Randallskovbjerg9151

SAIDs) were the most popular first-line management option (52.7%). Corticosteroids were the most frequently employed second-line option (37.8%). Referral to an in vitro fertilization (IVF) center (9.5%) and repeat surgery (2.7%) were also options pursued by survey respondents. Most providers repeated the SA every 8-12 weeks (41.2%) while following sub-par SA parameters. Conclusions VE is a technically demanding procedure that requires both microsurgical expertise and appropriate post-operative care. Our analysis demonstrates that a higher VR operative volume is associated with a higher rate of conversion to VE. This indicates either more experienced surgeons are more likely to perform a VE when indicated or more experience surgeons are getting referred and/or performing more complex VRs. 2019 Translational Andrology and Urology. All rights reserved.Background The influence of a previous transurethral resection of the prostate (TURP) on the outcomes of radical prostatectomy (RP) is still controversial. Therefore, we performed a meta-analysis to evaluate the perioperative, functional and oncological outcomes of RP with or without a previous TURP. Methods We conducted a computerized literature search of PubMed, Embase, and the Cochrane Library and included 15 retrospective studies evaluating RPs with or without a previous TURP in this meta-analysis. Results Fifteen studies, including 6,840 cases, were analyzed. RP after a previous TURP were related to smaller prostate volumes (WMD -6.93 cm3; 95% CI, -10.89 to -2.97; P less then 0.001), lower preoperative prostate-specific antigen (PSA) levels (WMD -1.51; 95% CI, -2.49 to -0.53; P=0.002), longer operative times (WMD 13.22 min; 95% CI, 4.55 to 21.89 min; P=0.003), more blood loss (WMD 55.38 mL; 95% CI, 12.35 to 98.41 mL; P=0.01), higher overall complication rates (OR =1.98; 95% CI, 1.27 to 3.08; P=0.002), longer hospital stays (WMD 1.16 days; 95% CI, 0.65 to 1.67; P less then 0.001), longer duration of catheter (WMD 0.60 days; 95% CI, 0.56 to 0.64; P less then 0.001), higher positive surgical margin rates (OR =1.30; 95% CI, 1.09 to 1.55; P=0.004), lower complete continence rates at 3 months (OR =0.67; 95% CI, 0.56 to 0.81; P less then 0.001), 6 months (OR =0.52; 95% CI, 0.31 to 0.88; P=0.01), 12 months (OR =0.59; 95% CI, 0.46 to 0.74; P less then 0.001), and lower potency rates at 12 months (OR =0.62; 95% CI, 0.51 to 0.77; P less then 0.001). Subgroup analysis indicated that open RP after previous TURP could achieve better outcomes. Conclusions RP after a previous TURP leads to worse perioperative, oncological, and functional outcomes. For these patients an open procedure is recommended. Due to the low number of studies and known biases, further large-scale studies are needed to support this result. 2019 Translational Andrology and Urology. All rights reserved.Background The deleterious effects of chronic ischemia on bladder function have been extensively studied; however, evaluation and characterization of the effects of acute ischemia and hypoxia are lacking. The present study examined pig and human detrusor smooth muscle (DSM) strips, in combination with an isolated perfused working pig bladder model to evaluate the relationship between transient ischemia and bladder function. Methods Organ bath and myographic studies were performed using pig and human DSM strips exposed to starvation/hypoxia conditions. Analogous conditions were then recreated in the ex vivo bladder preparation. Filled bladders were then treated with intravascular carbachol to induce contraction and subsequent void. An intravesical transducer continuously monitored changes in bladder pressure, while a tissue pO2 monitor analyzed changes in oxygenation. Results After 120 min in starved/hypoxic conditions, both pig and human DSM strips demonstrated significantly increased resting tone, with a greater than two-fold increase in force over control. This was effectively blocked with atropine. DSM strips also demonstrated significantly weaker contractions; however, contractile force was nearly recovered following 15-min exposure to replete/oxygenated buffer. In the ex vivo bladder preparation, filling under ischemic conditions yielded a 225% increase in end-fill vesical pressures (Pves) compared to controls. End-fill Pves returned to baseline with reperfusion during a subsequent filling cycle. Conclusions Transient ischemia/hypoxia leads to an acute increase in tone in both DSM strips and ex vivo pig bladder. Remarkably, the effect is reversible with re-perfusion and may be blocked with anticholinergics, suggesting a relationship between acute ischemia and increased local acetylcholine release. 2019 Translational Andrology and Urology. All rights reserved.Background This study was aimed to compare the sensitivity of transrectal ultrasound (TRUS) guided systematic biopsy (TRUS-SB), superb microvascular imaging guided targeted biopsy (SMI-TB), and elastography ultrasound guided targeted biopsy (EU-TB) in detecting prostate cancer (PCa). Methods One hundred and eighty-four patients with suspicious PCa were randomly divided into two groups, SMI-TB group (n=92) and EU-TB group (n=92). All the patients received a 2-core SMI-TB or a 2-core EU-TB before receiving a 12-core TRU-SB depending on the group. Suzetrigine in vivo The 2-core SMI-TB was conducted at the most increased vascularity areas rated by a radiologist on a semi-quantitative criterion. The 2-core EU-TB was performed at the dark blue areas that identified as suspicious areas. The PCa detection rate was compared among TRUS-SB, SMI-TB, and EU-TB in the total population and in two groups. Results PCa was detected in 65 out of 184 patients. The SMI-TB group patients received 1,272 cores in total with a positive rate of 23.81% (40/168) for SMI-TB cores and 4.17% (46/1,104) for TRUS-SB cores. The EU-TB group patients received a total of 1,262 cores with a positive rate of 31.01% (49/158) for EU-TB cores and 5.34% (59/1,104) for TRUS-SB cores. Targeted cores (27.30%, 89/326) achieved significantly higher sensitivity in PCa detection than systematic cores (4.76%, 105/2,208) (SMI-TB vs. TRUS-SB OR 7.188, P less then 0.001; EU-TB vs. TRUS-SB OR 7.962, P less then 0.001). Conclusions Superb microvascular imaging and elastography ultrasound guided targeted biopsy may result in higher prostate cancer detection rate as adjunct to gray-scale ultrasound guided systematic biopsy. However, targeted biopsy alone is not sufficient to detect PCa, compared with systematic biopsy. 2019 Translational Andrology and Urology. All rights reserved.