Training the resident in percutaneous nephrolithotomy

Objective: From the trainers\u27 perspective percutaneous nephrolithotomy (PCNL) is one of the most challenging endourological procedures. In this review we examine the problems arising when training residents in PCNL, and how to facilitate this process. Methods: The recommendations are derived from discussions and consensus during the First European Urolithiasis Society (EULIS) meeting held in London in September 2011. In addition, we searched Medline for articles identified using the keywords \u27training\u27, \u27percutaneous surgery\u27, \u27renal calculi\u27, \u27PCNL\u27, \u27virtual reality\u27 and \u27simulators\u27. We also assessed the effect of modern technology, including the availability of virtual reality models vs. operating room training, and how international organisations like EULIS and European Urological Association can help. Results: The difficulty of training residents in PCNL is partly due to the complexity of obtaining a safe access to the kidney for lithotripsy. The most common way of obtaining access is guided by imaging only, and usually only fluoroscopic imaging is available. This has the potential for injuring structures from the skin to the renal capsule. Minor vascular injuries are relatively common, although most are self-limiting. Visceral injuries that are particularly important are pleural and less commonly colonic injuries, but they are more complex and often require additional procedures. Conclusions: Teaching the skills is more challenging than performing PCNL. In most urological training programmes it is difficult to incorporate teaching and training skills when performing PCNL. To train an academic stone doctor, proficiency in the safe conduct of PCNL is mandatory

Association between serum uric acid and prostate cancer mortality in androgen deprivation therapy: A population‐based cohort study

Objective This population-based study examined the association between baseline uric acid (UA) and prostate cancer (PCa)-related mortality amongst PCa patients receiving androgen deprivation therapy (ADT). Methods Adults with PCa who received ADT in Hong Kong between December 1999 and March 2021 were identified. Patients with missing baseline UA were excluded. Patients were followed up until September 2021. The outcome was PCa-related mortality. Results Altogether, 4126 patients (median follow-up 3.1[interquartile range 1.4–6.0] years) were included. A J-shaped association was observed between baseline UA level and PCa-related mortality risk, with a direct association in those with mean(0.401 mmol/L) or above-mean baseline UA levels (hazard ratio (HR) per standard deviation-increase 1.35 [95% confidence interval 1.21,1.51], p < 0.001), and an inverse association in those with below-mean baseline UA levels (HR 0.78[0.67,0.92], p = 0.003). The former remained significant on competing risk regression, but not the latter. Conclusions A J-shaped relationship between baseline UA level and PCa-related mortality risk was identified. This study was mainly limited by potential unmeasured and residual confounders. Further validation studies are warranted

Impact of effective intravesical therapies on quality of life in patients with non-muscle invasive bladder cancer: a systematic review

Background: Conventional and newly emerged intravesical modalities have demonstrated prophylactic effectiveness that may improve quality of life (QoL) in non-muscle invasive bladder cancer. The purpose of this study is to analyze existing QoL evidence in patients receiving any form of intravesical therapy. Methods: A PubMed search without time restriction was conducted to identify all relevant studies in accordance with the PICOT question. Additionally, a search was also performed in the Cochrane library database, Internet, and citation. The CONSORT 2010 checklist and STROBE statement checklist were used to evaluate the risk of bias of the included studies. Results: A total of 24 eligible articles were included, which consisted of 11 interventional and 13 observational studies. Intravesical therapy with Bacillus Calmette&ndash;Gu&eacute;rin (BCG) or certain chemotherapeutic agents worsens symptom burdens and functional performance during the initial induction phase while continuous improved is observed throughout the maintenance treatment and beyond. Hyperthermia has shown a positive trend in enhancing QoL of patients receiving intravesical chemotherapy, which requires more investigations. However, QoL data were unavailable for other forms of immunotherapy, immune checkpoint inhibitors, electromotive drug administration, and photodynamic therapy. Conclusions: Limited studies suggested the long-term positive impact of intravesical BCG immunotherapy and chemotherapy. However, existing evidence was lacking to clarify the impact of many emerging intravesical therapies that have suggested to be effective and safe, which demands treatment-specific QoL studies

Outcome of Laparoscopic Live Donor Nephrectomy and Impact of Double Renal Arteries: Results From Two Transplant Centres

ObjectiveLive donor kidney transplantation is consistently superior to deceased donor kidney transplantation. Laparoscopic donor nephrectomy (LDN) is increasingly accepted as a safe and preferred surgical option. To evaluate the outcome of LDN and the impact of multiple arteries, a retrospective review was conducted on patients in two transplant centres.MethodsFifty patients including eight with double vessels were studied. Standard left transperitoneal LDN was performed. Grafts including those with double vessels were prepared using the bench technique. Postoperative outcomes (up to 1 year) for donors and recipients were studied. The outcomes of recipients of a single or double vessel graft were compared.ResultsAll donors had an eventful recovery. No difference was found between the single and multiple vessels groups for operating time (168.21 ± 5.712 minutes vs. 197.50 ± 15.755 minutes) or hospital stay (3.21±0.165 days vs. 4.13±0.789 days). The recipient outcomes including hospital stay (10.17±0.596 days vs. 12.13 ± 1.797 days) and creatinine levels at day 7 (106.53 ± 5.583 μmol/L vs. 107.13 ± 11.857 μmol/L) and 1 year (120.21 ± 6.562 μmol/L vs. 124.75 ± 11.857 μmol/L) were similar. No ureteric stricture or graft loss was noted at 1-year follow-up. Recipient complications included lymphocoele (n = 2), haematoma (n = 3 with 2 requiring exploration), sepsis (n = 1), renal artery stenosis (n = 2 with 1 stented), repeated anastomosis (n = 1), and incisional hernia (n = 1). No differences were noted between the two groups.ConclusionOur results showed that overall donor morbidity rate was low, as reflected by the short hospital stay. Also, the overall parameters of the recipients were good. In particular, no ureteric stricture was noted, and graft survival was 100% at 1 year. The outcomes of the reconstructed group, despite the technical challenge, were similar to those of the single-vessel group

CUCHILD: A Large-Scale Cantonese Corpus of Child Speech for Phonology and Articulation Assessment

This paper describes the design and development of CUCHILD, a large-scale Cantonese corpus of child speech. The corpus contains spoken words collected from 1,986 child speakers aged from 3 to 6 years old. The speech materials include 130 words of 1 to 4 syllables in length. The speakers cover both typically developing (TD) children and children with speech disorder. The intended use of the corpus is to support scientific and clinical research, as well as technology development related to child speech assessment. The design of the corpus, including selection of words, participants recruitment, data acquisition process, and data pre-processing are described in detail. The results of acoustical analysis are presented to illustrate the properties of child speech. Potential applications of the corpus in automatic speech recognition, phonological error detection and speaker diarization are also discussed.Comment: Accepted to INTERSPEECH 2020, Shanghai, Chin

Economic evaluation of the introduction of the Prostate Health Index as a rule-out test to avoid unnecessary biopsies in men with prostate specific antigen levels of 4-10 in Hong Kong

A recent study showed that the Prostate Health Index may avoid unnecessary biopsies in men with prostate specific antigen 4-10ng/ml and normal digital rectal examination in the diagnosis of prostate cancer in Hong Kong. This study aimed to conduct an economic evaluation of the impact of adopting this commercially-available test in the Hong Kong public health service to determine whether further research is justified. A cost-consequence analysis was undertaken comparing the current diagnostic pathway with a proposed diagnostic pathway using the Prostate Health Index. Data for the model was taken from a prospective cohort study recruited at a single-institution and micro-costing studies. Using a cut off PHI score of 35 to avoid biopsy would cost HK$3,000 and save HK$7,988 per patient in biopsy costs and HK$511 from a reduction in biopsy-related adverse events. The net cost impact of the change was estimated to be HK$5,500 under base case assumptions. At the base case sensitivity and specificity for all grades of cancer (61.3% and 77.5% respectively) all grade cancer could be missed in 4.22% of the population and high grade cancer in 0.53%. The introduction of the prostate health index into the diagnostic pathway for prostate cancer in Hong Kong has the potential to reduce biopsies, biopsy costs and biopsy-related adverse events. Policy makers should consider the clinical and economic impact of this proposal

Long-term prognostic impact of cardiovascular comorbidities in patients with prostate cancer receiving androgen deprivation therapy: A population-based competing risk analysis.

Our study investigated how adverse cardiovascular outcomes are impacted by cardiovascular comorbidities in patients with prostate cancer treated by androgen deprivation therapy (ADT). Using prospective, population-based data, all Hong Kong patients with prostate cancer who received ADT during 1 January 1993 to 3 March 2021 were identified and followed up for the endpoint of cardiovascular hospitalization/mortality until 31 September 2021, whichever earlier. Multivariable competing risk regression was used to compare the endpoint's cumulative incidence between different combinations of major cardiovascular comorbidities (heart failure [HF], myocardial infarction [MI], stroke and/or arrhythmia), with noncardiovascular death as competing event. Altogether, 13 537 patients were included (median age 75.9 [interquartile range 70.0-81.5] years old; median follow-up 3.3 [1.5-6.7] years). Compared to those with none of prior HF/MI/stroke/arrhythmia, the incidence of the endpoint was not different in those with only stroke (subhazard ratio [SHR] 1.06 [95% confidence interval (CI): 0.92-1.23], P = .391), but was higher in those with only HF (SHR 1.67 [1.37-2.02], P < .001), arrhythmia (SHR 1.63 [1.35-1.98], P < .001) or MI (SHR 1.43 [1.14-1.79], P = .002). Those with ≥2 of HF/MI/stroke/arrhythmia had the highest incidence of the endpoint (SHR 1.94 [1.62-2.33], P < .001), among whom different major cardiovascular comorbidities had similar prognostic impacts, with the number of comorbidities present being significantly prognostic instead. In conclusion, in patients with prostate cancer receiving ADT, the sole presence of HF, MI or arrhythmia, but not stroke, may be associated with elevated cardiovascular risks. In those with ≥2 of HF/MI/stroke/arrhythmia, the number of major cardiovascular comorbidities may be prognostically more important than the type of comorbidities. [Abstract copyright: © 2023 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.

Synergistic Cytotoxic Effects of Ganoderma lucidum

Bacillus Calmette-Guérin (BCG) is conventionally used as an adjuvant immunotherapy to reduce the recurrence of bladder cancer. To address the issues of efficacy and safety, an ethanol extract of Ganoderma lucidum (GLe) was evaluated for its interaction with BCG. In a model of premalignant human uroepithelial cells (HUC-PC), GLe exerted immediate cytotoxic effects while BCG showed a delayed response, given that both were immunological active in inducing the secretion of interleukin (IL)-6, IL-8, and monocyte chemotactic protein-1 (MCP-1). Synergistic cytotoxic effects were observed when cells were either coincubated with both drugs or firstly preincubated with GLe. Synergism between GLe and BCG was demonstrated to achieve a complete cytostasis in 24 hours, and such effects were progressed in the subsequent 5 days. However, the pretreatment of GLe resulted in suppression of IL-6, IL-8, and MCP-1 secretions without affecting the cytotoxicity. Given that numerous proinflammatory cytokines are associated with the high side effects toll of BCG, results herein suggested the potential implications of GL to supplement the BCG immunotherapy in bladder cancer, for better efficacy and reducing side effects