6,523 research outputs found
Risk calculator for prediction of treatment-related urethroplasty failure in patients with penile urethral strictures
Purpose To design a dedicated risk calculator for patients with penile urethra stricture who are scheduled to urethroplasty that might be used to counsel patients according to their pre-operative risk of failure. Methods Patients treated with penile urethroplasty at our center (1994-2018) were included in the study. Patients received 1-stage or staged penile urethroplasty. Patients with failed hypospadias repair, lichen sclerosus or incomplete clinical records were excluded. Treatment failure was defined as any required postoperative instrumentation, including dilation. Univariable Cox regression identified predictors of post-operative treatment failure and Kaplan-Meier analysis plotted the failure-free survival rates according to such predictors. Multivariable Cox regression-based risk calculator was generated to predict the risk of treatment failure at 10 years after surgery. Results 261 patients met the inclusion criteria. Median follow-up was 113 months. Out of 216 patients, 201 (77%) were classified as success and 60 (23%) failures. Former smoker (hazard ratio [HR] 2.12, p = 0.025), instrumentation-derived stricture (HR 2.55, p = 0.006), and use of grafts (HR 1.83, p = 0.037) were predictors of treatment failure. Model-derived probabilities showed that the 10-year risk of treatment failure varied from 5.8 to 41.1% according to patient's characteristics. Conclusions Long-term prognosis in patients who underwent penile urethroplasty is uncertain. To date, our risk-calculator represents the first tool that might help physicians to predict the risk of treatment failure at 10 years. According to our model, such risk is largely influenced by the etiology of the stricture, the use of graft, and patient's smoking habits
Repair of sphincter urethral strictures preserving urinary continence: surgical technique and outcomes
Introduction Repair of post-TURP sphincter urethral strictures represents challenging problem, due to the risk of urinary incontinence after the repair. We described a surgical technique we use to repair these strictures preserving urinary continence in patients with incompetent bladder neck. Materials and methods An observational, retrospective, study was conducted to include patients with post-TURP urethral strictures in the area of distal sphincter. We included only patients with complete clinical data and follow-up who previously underwent TURP or HOLEP or TUIP, and subsequently developed proximal bulbar urethral strictures close to the membranous urethra and the related distal urethral sphincter. Patients were included, if they were fully continent after TURP or other procedures to treat BPH. The primary outcome of the study was treatment failure, defined as the need for any post-operative instrumentation. Secondary outcome was post-urethroplasty urinary continence. Patients showing stricture recurrence or post-operative incontinence were classified as failure. Results Overall, 69 patients were included in the study. Median patient's age was 67 years; median stricture length was 4 cm. Thirty-tree patients (47.8%) underwent previous urethrotomy. Median follow-up was 52 months. Out of 69 patients, 55 (79.7%) were classified as success and 14 (20.3%) as failure. Out of the whole cohort, thus, 11/69 (16%) have a risk of recurrent strictures and 3/69 (4.3%) have incontinence. Conclusions The use of modified ventral onlay graft urethroplasty, using particular non-aggressive steps, is a suitable surgical technique for repair of sphincter urethral stricture in patients who underwent BPH transurethral surgery, using different procedures (TURP, HOLEP, TUIP)
Focus on Internal Urethrotomy as Primary Treatment for Untreated Bulbar Urethral Strictures: Results from a Multivariable Analysis
Background: The use of internal urethrotomy for treatment of urethral stricture remains a controversial topic in urology.Objective: To investigate outcomes and predictors of failure for internal urethrotomy as primary treatment for untreated bulbar urethral strictures.Design, setting, and participants: We performed a retrospective analysis of patients who underwent internal urethrotomy. Patients with bulbar urethral stricture who did not receive any previous treatment were included. Patients with traumatic, penile or posterior urethral strictures, lichen sclerosus, failed hypospadias repair, or stricture length >4 cm were excluded.Outcome measurements and statistical analysis: The primary outcome was treatment failure. Kaplan-Meyer plots were used to depict treatment failure-free survival. Univariate and multivariable Cox regression analyses were used to test the association between predictors (age, body mass index, diabetes, history of smoking, etiology, stenosis type and length, preoperative maximum flow [pQ(max)]) and treatment failure.Results and limitations: Overall, 136 patients were included. The median stricture length was 2 cm. Median follow-up was 55 mo. At 5-yr follow-up the failure-free survival rate was 57%. On univariate analysis, diabetes, nonidiopathic etiology, stricture length of 3-4 cm, and pQ(max) were significantly associated with treatment failure. These predictors were included in a multivariable analysis, in which pQ(max) was the only significant predictor of treatment failure.Conclusions: Failure of internal urethrotomy for untreated bulbar urethral strictures greatly depends on pQ(max) flow at uroflowmetry. Patients with pQ(max >) 8 ml/s have a high probability of success, while patients with pQ(max) <5 ml/s have a low probability of success.Patient summary: The use of internal urethrotomy in patients with an untreated bulbar urethral stricture should only be considered in selected cases. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved
Tectonic setting of the kenya rift in the nakuru area, based on geophysical prospecting
In this paper, we present results of tectonic and geophysical investigations in the Kenya Rift valley, in the Nakuru area. We compiled a detailed geological map of the area based on published earlier works, well data and satellite imagery. The map was then integrated with original fieldwork and cross sections were constructed. In key areas, we then performed geophysical survey using Electrical Resistivity Tomography (ERT), Hybrid Source AudioMagnetoTelluric (HSAMT), and single station passive seismic measurements (HVSR). In the study area, a volcano-sedimentary succession of the Neogene-Quaternary age characterized by basalts, trachytes, pyroclastic rocks, and tephra with intercalated lacustrine and fluvial deposits crops out. Faulting linked with rift development is evident and occurs throughout the area crosscutting all rock units. We show a rotation of the extension in this portion of the Kenya rift with the NE-SW extension direction of a Neogene-Middle Pleistocene age, followed by the E-Wextension direction of anUpper Pleistocene-Present age. Geophysical investigations allowed to outline main lithostratigraphic units and tectonic features at depth and were also useful to infer main cataclasites and fractured rock bodies, the primary paths for water flow in rocks. These investigations are integrated in a larger EU H2020 Programme aimed to produce a geological and hydrogeological model of the area to develop a sustainable water management system
How men step back â and recover â from suicide attempts: A relational and gendered account
Men account for three-quarters of suicide deaths in the UK, yet we know little about how at-risk men construct their experiences of moving towards - and then subsequently stepping back from - suicide, nor the part played by relational factors therein. An inductive thematic analysis was used to examine narrative interviews with eleven UK men who self-reported serious thoughts, plans and up-to and including suicide attempts in progress, but who consciously decided against carrying out an attempt. Their accounts suggest a highly social process of movements towards and away from suicide (e.g. frustrated help-seeking). Stepping back from suicide represents not a discrete issue, but a linked process in suicidality and wider recovery. Here, the use of military metaphors in particular (e.g. waging war, fighting back) highlights the gendered nature of the issue. Additionally, our article illuminates a range of social relations and forces that circulate in and around suicidality, which itself is embedded in varying forms of relationality, normativity and gendered practices. [Abstract copyright: © 2020 Foundation for the Sociology of Health & Illness.
Resolution of the type material of the Asian elephant, Elephas maximus Linnaeus, 1758 (Proboscidea, Elephantidae)
The understanding of Earthâs biodiversity depends critically on the accurate identification and nomenclature of
species. Many species were described centuries ago, and in a surprising number of cases their nomenclature or type
material remain unclear or inconsistent. A prime example is provided by Elephas maximus, one of the most iconic
and well-known mammalian species, described and named by Linnaeus (1758) and today designating the Asian
elephant. We used morphological, ancient DNA (aDNA), and high-throughput ancient proteomic analyses to
demonstrate that a widely discussed syntype specimen of E. maximus, a complete foetus preserved in ethanol, is
actually an African elephant, genus Loxodonta. We further discovered that an additional E. maximus syntype,
mentioned in a description by John Ray (1693) cited by Linnaeus, has been preserved as an almost complete skeleton
at the Natural History Museum of the University of Florence. Having confirmed its identity as an Asian elephant
through both morphological and ancient DNA analyses, we designate this specimen as the lectotype of E. maximus
Italyâs Path to Very Low Fertility: The Adequacy of Economic and Second Demographic Transition Theories: Le cheminement de lâItalie vers les trĂšs basses fĂ©conditĂ©s: AdĂ©quation des thĂ©ories Ă©conomique et de seconde transition dĂ©mographique
The deep drop of the fertility rate in Italy to among the lowest in the world challenges contemporary theories of childbearing and family building. Among high-income countries, Italy was presumed to have characteristics of family values and female labor force participation that would favor higher fertility than its European neighbors to the north. We test competing economic and cultural explanations, drawing on new nationally representative, longitudinal data to examine first union, first birth, and second birth. Our event history analysis finds some support for economic determinants of family formation and fertility, but the clear importance of regional differences and of secularization suggests that such an explanation is at best incomplete and that cultural and ideational factors must be considered
An NLO QCD analysis of inclusive cross-section and jet-production data from the ZEUS experiment
The ZEUS inclusive differential cross-section data from HERA, for charged and
neutral current processes taken with e+ and e- beams, together with
differential cross-section data on inclusive jet production in e+ p scattering
and dijet production in \gamma p scattering, have been used in a new NLO QCD
analysis to extract the parton distribution functions of the proton. The input
of jet data constrains the gluon and allows an accurate extraction of
\alpha_s(M_Z) at NLO;
\alpha_s(M_Z) = 0.1183 \pm 0.0028(exp.) \pm 0.0008(model)
An additional uncertainty from the choice of scales is estimated as \pm
0.005. This is the first extraction of \alpha_s(M_Z) from HERA data alone.Comment: 37 pages, 14 figures, to be submitted to EPJC. PDFs available at
http://durpdg.dur.ac.uk/hepdata in LHAPDFv
Measurement of the diffractive structure function in deep inelastic scattering at HERA
This paper presents an analysis of the inclusive properties of diffractive
deep inelastic scattering events produced in interactions at HERA. The
events are characterised by a rapidity gap between the outgoing proton system
and the remaining hadronic system. Inclusive distributions are presented and
compared with Monte Carlo models for diffractive processes. The data are
consistent with models where the pomeron structure function has a hard and a
soft contribution. The diffractive structure function is measured as a function
of \xpom, the momentum fraction lost by the proton, of , the momentum
fraction of the struck quark with respect to \xpom, and of . The \xpom
dependence is consistent with the form \xpoma where
in all bins of and
. In the measured range, the diffractive structure function
approximately scales with at fixed . In an Ingelman-Schlein type
model, where commonly used pomeron flux factor normalisations are assumed, it
is found that the quarks within the pomeron do not saturate the momentum sum
rule.Comment: 36 pages, latex, 11 figures appended as uuencoded fil
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