INTRODUCTIONThe surgical treatment of ureteral strictures in adults represents a challenging procedure for the variability of location, extension, and etiology of the disease. Open ureteral reimplantation (OUR) offered high success rates even when considering complex ureteral disease. The debate for defining the role of robotic in the treatment of adult ureteral disease is still ongoing. The aim of the current systematic review is to provide an updated analysis of the comparative outcomes of robot-assisted UR (RAUR) versus OUR based on the available literature.EVIDENCE ACQUISITIONAn independent systematic review of the literature was performed from 2010 to 2021. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations were followed to design search strategies, selection criteria, and evidence reports. The quality of the included studies was determined using the Newcastle-Ottawa scale for nonrandomized controlled trials. Pooled analysis of demographics and clinical characteristics, as well as surgical and postoperative outcomes, was performed.EVIDENCE SYNTHESISAfter an initial screening and full-text review, 5 studies published between 2002 and 2021 were identified and included in the analysis. All the studies were observational retrospective case-control studies. Among the 225 patients included in the pooled analysis, 94 (41.8%) and 131 (58.2%) were RAUR and OUR, respectively. There was no difference between groups in terms of baseline characteristics. No differences in surgical approach and operative time were reported among the groups. Estimated blood loss was lower for robotic approach (WMD: -121.71ml; p=0.0006). There were no significant differences between groups in overall (OR: 0.85; p=0.69) and major (OR:0.69; p=0.52) complication. RAUR group reported shorter length of stay (WMD: -2.39day; p<0.00001), catheter (WMD: -5.26day; p=0.004) and stent (WMD: -11.9day; p=0.001) time.CONCLUSIONSAvailable evidence shows that RAUR offers similar surgical outcomes if compared to OUR, and potential advantages in terms of lower blood loss, shorter hospital stay, catheter, and stent time. The adoption of one approach over the other is likely to be mainly dictated by the surgeon's preference and expertise.

우리나라 등록 장애인 수는 매년 증가하는 추세이지만 장애인에 대한 사회적 편견과 차별로 인하여 낮아진 장애인의 기본권을 보장하기 위한 지속적인 인식개선이 필요한 상황이다. 이에 본 연구는 ‘장애인’을 키워드로 민원 데이터를 분석해 장애인의 주된 불편사항을 파악하여 개선사항을 도출하고자 한다. 국민권익위원회 OPEN API에서 2018년 11월 1일부터 2021년 11월 1일까지의 ‘장애인’에 대한 민원을 수집하고 빅데이터 기반 텍스트 마이닝과 워드클라우드, 네트워크 그래프를 구현하여 핵심 민원을 파악하였다. 분석 결과, ‘점자 표기’와 보도와 차도의 경계면에 설치된 ‘연석의 높이’가 주된 불편사항으로 도출되었다. 도출된 불편사항을 해결하기 위하여 실내 편의시설과 의약품 등의 점자표기 의무화 및 전동킥보드 등 개인 모빌리티 기기 사용 증가로 인한 점자블록 훼손 방지, 시각장애인을 위한 보도 턱 개선 등이 필요할 것으로 사료된다. 또한 본 연구에서 파악된 장애인의 불편사항과 요구사항을 바탕으로 장애인의 삶의 질 향상에 긍정적인 정책이 제시될 수 있기를 기대한다.

뇌졸중 장애인을 대상으로 실시한 최근의 연구들을 살펴보면 신체의 기능회복 및 개선에 필요한 신체활동의 중요성이 강조되고 있다. 장애인의 운동 참여는 신체적, 사회적, 정신적 재활에 긍정적인 역할을 함에도 불구하고, 치료과정에서 반복적인 연습으로 힘들었던 경험들로 인해 필요악 정도의 가치로만 인식되고 있는 것이 현실이다. 이러한 측면에서 지루하게 느낄 수 있는 운동에 흥미요소를 더한 뉴스포츠 프로그램은 이를 해결할 좋은 대안이 될 수 있을 것으로 생각된다. 이에 본 연구는 뉴스포츠 프로그램을 개발하여 뇌졸중 장애인에게 적용했을 때 균형과 보행, 삶의 질, 우울증에 영향을 미치는지 알아보기 위한 목적으로 수행되었다. 본 연구에서는 재가 뇌졸중 장애인을 연구대상으로 하여, 뉴스포츠 훈련군(n=7)과 대조군(n=6)으로 나누어 실험을 진행하였다. 사전평가 후 8주간의 뉴스포츠 프로그램을 실시하고 사후평가를 하였으며, 그룹내, 그룹 간의 차이를 검증하고자 하였다. 뇌졸중 장애인의 삶의 질을 평가하기 위한 뇌졸중 영향 척도와 균형능력, 우울증 척도에서 뉴스포츠 프로그램 훈련군이 훈련 전에 비하여 유의하게 향상되었다. 또한 뉴스포츠 프로그램군에 참여한 대상자에게 만족도 조사를 한 결과 전체적으로 만족한다는 응답과 훈련 종목의 난이도 및 재미 부분에서도 높은 점수가 나타났다. 본 연구를 통해 뇌졸중 장애인에게 새롭게 시도된 뉴스포츠 프로그램은 신체기능과 심리사회적 부분에서의 긍정적인 효과를 가져다주며, 추후 특화된 중재 프로그램을 개발하는데 긍정적인 영향을 미칠 것으로 기대한다.

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (MP59)1 Sep 2021MP59-08 ASSESSING PREDICTORS OF CHRONIC KIDNEY DISEASE PROGRESSION IN PATIENTS RECEIVING MINIMALLY-INVASIVE PARTIAL NEPHRECTOMY: RESULTS OF A MULTI-INSTITUTIONAL COLLABORATIVE SERIES Umberto Anceschi, Aldo Brassetti, Maria Consiglia Ferriero, Gabriele Tuderti, Rocco Simone Flammia, Andrea Minervini, Andrea Mari, Antonio Andrea Grosso, Marco Carini, Umberto Capitano, Alessandro Larcher, Francesco Montorsi, Riccardo Autorino, Alessandro Veccia, Cristian Fiori, Daniele Amparore, Franceso Porpiglia, Daniel Eun, Jennifer Lee, Ithaar Derweesh, Chandru Sundaram, James Steward, Michele Gallucci, and Giuseppe Simone Umberto AnceschiUmberto Anceschi More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Maria Consiglia FerrieroMaria Consiglia Ferriero More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Rocco Simone FlammiaRocco Simone Flammia More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Andrea MariAndrea Mari More articles by this author , Antonio Andrea GrossoAntonio Andrea Grosso More articles by this author , Marco CariniMarco Carini More articles by this author , Umberto CapitanoUmberto Capitano More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Alessandro VecciaAlessandro Veccia More articles by this author , Cristian FioriCristian Fiori More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Franceso PorpigliaFranceso Porpiglia More articles by this author , Daniel EunDaniel Eun More articles by this author , Jennifer LeeJennifer Lee More articles by this author , Ithaar DerweeshIthaar Derweesh More articles by this author , Chandru SundaramChandru Sundaram More articles by this author , James StewardJames Steward More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002094.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this multicentric study was to identify predictors of newly onset severe chronic kidney disease (sCKD) in patients who underwent minimally-invasive partial nephrectomy (MIPN) with imperative (I) or elective (E) indication. METHODS: We analyzed perioperative, oncologic and functional outcomes of 2218 patients who underwent MIPN between 2007 and 2020, 1812 with E and 406 with I indications, respectively on a multicentric dataset. Categorical and continuous variables were reported as IQRs or frequencies, and compared with χ2 – and Student t tests, respectively. Univariable and multivariable Cox regression analyses were performed to identify predictors of pCKD (stages ≥3b) in both groups. For all statistical analyses, a two-sided p < 0.05 was considered significant. RESULTS: I-MIPN patients were older (p=0.001), with significantly lower baseline eGFR (p<0.001), higher ASA score, RENAL score, cT stage, CKD stages, lower preoperative hemoglobin levels and increased rate of major comorbidities (all p<0.05; Table 1). Warm ischemia time, positive surgical margins rate, length of hospital stay and trifecta were comparable between groups (each p>0.05), while I-MIPN patients had significantly higher pT stages, eGFR at discharge decrease and Clavien≥3 complication rates (each p<0.001; Tab.2). On multivariable Cox regression analysis, in the elective series, hypertension (HR 3.17; 95% CI 1.34-7.46; p=0.008), ASA score (HR 2.66; 95% CI 1.13-6.28; p=0.025) baseline eGFR (HR 0.93; 95% CI 0.90-0.96; p=0.001) and warm ischemia time (HR 1.06; 95% CI 1.02-1.10; p=0.003) were independent predictors of sCKD (Table 4). In the imperative cohort, RENAL score (HR 5.33; 95% CI 1.35-20.9; p=0.016), warm ischemia time (HR 1.04; 95% CI 1.05-1.08; p=0.025) and hilar control (HR 0.35; 95% CI 0.14-0.91; p=0.032) were independent predictors of sCKD (Table 5.) CONCLUSIONS: Compared to the elective setting, I-MIPN is associated to an increased rate of perioperative complications and significant renal function decline. In this scenario, a purely-off clamp approach may provide a significant functional benefit at mid-term follow-up. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1032-e1033 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Umberto Anceschi More articles by this author Aldo Brassetti More articles by this author Maria Consiglia Ferriero More articles by this author Gabriele Tuderti More articles by this author Rocco Simone Flammia More articles by this author Andrea Minervini More articles by this author Andrea Mari More articles by this author Antonio Andrea Grosso More articles by this author Marco Carini More articles by this author Umberto Capitano More articles by this author Alessandro Larcher More articles by this author Francesco Montorsi More articles by this author Riccardo Autorino More articles by this author Alessandro Veccia More articles by this author Cristian Fiori More articles by this author Daniele Amparore More articles by this author Franceso Porpiglia More articles by this author Daniel Eun More articles by this author Jennifer Lee More articles by this author Ithaar Derweesh More articles by this author Chandru Sundaram More articles by this author James Steward More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...

available at https://pubmed.ncbi.nlm.nih.gov/29848057/ Editorial Comment: These authors sought to develop an algorithm to predict bacteriuria in individuals with indwelling stents planning to undergo ureterorenoscopic procedures. They retrospectively reviewed records of patients at their institution over a 3-year period and found that 21.9% had positive urine cultures prior to planned surgical intervention. They looked for factors that could correlate with a positive urine culture but were unable to find any. Recursive partitioning did identify 4 criteria, which if all were filled had a strongly predictive low probability of bacteriuria (less than 8%). These factors included male gender, negative nitrites, urine leukocytes less than 1,174 per ml and blood C-reactive protein less than 13 mg/l. The authors attempted to develop an algorithm to replace preoperative urine culture. This nicely done retrospective study again confirms that it is very difficult to do this and, although the authors developed an algorithm that was predictive of low risk of bacterial infection, it is probably better just to wait and delay surgery if a culture is not present. Edward M. Schaeffer, MD, PhD Laparoscopy/New Technology Re: Effect of Obesity and Overweight Status on Complications and Survival after Minimally Invasive Kidney Surgery in Patients with Clinical T2-4 Renal Masses M. Marchioni, F. Berardinelli, C. Zhang, G. Simone, R. Uzzo, U. Capitanio, A. Minervini, C. Lau, J. Kaouk, P. Langenstroer, D. Amparore, N. de Luyk, J. Porter, M. Gallucci, A. Kutikov, A. Larcher, A. Mari, P. Kilday, K. Ho Rha, G. Quarto, S. Perdon a, W. White, D. Eun, I. Derweesh, A. Mottrie, U. Anele, K. Jacobsohn, F. Porpiglia, B. Challacombe, C. Sundaram, R. Autorino, B. Yang and L. Schips INFECTION AND INFLAMMATION OF THE GENITOURINARY TRACT 1077 Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. Department of Medical, Oral and Biotechnological Sciences, Urology Unit, SS Annunziata Hospital, “G. D’Annunzio” University of Chieti and Department of Urology, ASL 02 Lanciano Vasto Chieti, Chieti, Italy, Department of Urology, Changhai Hospital, Shanghai, China, Department of Urology, Regina Elena National Cancer Institute, Rome, Italy, Division of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy, Department of Urology, University of Florence, Careggi Hospital, Florence, Italy, Division of Urology, City of Hope Medical Center, Duarte, California, Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin, Department of Urology, University of Turin-San Luigi Gonzaga Hospital, Turin, Italy, Urology Centre, Guy’s Hospital, London, United Kingdom, Swedish Urology Group, Seattle, Washington, Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea, Uro-Gynecological Department, Fondazione “G. Pascale” IRCCS, Naples, Italy, Department of Urology, University of Tennessee Medical Center, Knoxville, Tennessee, Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania, Department of Urology, UC San Diego Health System, La Jolla, California, ORSI Academy, Melle, Belgium, Department of Urology, OLV Hospital, Aalst, Belgium, Division of Urology, VCU Health, Richmond, Virginia, and Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana J Endourol 2020; 34: 289e297. doi: 10.1089/end.2019.0604 Abstract available at https://pubmed.ncbi.nlm.nih.gov/31950886/available at https://pubmed.ncbi.nlm.nih.gov/31950886/ Editorial Comment: The authors review a multi-institutional series of more than 800 partial and radical nephrectomies performed minimally invasively to assess the impact of obesity on outcomes. Subjectively most of us would agree that obesity increases the operative time and challenges of kidney surgery, especially in larger tumors (cT2eT4). However, patient outcomes such as complications and renal function preservation were comparable to normal weight patients. Interestingly during 5-year followup obese patients had higher overall mortality and disease recurrence rates, suggesting a stricter followup regimen. Jeffrey A. Cadeddu, MD Re: A Multi-Institutional Analysis of the Effect of Positive Surgical Margins following Robot-Assisted Partial Nephrectomy on Oncologic Outcomes M. Rothberg, D. Paulucci, K. Okhawere, C. Reynolds, K. Badani, R. Abaza, D. Eun, A. Bhandari, J. Porter and A. Hemal Department of Urology, Wake Forest School of Medicine, Winston-Salem, North Carolina, Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, OhioHealth Robotic Urologic and Cancer Surgery, Dublin Methodist Hospital, Dublin, Ohio, Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania, Division of Urology, Columbia University at Mount Sinai Medical Center, Miami Beach, Florida, and Department of Urology, Swedish Medical Center, Seattle, Washington J Endourol 2020; 34: 304e311. doi: 10.1089/end.2019.0506 Abstract available at https://pubmed.ncbi.nlm.nih.gov/31931607/available at https://pubmed.ncbi.nlm.nih.gov/31931607/ Editorial Comment: This study adds to the literature supporting the observation that a positive surgical margin at partial nephrectomy does not result in an adverse oncologic outcome. Given the large database, the authors were able to study factors associated with worse recurrence-free survival, which, as expected, were advanced clinical stage (cT1b and cT2a) and pathological up staging (pT3a). Margin status, however, was not a factor. Reoperation for such patients is not warranted, but instead close observation is recommended. Jeffrey A. Cadeddu, MD Suggested Reading Wood EL, Adibi M, Qiao W et al: Local tumor bed recurrence following partial nephrectomy in patients with small renal masses. J Urol 2018; 199: 393. Male and Female Sexual Function and Dysfunction; Andrology Re: A Cost-Utility Analysis of Phosphodiesterase Type 5 Inhibitors in the Treatment of Erectile Dysfunction S. A. Hansen, E. Aas and O. Solli Department of Health Management and Health Economics, Institute for Health and Society, University of Oslo and Pfizer AS, Oslo, Norway 1078 MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.

기능적 제한이 많은 경수 손상 환자의 경우, 운동능력뿐만 아니라 호흡에 있어서도 많은 불편함을 느끼고 있으며, 이들을 위해 특화되어 개발된 호흡 운동 프로그램은 매우 부족한 실정이다. 선행연구에서 보고된 기존의 호흡 운동은 방식이 지루하고 호전되는 정도를 볼 수 없어 불편함을 겪고 있다. 이러한 문제점을 개선하여 모바일를 활용한 호흡 운동 게임을 통해 보다 재미있고 효과적인 호흡 운동을 실시하고자 하였다. 따라서 본 연구에서는 경수 손상 환자의 호흡기능증진을 위해 모바일 게임 기반의 호흡 운동이 호흡 근력과 기침 능력 개선에 미치는 효과를 알아보고자 하였다. 중재로는 경수 손상 환자 11명을 대상으로 호흡 운동 어플리케이션 게임을 가내에서 1회 60분, 주 2회, 총 8주간 실시하였다. 그 결과, 최대들숨압(p=.005)과 최대날숨압(p=.019), 최대 기침 유량(p=.013)이 유의하게 향상되었다. 경수 손상 환자의 호흡기능증진을 위해 실시한 모바일 게임 기반의 호흡 운동은 호흡 근력과 기침 능력 향상에 긍정적인 효과를 가져다주며, 추후 특화된 중재 프로그램을 개발하는데 긍정적인 영향을 미칠 것으로 기대한다.

OBJECTIVE To evaluate the effect of obesity and overweight on surgical, functional and survival outcomes in patients with large kidney masses after minimally invasive surgery (MIS). MATERIAL AND METHODS Within a multi-center, multi-national dataset, patients diagnosed with a ≥cT2 renal mass and treated with minimally invasive (laparoscopic or robotic) kidney surgery (radical or partial nephrectomy) during the period 2003-2017 were abstracted. They were stratified according to the body mass index (BMI) classes as normal-weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obese (≥30.0 kg/m2). Mixed models and Cox proportional hazard regression tested differences in complication rates, eGFR change over time, overall mortality (OM) and disease recurrence (DR) rates. RESULTS Of 812 patients, 30.6% were normal-weight, 42.7% were overweight and 26.8% obese. Overweight (OR 0.82, 95% CI: 0.51-1.51, p=0.406) and obese patients (0.81, 95% CI: 0.44-1.47, p=0.490) experienced similar complication rates than normal weight. Moreover, no statistically significant differences in eGFR were found for overweight (p=0.129) or obese (p=0.166) patients compared to normal-weight. However, higher OM rates were recorded in overweight (HR 3.59, 95%CI: 1.03-12.51, p=0.044) as well as in obese patients (HR 7.83, 95%CI: 2.20-27.83, p=0.002). Similarly, higher DR rates were recorded in obese (HR 2.76, 95%CI: 1.40-5.44, p=0.002). CONCLUSIONS Obese and overweight patients do not experience higher complication rates or worse eGFR after minimally invasive kidney surgery, which therefore can be deemed feasible and safe also in these subset of patients. Nevertheless, obese and overweight patients seem to carry a higher risk of OM, and therefore they should undergo a strict follow-up after surgery.

The goal of the study was to determine the effectiveness and safety of a novel technique in which the da Vinci S Surgical Robot (Intuitive Surgical Inc., Sunnyvale, CA, USA) was used in the dissection of the ventral lumbar spine to assist with anterior lumbar interbody fusion (R-ALIF). We performed a retrospective chart review of 11 patients who underwent R-ALIF between 2009 and 2010 at our institution. Due to variations in the surgical technique, the data were separated into three patient groups according to which disc level was operated on: L5-S1 (five patients), L4-L5 (two patients), and combined L4-L5 and L5-S1 (four patients). All patients showed radiographic evidence of fusion, and none of the procedures were converted to open. There were no intraoperative vascular complications, and no postoperative transfusions or ileus. This study shows the feasibility and safety of R-ALIF at L5-S1, L4-L5, and L4-L5 and L5-S1.