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1.
Urolithiasis ; 52(1): 92, 2024 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-38884642

RESUMO

The purpose of this review is to analyze the trend in optical features and flexibility changes of flexible ureteroscopes over the past decades, and determine the correlation of individual parameters with release period as well as with dimensional parameters. Flexible ureteroscopes mentioned in the literature or those commercially available were searched. To minimize the search bias, the instruments were grouped by release date time-periods of < 2000 year, 2000-2009, 2010-2019, and 2020 onwards. The final review included only those instrument models for which data on minimum and maximum depth of field, field of view, direction of view, and deflection degree had been determined. The correlation among features investigated as well as with release period was also determined. 61 models of flexible ureteroscopes (27 fibreoptic and 34 digital scopes) were included. Among the different features investigated among fiberoptic endoscopes, minimum depth of field positively and negatively correlated with channel size and field of view, respectively, whereas maximum depth of view and field of view positively correlated with overall shaft and deflection degree, respectively. Up and down deflection strongly correlated with each other and both were negatively proportional to the distal tip size. For the digital endoscopes, minimum depth of field negatively and positively correlated with distal tip size and working length, respectively. Maximum depth of field positively correlated with field of view, whereas the latter was negatively proportional to the overall shaft. As for the fiberoptic counterparts, up and down deflection strongly correlated with each other. Field of view, up and down deflection of fiberoptic flexible ureteroscopes, were significantly increased among fiberoptic and digital endoscopes over decades. As flexible ureteroscopy technology has evolved, there has been a trend towards increasing field of view with up and down deflection. Given the importance of scope ergonomics, one aspect of this popularity is the improvement of optical characteristics and deflection degree, which significantly correlates with the release period.


Assuntos
Desenho de Equipamento , Ureteroscópios , Humanos , Tecnologia de Fibra Óptica , Rim/diagnóstico por imagem , Rim/cirurgia , Ureteroscopia/instrumentação , Ureteroscopia/tendências
2.
Cancers (Basel) ; 16(10)2024 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-38791888

RESUMO

BACKGROUND: The aim was to analyze the current state of deep learning (DL)-based prostate cancer (PCa) diagnosis with a focus on magnetic resonance (MR) prostate reconstruction; PCa detection/stratification/reconstruction; positron emission tomography/computed tomography (PET/CT); androgen deprivation therapy (ADT); prostate biopsy; associated challenges and their clinical implications. METHODS: A search of the PubMed database was conducted based on the inclusion and exclusion criteria for the use of DL methods within the abovementioned areas. RESULTS: A total of 784 articles were found, of which, 64 were included. Reconstruction of the prostate, the detection and stratification of prostate cancer, the reconstruction of prostate cancer, and diagnosis on PET/CT, ADT, and biopsy were analyzed in 21, 22, 6, 7, 2, and 6 studies, respectively. Among studies describing DL use for MR-based purposes, datasets with magnetic field power of 3 T, 1.5 T, and 3/1.5 T were used in 18/19/5, 0/1/0, and 3/2/1 studies, respectively, of 6/7 studies analyzing DL for PET/CT diagnosis which used data from a single institution. Among the radiotracers, [68Ga]Ga-PSMA-11, [18F]DCFPyl, and [18F]PSMA-1007 were used in 5, 1, and 1 study, respectively. Only two studies that analyzed DL in the context of DT met the inclusion criteria. Both were performed with a single-institution dataset with only manual labeling of training data. Three studies, each analyzing DL for prostate biopsy, were performed with single- and multi-institutional datasets. TeUS, TRUS, and MRI were used as input modalities in two, three, and one study, respectively. CONCLUSION: DL models in prostate cancer diagnosis show promise but are not yet ready for clinical use due to variability in methods, labels, and evaluation criteria. Conducting additional research while acknowledging all the limitations outlined is crucial for reinforcing the utility and effectiveness of DL-based models in clinical settings.

3.
Heliyon ; 10(9): e30531, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38726123

RESUMO

The potentials of mesoporous TiO2-ZnO (3TiZn) were explored on photocatalytic degradation of doxycycline (DOX) antibiotic, likewise the influence of adsorption on the photocatalytic process. The 3TiZn was characterized for physical and chemical properties. Stability, reusability, kinetic and the ability of 3TiZn to degrade high concentration of pollutant under different operating conditions were investigated. Photocatalytic degradation of DOX was conducted at varied operating conditions, and the best was obtained at 1 g/L catalyst dosage, solution inherent pH (4.4) and 50 ppm of DOX. Complete degradation of 50 ppm and 100 ppm of DOX were attained within 30 and 100 min of the reaction time, respectively. The stability and reusability study of the photocatalyst proved that at the tenth (10th) cycle, the 3TiZn is as effective in the degradation of DOX as in the first cycle. This may be attributed to the fusion of the mixed oxides during calcination. The 3TiZn is mesoporous with a pore diameter of 17 nm, and this boosts it potential to degrade high concentration of DOX. It was observed that the adsorption capacity of 3TiZn enhance the photocatalytic process. It can be emphasized that 3TiZn portrayed a remarkable catalyst stability and good potentials for industrial application.

4.
World J Urol ; 42(1): 240, 2024 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-38630158

RESUMO

PURPOSE: To evaluate the impact of ureteroscope position within renal cavities as well as different locations of the tip of the ureteral access sheath (UAS) on fluid dynamics during retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS: A prospective observational clinical study was performed. Measurements with a flexible ureteroscope placed in the upper, middle and lower calyces were obtained with the tip of the UAS placed either 2 cm below the pyelo-ureteric junction (PUJ), or at the level of the iliac crest. RESULTS: 74 patients were included. The outflow rates from the middle and upper calyxes were statistically significantly higher compared to the lower calyx, both with the UAS close to the pyelo-ureteric junction and at the iliac crest. When the UAS was withdrawn and positioned at the level of the iliac crest, a significant decrease in outflow rates from the upper (40.1 ± 4.3 ml/min vs 35.8 ± 4.1 ml/min) and middle calyces (40.6 ± 4.0 ml/min vs 36.8 ± 4.6 ml/min) and an increase in the outflow from the lower calyx (28.5 ± 3.3 ml/min vs 33.7 ± 5.7 ml/min) were noted. CONCLUSIONS: Our study showed that higher fluid outflow rates are observed from upper and middle calyces compared to lower calyx. This was true when the UAS was positioned 2 cm below the PUJ and at the iliac crest. Significant worsening of fluid dynamics from upper and middle calyces was observed when the UAS was placed distally at the level of the iliac crest. While the difference was statistically significant, the absolute change was not significant. In contrast, for lower calyces, a statistically significant improvement was documented.


Assuntos
Ureter , Ureteroscópios , Humanos , Hidrodinâmica , Rim , Endoscopia , Ureter/cirurgia
5.
J Endourol ; 38(6): 536-544, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38545755

RESUMO

Introduction and Objective: Renal transplantation is the treatment for end-stage renal disease that offers better quality of life and survival. Among the possible complications that might affect allografts, urolithiasis might have severe consequences, causing acute kidney injury (AKI) or septic events in immunocompromised patients. Allograft stones might be treated with percutaneous nephrolithotomy (PCNL). The aim of this Cochrane style review was to assess the safety and efficacy of PCNL in patients with renal transplant. Methods: A comprehensive search in the literature was performed including articles between July 1982 and June 2023, with only English original articles selected for this review. Results: The final review encompassed nine articles (108 patients). The mean age was 46.4 ± 8.7 years, with a male:female ratio of 54:44. The average time from transplantation to urolithiasis onset was 47.54 ± 23.9 months. Predominant symptoms upon presentation were AKI (32.3%), followed by urinary tract infection and fever (24.2%), and oliguria (12.9%). The mean stone size was 20.1 ± 7.3 mm, with stones located in the calices or pelvis (41%), ureteropelvic junction (23.1%), or proximal ureter (28.2%). PCNL (22F-30F) was more frequently performed than mini-PCNLs (16F-20F) (52.4% vs 47.6%). Puncture was guided by ultrasound (42.9%), fluoroscopy (14.3%), or both (42.9%). The stone-free rate (SFR) and complication rates were 92.95% (range: 77%-100%) and 5.5%, respectively, with only one major complication reported. Postoperatively, a ureteral stent and nephrostomy were commonly placed in 47%, with four patients needing a second look PCNL. During an average follow-up of 32.5 months, the recurrence rate was 3.7% (4/108), and the mean creatinine level was 1.37 ± 0.28 mg/dL. Conclusions: PCNL remains a safe and effective option in de novo allograft urolithiasis, allowing to treat large stones in one-step surgery. A good SFR is achieved with a low risk of minor complications. These patients should be treated in an endourology center in conjunction with the renal or transplant team.


Assuntos
Transplante de Rim , Nefrolitotomia Percutânea , Urolitíase , Humanos , Transplante de Rim/efeitos adversos , Nefrolitotomia Percutânea/métodos , Nefrolitotomia Percutânea/efeitos adversos , Urolitíase/cirurgia , Urolitíase/etiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Masculino , Pessoa de Meia-Idade , Feminino
6.
BJUI Compass ; 5(1): 70-75, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38179023

RESUMO

Objectives: The objective of this study was to evaluate adverse events and device events related to accessories used during ureteroscopy (URS). Materials and methods: Analysis was performed of the records available in the Manufacturer and User Facility Device Experience database in the United States. Information was collected on characteristics of problem, timing, manufacturer verdict, successful completion of planned surgery, prolonged anaesthesia and injury to patient or staff. Results: Five-hundred seventy-one events related to URS accessories were recorded. These were associated with the following devices: baskets (n = 347), access sheath (n = 86), guidewires (n = 78), balloon dilators (n = 27), ARDs (n = 17) and ureteral catheters (n = 16). Of the events, 12.7% resulted in patient injuries. Forty-eight per cent of the events resulted in prolonged anaesthesia, but the planned surgery was successfully completed in 78.4% of all cases. Collectively, the manufacturers accepted responsibility due to actual device failure in only 0.5% of cases. Common problems for baskets were failure to deploy (39.5%) and complete detachment of basket head (34.6%) and partial breakage of the basket head (12.4%). Of the basket group, 4.3% required open or percutaneous surgery to remove stuck basket. Full break of the body of the access sheath occurred in 41.9% and complete ureteral avulsion in 3.5%. For balloon dilators, there was a burst in 37% of cases. Broken guidewires were associated with 11.5% requiring repeat intervention for retrieval and 6.4% required JJ stent due to perforation to the collecting system. No injuries to operating staff were recorded with accessory usage. Conclusion: Accessories used during URS are fragile. Potential for serious injury does exist as a direct result of their use. Surgeons should familiarise themselves with these events and how they can be prevented.

7.
Curr Urol Rep ; 25(1): 9-18, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37723300

RESUMO

PURPOSE OF REVIEW: Artificial intelligence (AI) chatbots have emerged as a potential tool to transform urology by improving patient care and physician efficiency. With an emphasis on their potential advantages and drawbacks, this literature review offers a thorough assessment of the state of AI-driven chatbots in urology today. RECENT FINDINGS: The capacity of AI-driven chatbots in urology to give patients individualized and timely medical advice is one of its key advantages. Chatbots can help patients prioritize their symptoms and give advice on the best course of treatment. By automating administrative duties and offering clinical decision support, chatbots can also help healthcare providers. Before chatbots are widely used in urology, there are a few issues that need to be resolved. The precision of chatbot diagnoses and recommendations might be impacted by technical constraints like system errors and flaws. Additionally, issues regarding the security and privacy of patient data must be resolved, and chatbots must adhere to all applicable laws. Important issues that must be addressed include accuracy and dependability because any mistakes or inaccuracies could seriously harm patients. The final obstacle is resistance from patients and healthcare professionals who are hesitant to use new technology or who value in-person encounters. AI-driven chatbots have the potential to significantly improve urology care and efficiency. However, it is essential to thoroughly test and ensure the accuracy of chatbots, address privacy and security concerns, and design user-friendly chatbots that can integrate into existing workflows. By exploring various scenarios and examining the current literature, this review provides an analysis of the prospects and limitations of implementing chatbots in urology.


Assuntos
Médicos , Urologia , Humanos , Inteligência Artificial , Assistência ao Paciente
8.
Curr Opin Urol ; 34(2): 116-127, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38038411

RESUMO

PURPOSE OF REVIEW: There are enough publications on the use of telemedicine, wearable devices, and mobile applications in urology; however, their collective impact on urological care has not been adequately studied. This review seeks to address this deficiency by providing a descriptive analysis of the recent use of telemedicine, wearable technology, and mobile applications in urology as well as elucidating their associated challenges. RECENT FINDINGS: There are studies that were dedicated to the use of telemedicine, wearables, and mobile apps in urology according to inclusion criteria, respectively. They were successfully implemented in different urological subfields, such as urogynecology, endourology, pediatric urology, and uro-oncology, and led to time safety, remote monitoring, and better patient awareness. However, several concerns also exist, such as issues with data safety, measurement deviations, technical limitations, and lack ofquality. SUMMARY: Telemedicine, wearables, and mobile apps have already shown their potential in urological practice. However, further studies are needed to expand both our understanding of their current state and their potential for further development and clinical use.


Assuntos
Aplicativos Móveis , Telemedicina , Urologia , Dispositivos Eletrônicos Vestíveis , Criança , Humanos , Saúde Digital
9.
Curr Urol Rep ; 25(1): 37-47, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38112900

RESUMO

PURPOSE OF REVIEW: Artificial intelligence (AI) can significantly improve physicians' workflow when examining patients with UTI. However, most contemporary reviews are focused on examining the usage of AI with a restricted quantity of data, analyzing only a subset of AI algorithms, or performing narrative work without analyzing all dedicated studies. Given the preceding, the goal of this work was to conduct a mini-review to determine the current state of AI-based systems as a support in UTI diagnosis. RECENT FINDINGS: There are sufficient publications to comprehend the potential applications of artificial intelligence in the diagnosis of UTIs. Existing research in this field, in general, publishes performance metrics that are exemplary. However, upon closer inspection, many of the available publications are burdened with flaws associated with the improper use of artificial intelligence, such as the use of a small number of samples, their lack of heterogeneity, and the absence of external validation. AI-based models cannot be classified as full-fledged physician assistants in diagnosing UTIs due to the fact that these limitations and flaws represent only a portion of all potential obstacles. Instead, such studies should be evaluated as exploratory, with a focus on the importance of future work that complies with all rules governing the use of AI. AI algorithms have demonstrated their potential for UTI diagnosis. However, further studies utilizing large, heterogeneous, prospectively collected datasets, as well as external validations, are required to define the actual clinical workflow value of artificial intelligence.


Assuntos
Médicos , Infecções Urinárias , Humanos , Inteligência Artificial , Algoritmos , Infecções Urinárias/diagnóstico , Benchmarking
10.
Urolithiasis ; 52(1): 16, 2023 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-38117336

RESUMO

The purpose of this review is to analyze the trend in miniaturization of flexible ureteroscopes over the past decades, identify the advantages and disadvantages, and determine the correlation of individual parameters with release period. Flexible ureteroscopes mentioned in the literature or those commercially available were searched. To minimize the search bias, the instruments were grouped by release date time periods of < 2000 year, 2000-2009, 2010-2019, and 2020 onwards. The final review included only those instrument models for which data on tip size, overall shaft, working length and channel size had been determined. The correlation among features investigated as well as with release period was also determined. 59 models of flexible ureteroscopes (26 fiber optic and 33 digital scopes) were included. Among the different features investigated among fiber optic endoscopes, only the sizes of the distal tip and overall shaft positively correlated with each other. In contrast to their fiber optic counterparts, a strong positive correlation was observed between tip and channel sizes, whereas negative correlation was found between channel size and overall shaft size and working length of digital scopes. Only distal tip of fiber optic flexible ureteroscopes and overall shaft of digital endoscopes were significantly reduced over their evolution. With the development of technology, there has been an improvement of flexible ureteroscopes and one of the indicators of this trend is a decrease in their size. With a definite trend towards miniaturization over the past decades, a significant correlation was observed in tip size and overall shaft for fiber optic and digital endoscopes, respectively.


Assuntos
Miniaturização , Ureteroscópios
11.
J Clin Med ; 12(17)2023 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-37685776

RESUMO

Flexible ureteroscopy (fURS) with laser lithotripsy is currently the gold standard surgical treatment for ureteral and kidney stones with a maximum diameter of 2 cm [...].

12.
J Endourol ; 37(11): 1191-1199, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37725588

RESUMO

Objectives: To explore beliefs and practice patterns of urologists regarding intrarenal pressure (IRP) during ureteroscopy (URS). Methods: A customized questionnaire was designed in a 4-step iterative process incorporating a systematic review of the literature and critical analysis of topics/questions by six endourologists. The 19-item questionnaire interrogated perceptions, practice patterns, and key areas of uncertainty regarding ureteroscopic IRP, and was disseminated via urologic societies, networks, and social media to the international urologic community. Consultants/attendings and trainees currently practicing urology were eligible to respond. Quantitative responses were compiled and analyzed using descriptive statistics and chi-square test, with subgroup analysis by procedure volume. Results: Responses were received from 522 urologists, practicing in six continents. The individual question response rate was >97%. Most (83.9%, 437/515) respondents were practicing at a consultant/attending level. An endourology fellowship incorporating stone management had been completed by 59.2% (307/519). The vast majority of respondents (85.4%, 446/520) scored the perceived clinical significance of IRP during URS ≥7/10 on a Likert scale. Concern was uniformly reported, with no difference between respondents with and without a high annual case volume (p = 0.16). Potential adverse outcomes respondents associated with elevated ureteroscopic IRP were urosepsis (96.2%, 501/520), collecting system rupture (80.8%, 421/520), postoperative pain (67%, 349/520), bleeding (63.72%, 332/520), and long-term renal damage (26.1%, 136/520). Almost all participants (96.2%, 501/520) used measures aiming to reduce IRP during URS. Regarding the perceived maximum acceptable threshold for mean IRP during URS, 30 mm Hg (40 cm H2O) was most frequently selected [23.2% (119/463)], with most participants (78.2%, 341/463) choosing a value ≤40 mm Hg. Conclusions: This is the first large-scale analysis of urologists' perceptions of ureteroscopic IRP. It identifies high levels of concern among the global urologic community, with almost unanimous agreement that elevated IRP is associated with adverse clinical outcomes. Equipoise remains regarding appropriate IRP limits intraoperatively and the most appropriate technical strategies to ensure adherence to these.


Assuntos
Ureteroscopia , Urologia , Humanos , Ureteroscopia/métodos , Estudos Transversais , Urologistas , Rim
13.
Front Surg ; 10: 1257191, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37744723

RESUMO

Purpose of review: ChatGPT has emerged as a potential tool for facilitating doctors' workflows. However, when it comes to applying these findings within a urological context, there have not been many studies. Thus, our objective was rooted in analyzing the pros and cons of ChatGPT use and how it can be exploited and used by urologists. Recent findings: ChatGPT can facilitate clinical documentation and note-taking, patient communication and support, medical education, and research. In urology, it was proven that ChatGPT has the potential as a virtual healthcare aide for benign prostatic hyperplasia, an educational and prevention tool on prostate cancer, educational support for urological residents, and as an assistant in writing urological papers and academic work. However, several concerns about its exploitation are presented, such as lack of web crawling, risk of accidental plagiarism, and concerns about patients-data privacy. Summary: The existing limitations mediate the need for further improvement of ChatGPT, such as ensuring the privacy of patient data and expanding the learning dataset to include medical databases, and developing guidance on its appropriate use. Urologists can also help by conducting studies to determine the effectiveness of ChatGPT in urology in clinical scenarios and nosologies other than those previously listed.

14.
Indian J Urol ; 39(3): 195-201, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37575157

RESUMO

Introduction: Oligometastatic prostate cancer (OMPC) has gained profound interest lately due to its different tumor biology and our ability to use multimodality therapy for cure or prolonged survival. Selecting the appropriate patient for treatment has become the aim of treating urologists, medical oncologists, and radiation oncologists. Through this review, we try to highlight the management of OMPC in light of recent literature. Methods: Literature search was performed on Pubmed, Scopus and Embase using keywords "Oligometastatic", " Prostate Cancer" using operators such as "And" & "Or". Relevant articles were screened and all the latest articles on this emerging entity were included in this review. Results: All trials relevant to oligometastatic prostate cancer defining the role of surgery, radiotherapy and systemic therapy were included and appropriate inferences were drawn. Relevant studies were compiled in tabular form for this article. Conclusion: The current standard of care of management for OMPC remains systemic therapy on the lines of hormone-sensitive metastatic prostate cancer. The evolving role of surgery, and radiotherapy along with systemic therapy is highlighted in this article.

15.
Int J Biol Macromol ; 242(Pt 2): 124786, 2023 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-37169046

RESUMO

Chitosan/bentonite beads (CsB) composites were prepared from chitosan (Cs) and bentonite (B) and cross-linked with epichlorohydrin for removal of reactive orange 16 (RO16) and methylene blue (MB). The adsorption results have shown that the (Cs20B80), 20 % wt of (Cs) and 80 % (B), was selected as the best adsorbent for (MB) and (RO16) dyes. SEM, EDX, FTIR, BET, and pHpzc were implemented to investigate the features of Cs, B, and Cs20B80 samples. The influence of contact time (0-72 h), initial RO16 concentration (15-300 mg/L), temperature (30, 40, and 50 °C), the quantity of adsorbent (1-4 g/L), ion strength (0.1-1 M), and solution pH (3-10) on RO16 adsorption onto Cs20B80 were explored. The pseudo-second-order and the Langmuir models fit adequately the adsorption kinetic results and the isotherms ones respectively. Also, the maximal monolayer capacities calculated using the non-linear form of the Langmuir isotherm are 55.27, 55.29, and 70.80 mg/g, at 30, 40 and 50 °C. Based to the statistical physics model, the RO16 could be retained on the surface of Cs20B80 through a non-parallel orientation. The RO16 adsorption process is endothermic and natural, as demonstrated by thermodynamic studies. After three regeneration cycles, the Cs20B80 composite has shown an adsorption capacity of around 20 % compared to the initial one. The adsorption energy of RO16 onto Cs, B, and Cs20B80 examined using the Monte Carlo simulation method (MC) ranged from -164.8 to -303.7 (kcal/mol), showing the potential of the three adsorbants for RO16 dye. Also, the process of adsorption of RO16 dye on the surface of Cs20B80 composite indicates several kinds of physical interactions, involving electrostatic interaction, hydrogen bonding, and π-π interactions, this finding was proved theoretically via molecular dynamic simulations.


Assuntos
Quitosana , Poluentes Químicos da Água , Quitosana/química , Corantes/química , Bentonita/química , Epicloroidrina/química , Simulação de Dinâmica Molecular , Cinética , Termodinâmica , Adsorção , Concentração de Íons de Hidrogênio , Poluentes Químicos da Água/química
16.
Curr Urol Rep ; 24(8): 355-363, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37079196

RESUMO

PURPOSE OF REVIEW: The prevalence of uric acid (UA) urolithiasis contributes significantly to global disease burden, due to high rates of recurrence and diagnostic challenges. Dissolution therapy plays a valuable role in the conservative management of UA calculi, reducing the requirement for surgical intervention. This review summarises the existing evidence for the efficacy of medical dissolution of uric acid urolithiasis. RECENT FINDINGS: A systematic search was conducted of worldwide literature according to PRISMA methodology and Cochrane standards for systematic review. Studies were included if they reported outcome data for the administration of medical therapy for the dissolution of UA calculi. A total of 1075 patients were included in the systematic review. Complete or partial dissolution of UA calculi was observed in 80.5% of patients (865/1075 patients), with 61.7% (647/1048 patients) achieving complete dissolution and 19.8% (207/1048 patients) achieving partial dissolution. A discontinuation rate of 10.2% (110/1075 patients) was noted, and 15.7% (169/1075 patients) required surgical intervention. Dissolution therapy is a safe and effective method of conservatively managing uric acid stones in the short term. Despite the significant disease burden of UA calculi, current guidelines are limited by deficiencies in the existing body of research. Further research should be undertaken to develop evidence-based clinical guidelines for diagnosis, treatment, and prevention of UA urolithiasis.


Assuntos
Cálculos Renais , Nefrolitíase , Cálculos Urinários , Humanos , Ácido Úrico/uso terapêutico , Solubilidade , Cálculos Urinários/terapia , Tratamento Conservador , Cálculos Renais/terapia
17.
Curr Opin Urol ; 33(2): 90-94, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36622261

RESUMO

PURPOSE OF REVIEW: With advancements in surgical technology along with procedural techniques, this article throws light on the latest developments and applications of artificial intelligence (AI), extended reality, 3D (three-dimensional) printing and robotics in percutaneous nephrolithotomy (PCNL). RECENT FINDINGS: This review highlights the applications of AI in PCNL over the past 2 years. Mostly studies have been reported on development of machine learning (ML) based predicting models and identification of stone composition using deep learning convolutional neural network (DL-CNN). But owing to the complexity of the models and lack of generalizability, it is still not incorporated in the routine clinical practice. Extended reality based simulation and training models have enabled trainees to enhance their skills and shorten the learning curve. Similar advantages have been reported with the use of 3D printed models when used to train young and novice endourologists to improve their skills in percutaneous access (PCA). Applications of robotics in PCNL look promising but are still in nascent stages. SUMMARY: Future research on PCNL should focus more on generalizability and adaptability of technological advancements in terms of training and improvement of patient outcomes.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Urolitíase , Humanos , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Urologistas , Inteligência Artificial , Urolitíase/cirurgia , Impressão Tridimensional , Cálculos Renais/cirurgia
18.
J Clin Med ; 11(23)2022 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-36498594

RESUMO

BACKGROUND: Wearable device technology has recently been involved in the healthcare industry substantially. India is the world's third largest market for wearable devices and is projected to expand at a compound annual growth rate of ~26.33%. However, there is a paucity of literature analyzing the factors determining the acceptance of wearable healthcare device technology among low-middle-income countries. METHODS: This cross-sectional, web-based survey aims to analyze the perceptions affecting the adoption and usage of wearable devices among the Indian population aged 16 years and above. RESULTS: A total of 495 responses were obtained. In all, 50.3% were aged between 25-50 years and 51.3% belonged to the lower-income group. While 62.2% of the participants reported using wearable devices for managing their health, 29.3% were using them daily. technology and task fitness (TTF) showed a significant positive correlation with connectivity (r = 0.716), health care (r = 0.780), communication (r = 0.637), infotainment (r = 0.598), perceived usefulness (PU) (r = 0.792), and perceived ease of use (PEOU) (r = 0.800). Behavioral intention (BI) to use wearable devices positively correlated with PEOU (r = 0.644) and PU (r = 0.711). All factors affecting the use of wearable devices studied had higher mean scores among participants who were already using wearable devices. Male respondents had significantly higher mean scores for BI (p = 0.034) and PEOU (p = 0.009). Respondents older than 25 years of age had higher mean scores for BI (p = 0.027) and Infotainment (p = 0.032). CONCLUSIONS: This study found a significant correlation with the adoption and acceptance of wearable devices for healthcare management in the Indian context.

20.
Front Surg ; 9: 862348, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36061049

RESUMO

The management of nephrolithiasis has been complemented well by modern technological advancements like virtual reality, three-dimensional (3D) printing etc. In this review, we discuss the applications of 3D printing in treating stone disease using percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). PCNL surgeries, when preceded by a training phase using a 3D printed model, aid surgeons to choose the proper course of action, which results in better procedural outcomes. The 3D printed models have also been extensively used to train junior residents and novice surgeons to improve their proficiency in the procedure. Such novel measures include different approaches employed to 3D print a model, from 3D printing the entire pelvicalyceal system with the surrounding tissues to 3D printing simple surgical guides.

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