
To analyze the association between US urology department Twitter presence and U.S. News and World Report (USNWR) reputation scores, to examine the content, informational value, and intended audience of these platforms, and to identify objectives for Twitter use.
Independent Validation of the American Joint Committee on Cancer 8th Edition Prostate Cancer Staging Classification
We sought to independently validate the American Joint Committee on Cancer (AJCC) 8th edition prostate cancer (PCa) staging classification, which includes the elimination of pT2 subcategories and the reclassification of patients with PSA≥20ng/ml and Gleason Grade Group (GG)-5 as Stage Group III-A and III-C, respectively.
The comment indicates that laser energy for focal therapy belongs in the MRI suite, ie in bore. However, FLA out of bore performed in clinic can yield an ablation zone indistinguishable from that of in bore FLA (see figure). The key conclusion of our phase I trial is that FLA can be performed safely and satisfactorily by a urologist in a clinic setting out of bore using MRI-US fusion for guidance. Nonrigid registration was used to match MRI to ultrasound and the cancer location was targeted using the same platform for diagnosis and treatment.
Targeted lesion based, zonal based and hemiablation strategies have been proposed for focal therapy. It is intuitive that the smaller the ablated volume to achieve cancer control, the less the potential of side effects from treatment. Laser ablation is precise and allows for targeted ablation up to 2 cm in diameter. Larger ablations necessitate an increase in insertions and time (reference 8 in article). Therefore, laser energy is ideally suited for targeted lesion based ablation and it relies on accurate imaging provided by MRI and biopsy information to guide therapy.
Prognostic Value of PD-1 and PD-L1 Expression in Patients with High-Grade Upper Tract Urothelial Carcinoma
To investigate the prognostic value of PD-1 and PD-L1 expression in patients with high-grade upper tract urothelial carcinoma (UTUC).
Understanding the variability in semen analysis and the effects of any 1 contributing factor is exceedingly difficult given the multifactorial nature of the physiological process. Epidemiologic issues such as insurance coverage, outpatient treatment settings, and income bias make assessment of patient cohorts subject to a multitude of confounders. As such, Eisenberg1 should be commended for tackling this exceedingly difficult topic as the author has attempted to identify differences in semen quality that are attributable solely to race.
The authors are to be congratulated for presenting innovative data on the role of frailty and overactive bladder in a geriatric population. Statistically, both frailty and overactive bladder are conditions with a higher prevalence as age increases.1-3 The authors prospectively report the association of 1363 patients (>/=65 years old); 201 with OAB and 1162 without OAB. They characterized these patients as “frail” based on their results in the “Timed Up and Go Test” (TUGT), which has been previously used to assess frailty and predict morbidity in the elderly.
To assess the sensitivity of gaze-based metrics in detecting cognitive demands imposed by surgical procedures. We analyzed urologists' gaze entropy and velocity while performing two standardized high-fidelity simulated stone procedures with different levels of complexity.
Post-Kidney Transplant Robot-Assisted Laparoscopic Ureteral (Donor-Receiver) Anastomosis for Kidney Graft Reflux or Stricture Disease
To report our experience with robot-assisted ureteral anastomosis for kidney graft. Kidney graft complex ureteral strictures and/or symptomatic vesico-ureteral reflux may require complex reconstruction. This is classically done through an open surgical access, which adds to the morbidity of kidney transplantation. The da Vinci robot enables to perform complex laparoscopic procedures, and may hence be used for such reconstructions.