Dissertations / Theses: 'Urology'

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Stocks, Tanja. "Metabolic factors and cancer risk : prospective studies on prostate cancer, colorectal cancer, and cancer overall." Doctoral thesis, Umeå universitet, Urologi och andrologi, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-22567.

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Background: A large number of prospective studies have shown that overweight and diabetes are related to an increased risk of many cancers, including colorectal cancer. In contrast, diabetes has been related to a decreased risk of prostate cancer, and overweight has been related to an increased risk of fatal, but not of incident, prostate cancer. Data from studies on metabolic factors related to overweight and diabetes, and the association with cancer risk, are limited. Aim: The aim of this thesis was to study metabolic factors in relation to risk of prostate cancer (paper I and III), colorectal cancer (paper II and V), and cancer overall (paper VI). Methods: Study designs were i) case-control studies, nested within the Northern Sweden Health and Disease Cohort (paper I and II), and ii) cohort studies of the Swedish Construction Workers cohort (paper III), and the Metabolic syndrome and Cancer project (Me-Can) comprising seven European cohorts (paper V and VI). Paper IV was a descriptive paper of Me-Can. Results, prostate cancer: In paper I, increasing levels of several factors related to insulin resistance (insulin, insulin resistance index, leptin, HbA1c, and glucose) were associated with a decreased risk of overall incident prostate cancer, and the associations were stronger for non-aggressive tumours. In paper III, increasing levels of blood pressure was associated with a significant decreased risk of overall incident prostate cancer and of non-aggressive tumours. Body mass index (BMI) was significantly positively related to fatal prostate cancer. Results, colorectal cancer: In paper II, obesity, hypertension, and hyperglycaemia, were associated with an increased risk of colorectal cancer, and presence of two or three of these factors was associated with a higher risk than the presence of one single factor. In paper V, BMI was associated with a significant linear positive association with risk of colorectal cancer in men and women, and significant positive associations were also found in men for blood pressure and triglycerides. A high metabolic syndrome score, based on levels of BMI, blood pressure, glucose, cholesterol, and triglycerides, was associated with a significant increased risk of colorectal cancer in men and women. The association was stronger than for any of the factors in single, but there was no evidence of a positive interaction between these metabolic factors. Results, cancer overall: Blood glucose was significantly positively associated with risk of incident and fatal cancer overall, and at several specific sites. The associations were stronger in women than in men, and for fatal than for incident cancer. Conclusions: Results from these studies indicate that elevated blood glucose is related to an increased risk of cancer overall and at several specific sites, and further, that overweight and metabolic aberrations increase the risk of colorectal cancer in an additive way. The association with prostate cancer seems to be more complex; insulin resistance and high blood pressure were in our studies related to a decreased risk of overall incident prostate cancer and of non-aggressive tumours, whereas overweight increased the risk of fatal prostate cancer.

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Johansson, Mattias. "Prostate cancer aetiology : epidemiological studies of the IGF- and one-carbon metabolism pathways." Doctoral thesis, Umeå universitet, Institutionen för kirurgisk och perioperativ vetenskap, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1645.

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The aim of this thesis was to investigate the involvement of the insulin-like growth factor- and the one-carbon metabolism pathways in prostate cancer aetiology, studying both circulating biomarkers and genetic variation. Papers included in the thesis were conducted within the case-control study CAncer Prostate in Sweden (CAPS), and the two prospective studies European Prospective Investigation into nutrition and Cancer (EPIC), and Northern Sweden Health and Disease Cohort (NSHDC). In paper I, we investigated the relation between genetic variants of the IGF1 gene and prostate cancer risk within the CAPS study. We found that a common haplotype within the 3’ region of the IGF1 gene is associated with increased prostate cancer risk. In paper II, we investigated if the variants of the IGF1 gene that were associated with prostate cancer risk in paper I, are also associated with circulating levels of IGF1. Circulating levels of IGF1 were analysed in controls from the CAPS study and three haplotype tagging SNPs (htSNPs) were genotyped in subjects from the NSHDC study in which circulating IGF1 had previously been analysed. The genetic variants previously associated with increased prostate cancer risk were now also found to be associated with elevated levels of circulating IGF1. We concluded that variation in the 3’ region of the IGF1 gene affects prostate cancer risk by influencing circulating levels of IGF1. In paper III, we investigated if variants of the IGFBP1, IGFBP3 and IGFALS genes are associated with i) prostate cancer risk, ii) circulating concentrations of total and intact IGFBP3, and iii) prostate cancer-specific survival probability. In addition, we investigated if circulating concentrations of total and intact IGFBP3 are associated with prostate cancer-specific survival probability. No association between genetic variation and overall prostate cancer risk or survival was observed, but we found a strong association between elevated levels of intact IGFBP3 and increased risk of prostate cancer-specific death. We could, however, not exclude that this association was confounded by treatment or by the tumour. In paper IV, we investigated if circulating levels of folate and vitamin B12 are associated with prostate cancer risk within the EPIC study. We observed no associations between levels of folate, vitamin B12 and overall prostate cancer risk, but elevated levels of vitamin B12 were associated with increased risk of advanced stage disease. In paper V, we investigated if circulating levels of ten B-vitamins and related metabolites within the one-carbon metabolism pathway are associated with prostate cancer risk within the NSHDC study. Overall positive associations with prostate cancer risk were observed for levels of choline, vitamin B2 and vitamin B12, and inverse associations were observed for levels of homocysteine and MMA. We also observed a biologically plausible risk modification by smoking status on the association between vitamin B12 and risk; in non-smokers vitamin B12 was positively associated with risk, whereas the association between vitamin B12 and risk was inverse or null in ever/current-smokers. In summary, our results suggest that genetic variation of the IGF1 gene affects prostate cancer risk by affecting circulating levels of IGF1. The association between circulating concentrations of intact IGFBP3 and prostate cancer-specific survival is intriguing, but further studies are needed to conclude if this association is caused by confounding. We also observed associations between several factors of one-carbon metabolism and risk, but these associations were statistically week and require confirmation in other prospective studies.

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Borges, Cláudio Ferreira 1980. "Nefrolitotripsia percutânea com ou sem nefrostomia = revisão sistemática com metanálise." [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313710.

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Orientadores: Adriano Fregonesi, André Deeke Sasse
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-16T02:08:25Z (GMT). No. of bitstreams: 1 Borges_ClaudioFerreira_M.pdf: 4164710 bytes, checksum: 9f518f9bfaf2ebc75a3dd5241d26cdcf (MD5) Previous issue date: 2010
Resumo: Propósito: Comparar a segurança e efetividade da realização de nefrolitotripsia percutânea (NPC) com e sem a inserção de nefrostomia, através de revisão sistemática e metanálise de estudos Materiais e métodos: Uma revisão sistemática da literatura foi realizada. Foi feita busca nos bancos de dados PUBMED, EMBASE, LILACS e Cochrane para identificação de estudos clínicos prospectivos randomizados que compararam a NPC com e sem inserção de nefrostomia. Os desfechos avaliados foram os índices de remoção total de cálculos, dor pós-operatória, necessidades de analgésicos, tempo cirúrgico, tempo de internação, perda de sangue e complicações. Resultados: Um total de dez estudos clínicos prospectivos randomizados (ECR) foram identificados somando 621 pacientes. Sete estudos analisaram os índices de remoção total de cálculos. A metanálise dos dados resultou em ausência de diferença entre os grupos de NPC sem nefrostomia e convencional. Quando avaliados o tempo cirúrgico, transfusão sanguínea, queda de hemoglobina e febre pós-operatória não houve diferença entre os grupos. A metanálise do tempo de internação hospitalar e da drenagem prolongada de urina pela região lombar favoreceu o grupo de NPC sem o uso de nefrostomia. Conclusão: Em pacientes selecionados, a NPC sem nefrostomia é um procedimento seguro e eficaz com taxas de remoção total de cálculo comparáveis a NPC convencional. A NPC sem nefrostomia apresentou um menor tempo de internação hospitalar e menos casos de drenagem prolongada de urina. Não foi possível realização de metanálise na avaliação da redução da dor pós-operatória e minimização das necessidades analgésicas. Entretanto, a maioria do estudos avaliados apresentaram benefícios nestes parâmetros para o grupo de NPC sem nefrostomia
Abstract: Purpose: We performed a systemic review with meta-analysis to compare tubeless versus conventional percutaneous nephrolithotripsy and assess the effectiveness and safety of this innovative procedure. Material and Methods: A systematic review of PUBMED, EMBASE, LILACS and Cochrane Library was done to identify all randomized controlled trials comparing tubeless PCNL versus conventional PCNL. The outcomes analyzed were stone free rate, pain assessment, analgesic medication requirements, operative time, hospitalization time, blood loss, stone-free rates and complications. Results: A total of 10 RCT were identified reporting 621 patients. Seven studies analyzed stone free rates. Meta-analysis of the data resulted in no difference between tubeless and conventional PCNL. Operative time, blood transfusion, hemoglobin drop and postoperative fever did not differ between the groups. Meta-analysis of length of hospitalization and prolonged urinary drainage was analyzed and favoured the tubeless PCNL group. Conclusions: Tubeless PCNL is a safe and effective procedure with a stone free rate compared to conventional PCNL. Tubeless PCNL presented a shorter hospital stay and less postoperative urinary leakage. Pain reduction and minimization of analgesic requirements also were demonstrated
Mestrado
Cirurgia
Mestre em Cirurgia

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Hart, Prieto Maria Consuelo. "Applications of Raman spectroscopy to urology." Thesis, Cranfield University, 2006. http://dspace.lib.cranfield.ac.uk/handle/1826/8540.

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Raman spectroscopy is an optical technique that can interrogate biological tissues. In doing so it gives us an understanding of the changes in the molecular structure that are associated with disease development. The Kerr gating technique uses a picosecond pulsed laser and fast temporal gating of inelastically (Raman) scattered light. The tissue samples used were taken following fully informed consent and ethics approval. Bladder samples were obtained by taking a biopsy during a TURBT or TURP, prostate samples were taken during TURP and the liver and kidney (pigs) were bought at a supermarket. The bladder and prostate samples were snap frozen in liquid nitrogen and stored in an -80°C freezer until required for experimentation. The liver and kidney tissue were used fresh. The constituent samples were bought from Sigma – Aldrich. Multivariate and least squares analysis were used to ascertain the biochemical basis of the differing pathologies within the bladder and the prostate gland, as well as to test diagnostic algorithms produced by a colleague in our group. Depth profiling through the bladder and prostate gland was shown to be feasible by utilizing the Kerr gating technique as was the suppression of fluorescence from dark tissue (liver and kidney). We have shown for the first time, that we can utilise Raman spectroscopy to determine the biochemical basis of pathologies of the bladder and the prostate gland. With the help of the Kerr gating technique we also obtained spectra from different depths through them. We also suppressed fluorescence and resonantly enhanced Raman spectra from dark tissue. These have major implications in terms of understanding pathogenesis and disease progression and also the potential to accurately assess depth of tumour invasion.

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Vargas, Blasco César. "Responsabilidad profesional médica en urología." Doctoral thesis, Universitat de Barcelona, 2016. http://hdl.handle.net/10803/396281.

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INTRODUCCIÓN La responsabilidad profesional médica (RPM) tiene repercusiones innegables en la praxis médica. Existen tasas especialmente elevadas de reclamaciones por presunto defecto de praxis en el ámbito quirúrgico, afectando a especialidades médico-quirúrgicas como la urología. En nuestro entorno la urología ocupa el décimo lugar de las especialidades en el número de reclamaciones, el riesgo de reclamación no es desdeñable, existiendo áreas de especial litigiosidad en las que resulta recomendable implementar mejoras en materia de seguridad clínica. HIPÓTESIS Las reclamaciones en urología presentan una frecuencia media de reclamación por responsabilidad profesional médica respecto al conjunto de especialidades. Existen determinadas áreas de la actividad asistencial en urología de elevada frecuencia de reclamación. Existen defectos de praxis en urología que por su incidencia precisan la implantación de medidas de seguridad clínica específicas. Una praxis médica adecuada clínicamente no implica necesariamente una ausencia de responsabilidad profesional médica. OBJETIVOS Determinar la frecuencia de reclamación en urología por responsabilidad profesional médica. Identificar las áreas de actividad asistencial de mayor frecuencia de reclamación en urología. Detectar los defectos de praxis frecuentes en urología y guiar el desarrollo de medidas de seguridad clínica específicas. Identificar los factores diferentes de la praxis clínica que se asocian a responsabilidad profesional médica. MATERIAL Y MÉTODO En esta tesis, se analizan las reclamaciones interpuestas ante el CCMC entre los años 1990 y 2012, identificando los procedimientos correspondientes a todas las reclamaciones relacionadas con la especialidad de urología. Se identifican en la base de datos los casos en los que el acto médico reclamado se haya asignado a la especialidad de urología. Los expedientes revisados corresponden a la especialidad de urología y registrando diferentes variables clínicas, asistenciales y legales del caso. Se ha realizado un análisis descriptivo de la muestra, así como el estudio de asociaciones significativas (p<0.05), mediante el paquete estadístico para ciencias sociales (SPSS). RESULTADOS Se identifican áreas concretas en Urología de elevada frecuencia de reclamación y se detectan áreas en que existen defectos de praxis recomendándose modificaciones en la praxis que minimicen el riesgo de eventos adversos. Se contribuye a clarificar los criterios jurídicos que predominan frente a los clínicos en la valoración de los casos de urología. La resección de próstata transuretral, la litiasis y la patología testicular están entre las patologías más implicadas en reclamaciones, alegándose con frecuencia una deficiente ejecución técnica, un error de diagnóstico o un defecto de seguimiento. En general los procedimientos quirúrgicos generan el mayor número de reclamaciones en urología. Las frecuencias más elevadas de reclamación son las consecuentes a la patología escroto-testicular (34%), especialmente la torsión testicular (7,5%) y la vasectomía (19,6%), y a la patología prostática (26%), más específicamente el tratamiento quirúrgico de la hiperplasia benigna de próstata (17,9%). Se analizan todas ellas.
Introduction There is a particularly high rate of claims for alleged defects in the surgical field, affecting specialties such as urology. Urology ranks tenth in number of claims, with a risk that is not negligible, existing areas of special litigation in which it is advisable to implement improvements in clinical safety. Aim To determine the frequency of claims in urology, identify the areas of greatest demand and detect defects in praxis. Methods Cases in which the medical act in question was identified in the database were assigned to the specialty of urology. 182 cases (1990 – 2012) registering different clinics, legal assistance and instance variables were included. Results Transurethral resection of the prostate, lithiasis and testicular pathology are amongst the areas most frequently involved in complaints, being alleged often poor technical implementation, an error in diagnosis or defect tracking. In general, surgical procedures generate the highest number of complaints in urology. The biggest proportion of claims was related to scrotum and testicular pathology (34%), especially testicular torsion (7.5%) and vasectomy (19.6%). In second place, prostatic surgery (26%), with 17.9% related to benign prostatic hyperplasia.

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Thompson, Stephen Alexander. "Image guidance in telemanipulator assisted urology surgery." Thesis, University College London (University of London), 2011. http://discovery.ucl.ac.uk/1475351/.

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This thesis describes an image guided surgery system for use during telemanipulator assisted radical prostatectomy. The thesis is primarily concerned with determining the system accuracy. We first defined a method to present the component errors as an on-screen projection error in pixels. This allowed the error due to each component to be compared and then summed to give a system error. An MRI image of the patient is transformed into the intraoperative coordinate system, defined by the coordinate system of an optical tracking system. The endoscope is calibrated and tracked during surgery, defining a transformation to the endoscope screen. This transform is used to project the MRI image onto the endoscope video display. A novel algorithm for registering MRI to ultrasound images of pelvic bone was used to transform the MRI image to the intraoperative coordinate system. This algorithm localises the prostate to within 7 mm, giving an on-screen error of 28 pixels. The on-screen error due to endoscope tracking was found to be 65 pixels. The high tracking error is caused by a non-normally distributed marker tracking error, highlighting an important shortcoming in the bulk of the image guided surgery literature. Due to the high tracking errors we implemented a limited image guidance system that does not use endoscope tracking. The final part of the thesis details our experience in implementing this system on 5 patients. The main contributions of this thesis are: • A robust error analysis of an image guided endoscopic surgery system. • A novel algorithm for fitting inter patient CT data to an MRI image. The algorithm compares well in with the state of the art for segmenting pelvic bone from MRI images. • A method to analyse the endoscope tracking error that does not depend on the assumption of normally distributed, homogeneous marker tracking error.

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Boyle, Peter. "Successes and failures of evidence based urology." Thesis, University of Glasgow, 2005. http://theses.gla.ac.uk/30972/.

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I have conceived, undertaken and published a body of work in Urology which has applied an evidence-based approach to different aspects with widely varying success in modifying the impact on treatment choices and outcome. On the positive side, the research work I have led has demonstrated that the era when death statistics could be used to the occurrence of benign prostatic hyperplasia was gone and that we had moved to an epoch where symptomatic disease and quality of life were the key issues. I have worked on the creation of the questionnaire-based approach necessary for evaluating the presence of various urological conditions for use in different populations clearly identified and quantified the extent and inter-relationships between the various benign urological conditions in communities. This work has made it quite clear that such benign conditions as benign prostatic hyperplasia, erectile dysfunction, incontinence, prostatitis and cystitis are remarkably common conditions world-wide in ageing populations. Since 1990, treatment options for men and symptomatic BPH have moved from an essentially surgical approach to an increasing introduction of pharmacologic options and less invasive approaches to disease management. The meta-analysis of the Phase III clinical trials of finasteride which I undertook, demonstrated that this drug was effective only in men with enlarged prostates and justified the biological approach taken in the development of this drug which was an inhibitor of 5-alpha reductase, the enzyme which converts Testosterone (T) to Dihydrotestosterone (DHT) the metabolite which made the prostate hyperplastic. I then demonstrated that serum PSA was a good indicator of prostate volume thus making identification of men who would most likely respond to this drug easily identifiable. Using this same dataset, I was able to demonstrate that finasteride reduced the risk of Acute Urinary Retention (AUR) and that it was superior to alpha-blockers, the other major class of drugs used to treat symptomatic BPH, in this regard. I designed the phase III trials of dutasteride, a new five-alpha reductase inhibitor, and the findings lay on the regression line demonstrated in the meta-analysis of finasteride and also had the identical effect on reducing the risk of AUR. I was able to develop a method of predicting individual risk of AUR in men who were diagnosed with benign prostatic hyperplasia.

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Jehle, Karlheinz. "A review of transrectal ultrasound guided prostate biopsies is there still a role for finger-guided prostate biopsies?" Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/2907.

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Includes abstract.
Includes bibliographical references.
Prostate cancer is the most common male malignancy amongst black males in South Africa and the second commonest amongst white males (1,2). Prostate biopsy, via the rectum, is an essential part of diagnosing and treating this disease. Traditionally needle biopsies of the prostate were performed blindly by digital palpation of the gland per rectum.

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Moolman, Conray. "Non-operative versus operative management of penetrating kidney injuries : a prospective audit." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10690.

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To date there is little data on conservative management of penetrating renal trauma. The aim of this study was to review the management and outcome of a large patient cohort presenting with penetrating renal trauma to a tertiary referral centre in South Africa. All patients presenting with penetrating abdominal trauma and haematuria admitted to the Trauma Centre at Groote Schuur Hospital over a 19-month period was prospectively evaluated. Patients demographics, mechanism of injury, microscopic versus macroscopic haematuria, grade of injury, management decision (non-operative, laparotomy for other reasons without renal exploration or true renal surgery with Gerotas fascia opened), nonsurgical success rate, complications, hospital stay, transfusion requirements and nephrectomy rate were analysed.

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Govender, Prenevin. "Retrospective review of radical cystectomies at GSH 1993-2007." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/10503.

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Includes bibliographical references (leaves 54-59).
The objective of the thesis was to look at the epidemiology of patients needing this procedure, clinical presentation and investigation, pathology, complications related to the procedure, adjuvant and neoadjuvant treatment, and survival.

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Kaestner, Lisa-Ann. "Is ethnicity a risk for high grade prostate cancer?" Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/13401.

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Includes bibliographical references.
To assess the association between ethnicity and grade of prostatic adenocarcinoma, prostatespecific antigen (PSA) and age, and to determine whether Africans of African descent (AAD) have higher grade cancers than other ethnic groups.

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Le, Roux Pieter Johannes. "The use of SurgiSIS, an acellular collagen matrix, in endoscopic urethroplasty." Master's thesis, University of Cape Town, 2003. http://hdl.handle.net/11427/2908.

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Includes bibliographical references.
To evaluate small intestinal submucosa (SurgiSIS) as a substitute for skin in endoscopic urethroplasty performed as treatment for inflammatory and iatrogenic stricutres of the male bulbar urethra and in the early treatment of bulbumembranous urethral injuries associated with recent pelvic fractures. The tissue integration and epithelialisation of surgiSIS used in endoscopic urethroplasty is assessed. The long term maintenance of urethral patency following this treatment from is assessed.

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Dewar, Malcolm James. "Investigating racial differences in clinical and pathological features of prostate cancer in South African men." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22753.

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The aim of this project is to study the clinical and pathological features of prostate cancer in men from different racial groups in the Western Cape in an attempt to define the characteristics of the disease locally. Specifically we wanted to compare black with coloured and white patients.

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de, Jager Simon. "Is The Learning Curve In Robotic Assisted Laparoscopic Radical Prostatectomies (RALP) in South Africa Comparable to International Standards?" Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32234.

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Background and purpose Prostate cancer (PCa) is the second most common cancer in men, and the sixth leading cause of cancer death among men worldwide (1). Radical Prostatectomy (RP) is widely considered a gold standard treatment for clinically significant localized PCa. Robotic assisted laparoscopic radical prostatectomy (RALP) represents a modern minimally invasive technique for performing a RP. The aim of the study is to demonstrate a progression in the learning curve of two South Africa based urologists, as each embarks on their first series of RALP cases between September 2014 to July 2019. An audit of peri-operative outcomes for each surgeon's first uninterrupted series of RALP's has been undertaken. We also compare our results to international series to assess if local South African outcomes are similar to these. Materials and Methods We performed a retrospective audit of all patients who had a RALP with our two urologists between the dates of September 2014 to May 2019. Patients were only excluded if critical data could not be collected. For each included patient we collected peri-operative data. Pre-operative data collected was required for risk stratification grouping of patients according the D'Amico Risk group classification. Post-operative data included operative details (such as console time and blood loos), functional outcomes (such as potency and continence rates), and pathological outcomes (such a T-staging and positive surgical margin rates). The total number of patients for each of the two surgeons have been divided into a series of consecutive groups. The first 100 have been divided into groups of 25, and the subsequent patients into groups of 50. Results/main findings Our two surgeons have been designated Surgeon-X and Surgeon-Y. A total of 700 patients met our inclusion criteria, 400 and 300 cases for Surgeons-X and -Y respectively. Our study demonstrates that in a South Africa setting, for the parameters of median console time (CT), estimated blood loss (EBL), length of hospital stay (LOS), and positive surgical margins (PSM), there were notable improvements between the first and last groups of each surgeon's series. Although each parameter tends to fluctuate around a median value, there is a general trend towards improved outcomes. For the parameters of post-operative continence and potency our study failed to show a statistically significant improvement in outcomes between the first and last groups in each surgeon's series. Conclusions This study demonstrates that, similar to internationally published data, notable improvements in perioperative outcomes can be observed as each of our two surgeons gain experience in this relatively new operative approach to managing men with localized prostate cancer. The overall picture is one of improved outcomes with each consecutive group analysed and that when individually assessed, these outcomes display differing rates of improvement depending on which is being assessed. When analysing our outcomes of CT, EBL, PSM rate and LOS, we see that our results compare favourably to other internationally published data. For all intents and purposes our learning curve and peri-operative results are on par with our overseas counterparts and in some cases bette

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Akpakli, Evans Ametefe. "Comparative Analysis of Kidney Stone Composition in Patients from Ghana and South Africa: Case Study of Kidney Stones from Accra and Cape Town." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31592.

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Aim: The primary aim of this study was to describe and compare the kidney stone composition of kidney stone patients receiving treatment at the Korle-Bu Teaching Hospital (KBTH), Accra (Ghana) and Groote Schuur Hospital (GSH), Cape Town (South Africa). Methods: The study was a retrospective folder review of patients treated for kidney stone disease at the Korle-Bu Teaching Hospital in Accra (Ghana) and Groote Schuur Hospital in Cape Town (South Africa). Patients who were treated for kidney stone disease between 1st June 2016 and 31st May 2018 were recruited and their folder numbers were retrieved from theatre log books. A total of hundred and sixty-three (n=163) folders (n=30 KBTH; n=133 GSH) were subsequently retrieved from the records department of the two facilities. Demographic data and kidney stone analysis results were extracted and analyzed using the R statistical software. Results: The age of participants at the KBTH ranged from 24 to 75 years with a median age of 45 years, while the ages of participants at the GSH ranged between 19 to 77 years with a median age of 48 years. Males were the majority stone formers for both hospitals [56.7% KBTH; 59.4% GSH]. However, there was no significant statistical difference in gender (p=0.9447) and age (p=0.2612) between the two groups. Calcium oxalate (86.7%) and uric acid (90.0%) were the commonest components of the kidney stones analyzed from the KBTH. Calcium oxalate (66.2%) and carbonate apatite (40.6%) emerged as the most common components of the stones analyzed from the GSH. Brushite (3.0%), cystine (3.8%) and struvite (19.6%) stones were only found in the stones of participants receiving treatment at the GSH. All kidney stones from the KBTH were mixed; made up of at least two chemical components. Pure kidney stones were only found among the GSH dataset constituting 48.9% of all the stones analyzed. While all KBTH stones were mixed stones, female patients from GSH formed more mixed stones than their male counterparts (M:F = 40.5%:66.67%). Infection kidney stones (struvite and carbonate apatite) were also predominantly found among female stone formers in this study. Conclusion: The findings indicate that the participants from the two facilities are not different in terms of gender and age. However, the composition of stones was found to be different between participants from both hospitals. This suggests that that kidney stone composition may be influenced by patients’ geographical location and/or cultural background. Further studies with prospective or longitudinal data and larger samples are needed to provide more insight into the composition of kidney stones of African patients.

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De, Wet Christiaan Ernst. "Do percutaneous nephrostomies for malignant obstructive uropathy improve renal function six months post intervention?" Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31590.

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Background and purpose Malignant conditions of the pelvis and/or abdomen can cause ureteric obstruction and associated impaired renal function, which can be managed by performing percutaneous nephrostomy (PCN) tube insertion. Nephrostomy tubes are associated with prolonged hospital stay which affects quality of life. The main objective of this study was to assess the changes in estimated glomerular filtration rate (eGFR) over the first six months following percutaneous nephrostomy for malignant ureteric obstruction. We also explored the role of UTIs in the changes of eGFR following PCN. Materials and Methods We performed a retrospective folder review of patients who had PCN procedures at Groote Schuur Hospital for malignant obstructive uropathy from January 2015 to 31 December 2017. For each included patient, eGFR was recorded at baseline pre-PCN, and at its best and worst value in the first six months after PCN. The timing of baseline, best and worst values were also recorded. Other data collected included demographic data, type of malignancy, laterality of nephrostomy and presence of confirmed UTI at least one week post PCN. Results/main findings A total of 90 patients fulfilled our inclusion criteria. The most common cancers in men were bladder 59% (n=32), prostate 20% (n=11), lymphoma 7% (n=4), and colorectal 4% (n=2). The most common cancers in women were cervix 64% (n=23), bladder 19% (n=7), lymphoma 6% (n=2), colorectal 6% (n=2) and endometrial 6% (n=2). Men were of higher age, median (IQR), 60 (56, 67) years, compared to women, 48 (40, 67). 64% of patients (n=58) had bilateral PCN procedures (as opposed to a unilateral procedure). 52% (n=47) of patients developed at least one episode of UTI post PCN during the six-month observation period. Median (IQR) timepoint of pre-PCN eGFR measurement was 1.0 (2.0, 0) day pre PCN. The best post-PCN eGFR measurement was 13.0 (6.0, 26.0) days post PCN. The worst post-PCN measurement was 33.5 (14.0, 92.5) days post PCN. Pre-PCN eGFR, median (IQR), was 9 (5, 26). Post-PCN eGFR improved to 48 (30, 75) before deteriorating to 23 (9, 44) within the six-month follow-up window. Compared to patients who do not develop UTI post-PCN, those who develop one or more post-PCN UTI(s) have a 6.15 (95% CI: 0.87, 11.43) unit lower eGFR at their worst eGFR measurement. There are also markedly fewer deteriorations in chronic kidney disease (CKD) stages between best and worst post-PCN interval in those without UTI (42%, 18/43), compared to those with at least one post-PCN UTI (72%, 34/47). Conclusions Our study confirmed a similar renal function trend post-PCN for malignant ureteric obstruction across different demographics. It is clear that although most patients’ renal function initially improve post-PCN, the general trend for the majority of patients is to deteriorate towards pre-PCN eGFR and CKD stage values. Our data suggest that urinary tract infections play an important role in poor renal function response within six months post-PCN. Future studies should explore whether the development of UTI following PCN is an independent and modifiable risk factor for poor renal outcome.

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Van, der Merwe André. "Gunshot wounds to the male external genitalia." Master's thesis, University of Cape Town, 2007. http://hdl.handle.net/11427/2909.

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Includes bibliographical references ( leaves 38-39).
This is a retrospective study of male patients that suffered gunshot wounds to the extental genitalia from August 1997 to September 2006. This study also reviews the literature and compares treatment methods locally and internationally.

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Maison, Patrick Opoku Manu. "Genetic basis of human disorders of gonadal development." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/28015.

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South Africa is unique in the arena of Intersex, in that for unknown reasons we have a very high percentage of ovotesticular DSD (True Hermaphrodite). Whereas ovotesticular DSD is the least common cause of hermaphroditism in other parts of the world, it is the most common cause of hermaphroditism in South Africa. There have been several studies in the past to determine the cause of ovotesticular DSD in our population but none of these studies found appropriate answers. The current state of understanding implicates signaling and signal transduction molecules and transcription factors suggesting that it is likely not all of the genetic factors involved have already been identified. It was hypothesized that exome sequencing of individuals with DGDs will identify new mutations and genes for these conditions. Therefore, this study aims to identify additional genes that are associated with ovotesticular DSD. By using a whole-genome sequencing approach we expected to be able to identify rare variants with this condition and determine the prevalence of mutations in these genes in the ovotesticular DSD population. After obtaining informed consent, blood specimen was obtained from eleven out of fifteen patients who had histological diagnosis of Ovotesticular DSD at the Red Cross War Memorial Hospital over a 10 year period. Blood specimen was also obtained from the biological parents of these children and sent to the Ostrer laboratory for whole genome sequencing and analysis. At the Ostrer laboratory, high quality DNA was extracted from blood for all of subjects and lymphoblastoid cell lines were created. Following sample preparation using the Illumina library preparation kit, sequencing was accomplished using paired-end sequencing technology on an Illumina HiSeq2000 sequencer. The data from the Illumina sequencers was analyzed first using the Illumina sequencing data analysis pipeline for quality control. Paired end reads were aligned to the Human Reference Genome (NCBI Build 36) using the BWA software. Each alignment was assigned a mapping quality score by BWA, which is the Phredscaled probability that a read is misaligned. The basic functional annotation of SNPs/Indels is performed by ANNOVAR. The clinical features of these patients was consistent with those found by other studies on Ovotesticular DSD in South Africa and it also showed the same pattern of variation to the clinical features of Ovotesticular DSD from other parts of the world. Similar to previous South African studies, this study found no convincing gene mutations as the possible etiology of Ovotesticular DSD in South Africa. Whiles gene mutations such as duplication of SOX 9 have been found in patients with XX Ovotesticular DSD from outside South Africa, this study could not identify any such mutations. This further adds to the suspicion that the unique features of Ovotesticular DSD in South Africa suggests a different etiology from that of other parts of the world. In conclusion, the etiology of Ovotesticular DSD in South Africa still remains elusive. It is however possible that a genetic mutation may be found from a more critical analysis of the genome of the patients and their parents.

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Cassim, Farzana. "Retrospective review of open versus laparoscopic radical cystectomy for the treatment of bladder cancer: complications and oncological outcome." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16479.

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Includes bibliographical references
Objective: Radical cystectomy with extended lymphadenectomy and urinary diversion remains the standard of care for muscle-invasive urothelial carcinoma. Our centre (Groote Schuur Hospital) has been performing laparoscopic radical cystectomies since 2009. We aimed to audit our data regarding complications and oncological outcome and compare it to data obtained from patients undergoing open radical cystectomy by the same surgeon since 2007. The two procedures will be compared in terms of operative duration, intra-operative blood loss, peri-operative blood transfusion requirements, post-operative complications (using the Clavien Classification) and differences in pre- vs. post-operative staging. Patients and Methods: All adult patients (>18 years) that underwent open and laparoscopic radical cystectomy from 2007 to 2013 have been included in the study. Data on demographics, operative time, intra-operative blood loss, post-operative complications (as per Clavien-Dindo Classification), margin positivity, and lymph nodes (number obtained and number of positive nodes) was obtained retrospectively by means of folder review. Extracted data was collected on a Microsoft Excel spreadsheet. Only folders with complete data sets were included f or statistical analysis. Patients undergoing laparoscopic radical cystectomy converted to open were analysed on an intention-to-treat basis. Data was analysed using bivariate statistics and survival analysis was performed to compare mortality rate. Results: Physician's choice of surgical modality was associated with clinical disease staging with 59% of participants who underwent ORC presented with a palpable mass on examination under anaesthesia (EUA) compared to 36% of participants in the LRC arm. This association was confirmed on pathological staging. Participants undergoing ORC experienced shorter operative duration (301 minutes versus 382 minutes; p-value < 0.0001), increased blood loss (1376ml versus 778 ml; p-value = 0.00 2 3) and transfusion requirement (2 units versus 0; p-value = 0.071) in contrast to LRC. Post-operative complications were more prevalent in the ORC arm compared to the LRC arm (61% versus 43%) and this trend was reflected in the Clavien classification. The only complication that differed in its occurrence between the two arms was wound complications (18% for LRC versus 44% for ORC) with the main type being sepsis. Patients with a past medical history were at higher risk of experiencing post-operative complications (p-value = 0.04; Risk Ratio: 1.6). Margin positivity was comparable between the two arms. A trend was observed when comparing the number of lymph nodes sampled using the two techniques and this trend was maintained irrespective of the area sampled, whereby a higher number of nodes was sampled by the laparoscopic technique in this study (overall p-value = 0.07 ). Conclusion: Laparoscopic radical cystectomy is associated with longer operative times, decreased blood loss, and equivalent oncological outcomes when compared to open radical cystectomy. Laparoscopic RC is a feasible option in our setting. LRC affords patients a lower risk of requiring transfusion, with minimal risk of post-operative ileus and a lower risk of wound complications. Given the increasing number of laparoscopic procedures being performed at GSH, a prospective trial would be possible in order to confirm these findings.

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Mignon, Paul. "Guidage robotisé d'une aiguille flexible sous échographie 3D pour la curiethérapie de la prostate." Thesis, Université Grenoble Alpes (ComUE), 2016. http://www.theses.fr/2016GREAS019/document.

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La curiethérapie constitue 25% à 30% des opérations de traitement utilisées sur les 40.000 cas de cancer de prostate par an en France. Elle consiste à mettre manuellement une trentaine d'aiguilles creuses dans la prostate, à travers le périnée, en utilisant des images échographiques pour localiser la prostate et les aiguilles. Au moyen de ces aiguilles, des grains radioactifs sont insérés dans la prostate à des endroits précis pré-planifiés grâce à l'imagerie. Le succès de l'opération est étroitement lié à la répartition et l'homogénéité de la dose radioactive répartie dans la prostate, donc à la précision avec laquelle les grains y sont placés. Cette précision est affectée par plusieurs facteurs. Premièrement, la prostate bouge et se déforme pendant l'insertion des aiguilles et lors des déplacements de la sonde échographique pour les acquisitions d'images. Deuxièmement, la taille de la prostate est susceptible d'augmenter pendant l'opération à cause des saignements occasionnés. Enfin, les aiguilles sont très minces et susceptibles de se courber pendant leur insertion.Le laboratoire TIMC-IMAG (équipe GMCAO) a mis au point un système robotisé d'insertion d'aiguilles transpérinéale, guidé par échographie 3D avec le but d'améliorer la précision, la fiabilité et l'efficacité de la pose des grains. Ces travaux ont montré une première faisabilité globale de l'approche avec un premier prototype de laboratoire. Cependant l'approche actuelle permet de corriger seulement en partie les bougés et déformations de la prostate en cours de geste grâce au couplage avec des méthodes d'imagerie 3D. La correction ne tire pas parti des informations très riches issues de l'imagerie : seule la profondeur d'insertion est modifiée pendant le geste. Le LIRMM (équipe DEXTER) a développé récemment une approche de planification adaptative pour le guidage d'aiguille flexible lors de leur insertion dans des procédures percutanées. La technique proposée permet la mise à jour du chemin suivi par l'aiguille en intégrant des informations obtenues en ligne par un retour visuel. Cette stratégie de planification et de contrôle est définie dans une architecture en boucle fermée et permet ainsi de compenser les incertitudes du système et les perturbations (déformations des organes, inhomogénéité des tissus, etc) auxquelles il est soumis.Le but de ces travaux de thèse est donc de coupler les savoir-faire de chacun des deux laboratoires afin d’apporter une solution de guidage d’aiguilles flexibles pour la curiethérapie de prostate. La réalisation de cet objectif passe, dans un premier temps, par l’élaboration d’un algorithme de suivi d’aiguille sous échographie 3D. Cet algorithme est confronté à la faible visibilité des aiguilles offerte par cette modalité d’imagerie, associée à diverses sources de bruit. Ces conditions rendent très difficile la détection de l’aiguille. Dans le but d’améliorer la robustesse de cet algorithme, la zone de recherche de l’aiguille dans le volume est déterminée par un modèle prédictif, qui constitue une première contribution de ce manuscrit. Le contrôle de l’aiguille par planification en boucle fermée a été adapté aux spécificités de l’imagerie échographique 3D ainsi qu’à celles du robot développé précédemment. Ce contrôle est couplé au retour visuel de l’aiguille donné par l’algorithme de détection. Ce dispositif a, par la suite, été testé sur fantômes puis sur pièce anatomique afin de déterminer la viabilité et la pertinence du système proposé.Ce travail constitue donc une première étape vers une future application clinique du guidage d’aiguilles flexibles. Si voir un système robotique insérer seul une aiguille flexible en clinique est encore un rêve lointain, l’idée d’un système d’assistance à l’insertion d’aiguille, où le clinicien et le robot travaillent de pairs, est une solution envisageable dès maintenant
In France, 25% to 30% of the 40,000 prostate cancer cases per year are treated with brachytherapy. During this procedure, about thirty needles are manually inserted into the prostate through the perineum using ultrasound images to locate the prostate and needles. Radioactive seeds are then inserted into the prostate specific pre-planned locations using needle cannula. The success of the operation is closely related to the distribution and homogeneity of the radioactive dose distribution in the prostate, therefore the precision with which the seeds are positioned. This accuracy is affected by many factors. Firstly, the prostate moves and deforms due to the insertion of the needles and to the movements of the ultrasonic probe. Secondly, the size of the prostate increases due to tissue inflammation and bleeding. Finally, the needles are very thin and could bend during insertion.The TIMC-IMAG laboratory (CAMI team) has developed a robotic system for transperineal needle insertion. This system is guided by 3D ultrasound to improve the precision, reliability and efficiency of the radioactive source positioning. These works showed a first proof of concept using a laboratory prototype. However the current approach can only partially correct prostate movements and deformations using 3D imaging methods. The correction does not take advantage of the rich information of this imaging modality: only the insertion depth is changed during the gesture. LIRMM (DEXTER team) recently developed an adaptive planning approach to guide a flexible needle during its insertion in percutaneous procedures. The proposed technique allows to update the path followed by the needle using online information from the visual feedback. This planning and control approach forms a closed-loop architecture and allows to compensate system disturbances (organ deformities, tissue inhomogeneity, etc.).The purpose of this thesis is to combine the expertise of the two laboratories to provide a flexible needle steering system for prostate brachytherapy purposes. This objective is achieved first by developing a needle tracking algorithm in 3D ultrasound. This algorithm deals with low visibility of the needles offered by this imaging modality, combined with various noises. These conditions complicate the detection of the needle. In order to improve the robustness of our algorithm, a search area is defined to detect the needle in the volume. This area is then determined by a predictive model, which is a first contribution of this manuscript. Control of the closed-loop planning needle is adapted to the specifications of the 3D ultrasound imaging system as well as those of the previously developed robot. This control is coupled to the needle visual feedback given by the detection algorithm. This device is tested on phantoms then on anatomical specimen to assess the viability and relevance of the proposed system.This work is therefore a first step towards a future clinical application of flexible needle steering. The entirely automatic insertion of flexible needle in clinic is a distant dream. However, the idea of an assistance system for needle insertion, where the clinician and the robot work together, is reachable from now

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Reynard, John. "The assessment and significance of lower urinary tract symptoms in men with benign prostatic enlargement : a reappraisal." Thesis, University of Oxford, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.360029.

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Radford, Anna Rebecca. "Regenerative medicine applications in paediatric urology : barriers and solutions." Thesis, University of Hull, 2015. http://hydra.hull.ac.uk/resources/hull:13127.

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Tissue engineering and regenerative medicine offers opportunities to introduce new techniques into paediatric urology practice. In this thesis, two experimental approaches were used. The initial approach considered improvements to the concept of composite cystoplasty; where high pressure in end-stage disease bladders is alleviated by augmentation using bowel smooth muscle lined by an autologous in vitro-grown bladder epithelium. Secondly, a porcine bladder acellular matrix (PABM) was tested as a free graft in a surgical model as proof of principle for its use in hypospadias repair. Immunohistochemical characterisation of neuropathic bladders was performed. A disease-model was created in order to mimic the disease phenotype using propagated normal urothelial cells and tissue in vitro. Trans-epithelial electrical resistance was used to measure barrier function in differentiated urothelium. Immunocytochemistry, immunoblotting and RTPCR was utilised to identify any mechanistic pathways leading to heritable changes in phenotype. Assessment of human neuropathic bladder biopsies demonstrated significant labelling of a hypoxia-related transcription factor. In vitro hypoxia significantly reduced the proliferation and differentiation capacity of urothelial cells. The proliferative capacity recovered upon switching to normoxia, however, the differentiation-associated compromise persisted. Repressive epigenetic marks were found to alter location and abundance in the compromised urothelium. These marks were targeted using an epigenetic-modifying agent, which significantly recovered the differentiated urothelial phenotype. Importantly this was replicated in urothelium from diseased bladders. Integration of the PABM was superior to Pelvicol™. A subpopulation of CD45⁻ CD163⁺ cells was identified, which were believed to be important in biomaterial remodelling. It is proposed that hypoxia results in persistent heritable compromise in differentiated urothelium. The urothelial phenotype is recoverable by the application of an epigenetic modifying agent. By using an integrated approach both the epigenetic–modifying agent and PABM may provide strategies to improve the efficacy of autologous tissue engineering approaches in paediatric and adult urology.

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Montalbo, Calafell Ruth. "Estudi del carcinoma urotelial. Identificació de biomarcadors amb valor diagnòstic i pronòstic." Doctoral thesis, Universitat de Barcelona, 2018. http://hdl.handle.net/10803/667537.

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Aquesta tesi és una contribució a l’estudi del carcinoma urotelial de vies urinàries superiors i de bufeta. Es centra en la recerca de biomarcadors diagnòstics i pronòstics amb potencial utilitat a la pràctica clínica diària en aquests tipus de tumors. El carcinoma urotelial (CU), també anomenat carcinoma de cèl·lules transicionals, és una malaltia neoplàsica que s’origina a l’uroteli. La localització més freqüent és la bufeta (90%), seguida pel tracte urinari superior (5-10%) i finalment per la uretra (1%). És el novè tumor més freqüent a nivell global, i a la Unió Europea, es posiciona com a cinquè en incidència. El carcinoma urotelial de tracte urinari superior és un tumor de mal pronòstic. En aquests pacients, la supervivència als 5 anys no arriba al 50% per aquells tumors que al diagnòstic són pT2/pT3 i és inferior al 10% quan es tracta de pT4. Actualment, l’estadi patològic i el grau histològic són els factors pronòstics més habitualment utilitzats a la pràctica clínica, tot i que resulten insuficients per a predir l’evolució de la malaltia de manera individualitzada, donat que pacients amb els mateix fenotip tumoral presenten evolucions clíniques diferents. Aproximadament el 75% dels tumors de bufeta es diagnostiquen inicialment com no múscul-invasius (NMIBC). Desafortunadament aquests tumors estan caracteritzats per uns índexs de recidiva que oscil·len entre el 60 i el 85% (un cop que el tumor primari ha estat tractat). A més, entre el 15 i el 30% dels NMIBC progressaran a múscul-invasius (MIBC), podent arribar a produir la mort del pacient. El gold estàndard de diagnòstic i seguiment del CB és la cistoscòpia combinada en alguns casos amb la citologia urinària. La cistoscòpia és un mètode invasiu, incòmode i dolorós pels pacients. D’altra banda, el mètode no invasiu, la citologia urinària, presenta una baixa sensibilitat, sobretot en els tumors de baix grau. Tot i els nombrosos esforços descrits a la literatura per identificar biomarcadors no invasius pel diagnòstic i seguiment del CU de bufeta, els biomarcadors estudiats fins al moment no superen la precisió diagnòstica d’aquesta combinació (aproximadament SN=80%, SP=90%). La identificació de biomarcadors en CU és de gran importància per millorar diferents aspectes del seu diagnòstic , pronòstic o per predir la resposta a tractaments. Cap dels biomarcadors descrits als últims temps ha estat implementat a la pràctica clínica diària. En la tesi per una banda s’identifiquen i validen biomarcadors pronòstics tissulars i sèrics en el carcinoma urotelial de vies urinàries superiors, i per l’ altra, es presenta una nova firma d’expressió gènica amb una alta precisió pel diagnòstic i seguiment del CU de bufeta. Finalment, també s’investiga si és pertinent realitzar anàlisis addicionals en pacients amb citologia urinària sospitosa per CU.
This thesis is a contribution to the study of urothelial carcinoma (UC) in the upper urinary tract and in the bladder. It focuses on the search for diagnostic and prognostic biomarkers in these tumors with potential utility in daily clinical practice. Urothelial carcinoma is a neoplastic disease that originates in the urothelium. The most frequent location is the bladder (90%), followed by the upper urinary tract (5-10%) and finally the urethra (1%). It is the ninth most frequent tumor on a global level, and in the European Union, it is ranked fifth in incidence. Urothelial carcinoma of upper urinary tract is a tumor of poor prognosis. In these patients, survival at 5 years does not reach 50% for those with pT2 and/or pT3 and less than 10% for pT4. Nowadays, pathological stage and histological grade are the most commonly used prognostic factors in clinical practice, although they are insufficient to predict the evolution of the disease in an individualized way, since patients with the same tumor phenotype present different follow up. The gold standard for diagnosis and monitoring of bladder cancer is cystoscopy combined in some cases with urinary cytology. Cystoscopy is an invasive, uncomfortable and painful method for patients. The non-invasive method, cytology, has a low sensitivity, especially in low-grade tumors. Consequently, the identification of biomarkers in UC is of great importance to improve different aspects of their diagnosis, prognosis or prediction of the response to treatments. None of the biomarkers described in recent years has been implemented in daily clinical practice yet. In this thesis, on the one hand, prognostic biomarkers for Upper Tact Urothelial Carcinoma are identified and validated in tissue and in serum and on the other hand, a new gene expression signature with high accuracy for the diagnosis and surveillance of bladder cancer is also described. Finally, the utility of an additional analysis in the follow up of patients with cytology suspicious for UC is investigated.

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Tan, Hock Lim. "The development of paediatric endoscopic surgery /." Title page, contents and abstract only, 1999. http://web4.library.adelaide.edu.au/theses/09MD/09mdt161.pdf.

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Thomas, Kay. "Design, implementation and evaluation of a structured medical record in urology." Thesis, University College London (University of London), 2005. http://discovery.ucl.ac.uk/1446546/.

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Traditional narrative medical records (TNR) have become multidisciplinary tools, however, the quality of documentation in them remains poor and their lack of structure inhibits the retrieval of information. Previous attempts to restructure the TNR have achieved limited success because they have entailed duplication of the information in the existing TNR. The aims of this thesis were to; agree a minimum dataset, design a structured medical record (SMR) around the dataset, compare the completeness of documentation of key clinical information when using the SMR versus TNR, determine the time taken to use a SMR versus TNR, implement the SMR in routine clinical practice in a variety of settings (i.e. ward, outpatients, theatre) and assess its acceptability. A SMR designed around a dataset agreed by consensus was successfully implemented in routine practice throughout one specialty (urology). The SMR resulted in improved completeness of documentation without adding extra time to the consultation and was acceptable to the majority of users. Agreeing a structure for medical records is not only pertinent to the paper records but is a necessity before they can be converted electronically. This locally agreed datatset and structure could form the template for restructuring of the medical record irrespective of specialty or medium used.

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ODERDA, MARCO. "New technologies and applications of laparoscopic and robotic surgery in urology." Doctoral thesis, Politecnico di Torino, 2018. http://hdl.handle.net/11583/2710818.

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Background: cool and dry gas insufflation during laparoscopy induces hypothermia and cytokine increase, with significant perioperative morbidity. Few studies have suggested that warmed and humidified insufflation leads to an improved body core temperature (BCT) maintenance, a reduction of the inflammatory response and an improved quality of postoperative course, compared with standard insufflation. Objective: to assess if warmed and humidified CO2 insufflation with HumiGard™ device can achieve significant benefits over standard insufflation in terms of risk of hypothermia and cytokine response, in the setting of robot-assisted radical prostatectomy (RARP). Design: prospective, randomized, controlled clinical trial (September, 2015, June, 2016). Setting: single center study in a tertiary hospital. Participants: 64 patients with prostate cancer undergoing RARP were randomized, 32 to the treatment group and 32 to the control group. Intervention: the treatment group (H+WB) received warmed, humidified CO2 insufflation with HumiGard™ device, plus hot air warming blanket; the control group (WB) received standard CO2 insufflation, plus hot air warming blanket. Main outcomes and measures: BCT, plasma levels of cytokines IL-6 and TNF-α, pain scores, and intraoperative parameters. The data were analyzed according to the Bayesian paradigm. Results: intraoperative BCT increased in both groups during surgery, with a statistically significant difference favoring group H+WB, ending at 0.2°C higher on average than group WB. The overall BCT increase was 0.088 degree per hour in the WB group, with an additional 0.064 degree per hour in the H+WB group. No difference across groups, at none of the time points, could be shown as far as mean serum cytokine levels was concerned. No statistical differences were noted for pain scores and the other intraoperative parameters. Conclusions: during RARP, warm and humidified CO2 insufflation with the HumiGard™ device was more effective than the standard CO2 insufflation in maintaining the patient’s heat homeostasis, even if the difference was minimal. No benefit could be shown in terms of cytokine levels and pain scores. Trial registration: Clinicaltrials.gov Identifier: NCT02586974

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James, Michael J. "Relaxation of the human detrusor." Thesis, University of Nottingham, 1993. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.284528.

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Jalil, Rozh. "Assessing and improving the efficacy of cancer multi-disciplinary teams in urology." Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/25011.

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Cancer care driven by a multidisciplinary team (MDT) meeting is mandatory in UK and has become the platform to discuss cancer cases in many countries worldwide. My aim in this research is to assess the functionality and efficacy of the MDT meeting in making and implementing decisions. Specifically, I aim to develop tools to evaluate how MDTs make clinical decisions and recommendations, understand the role of leadership within these teams and measure why MDT decisions may not get implemented in patient care. The introduction chapter presents an exploration of the evidence base available in the literature on the functionality of cancer MDTs with a focus on how to assess the efficacy of MDTs. In this chapter, I used an 'input-process-outcome' framework as a systems approach to the MDT and its working. Chapter 2 is a systematic review of the existing evidence on MDT decision making and decision implementation across surgical specialties. Chapter 3 focuses on urological cancers and retrospectively evaluates MDT decision making from the perspective of implementation of team decisions into patient care. Chapters 4 and 5 present the views of core MDT members on the efficacy of the MDT in addition to problems and shortcomings faced by the MDT and also suggestions for improvement. Chapter 6 presents analysis of a survey on how to improve the efficiency of MDT. Chapters 7 and 8 present data from studies that objectively assess MDT performance by developing and validating observational assessment tools. Finally, the discussion chapter reflects on the findings of this research and discusses their implications for future research and practice.

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Holmström, Benny. "Early diagnosis and treatment of prostate cancer : observational studies in the National Prostate Cancer Register of Sweden and the Västerbotten Intervention Project." Doctoral thesis, Umeå universitet, Urologi och andrologi, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-42843.

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Prostate-specific antigen (PSA) testing has caused a steep increase in the incidence of prostate cancer, especially the incidence of localised low risk disease. In order to decrease the overdiagnosis accompanied by PSA testing, analysis of inherited genetic variants have been suggested as potential tools for clinical assessment of disease risk. With the aim of minimizing overtreatment and postpone side-effects of curative treatment for low risk prostate cancer, active surveillance, a treatment strategy with initial surveillance and deferred radical prostatectomy at the time of progression has evolved. The aim of this thesis was to study the validity of PSA (paper I) and inherited genetic variants (paper II) for early diagnosis of prostate cancer, to assess the extent of PSA testing in Sweden (paper III), and to study the safety of deferred radical prostatectomy in localised low to intermediate risk prostate cancer (paper IV). The study designs were i) case-control studies nested within the Västerbotten intervention project (paper I and II), ii) observational study in the Cancer Register of Sweden (paper III), and iii) observational study in the NPCR Follow-up study (paper IV). PSA had a high validity in predicting a prostate cancer diagnosis with an area under the receiver operating characteristics (ROC) curve of 0.86 (95% CI, 0.84 to 0.88). A combined test, including PSA, the ratio of free to total PSA, and 33 single nucleotide polymorphisms (SNPs) in a genetic risk score, increased the area under curve to 0.87 (95% CI, 0.85 to 0.89). The estimated uptake of PSA testing among men aged 55 to 69 years increased from zero to 56% between 1997 and 2007 and there were large variations in the uptake of PSA testing between counties in Sweden. After a median follow-up time of eight years there was no significant difference in presence of any one or more adverse pathology features or prostate cancer specific mortality after primary compared to deferred radical prostatectomy in localised low to intermediate risk prostate cancer. Results from these studies indicate that PSA and the hitherto identified SNPs are not suitable biomarkers in single-test prostate cancer screening. It is possible to estimate the uptake of PSA testing on a population level. Initial surveillance and deferred radical prostatectomy represent a feasible treatment strategy in localised low to intermediate risk prostate cancer.

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Mateu, Arrom Laura. "Desenvolupament d'una aplicació electrònica de diari miccional. Validació i estudi comparatiu respecte al diari miccional convencional en paper." Doctoral thesis, Universitat de Barcelona, 2019. http://hdl.handle.net/10803/667976.

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En aquesta tesi en primer lloc s’ha dut a terme el desenvolupament d’una aplicació de diari miccional per a smart-phon (eDM3d), seguint l’estructura del diari miccional de tres dies validat en espanyol i amb un disseny intuïtiu per facilitar el compliment per part dels pacients. Els resultats del diari miccional electrònic són transmesos de forma automàtica a un servidor web que és capaç de calcular els valors mitjans i màxims del diari miccional. D’aquest diari miccional electrònic se n’ha valorat la factibilitat en primer lloc en un grup reduït de pacients. Posteriorment s’ha demostrat la factibilitat, fiabilitat, bona correlació amb el diari miccional en paper i validesa convergent d’aquesta aplicació electrònica de diari miccional en un grup de pacients amb síndrome de bufeta hiperactiva o nictúria que disposaven de smart-phone. La majoria dels pacients han manifestat que elegirien el diari miccional electrònic eDM3d front al diari miccional convencional en paper si haguessin de repetir un diari miccional.
In a first phase a 3 day bladder diary as an easy-to-use application for smart-phone (eDM3d) was developed following the structure of the Spanish validated 3 day bladder diary. The preliminary feasibility of the app was assessed in a reduced number of patients. In a second phase, the feasibility, reliability, correlation with paper bladder diary and convergent validity of the app was proved in a group of patients with nocturia or overactive bladder syndrome and who possessed a smart-phone. Most of patients referred they would choose the electronic bladder diary eDM3d if they had to repeat a bladder diary again.

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Tunney, Michael Martin. "Characterisation, assessment and modification of ureteral stent biomaterials." Thesis, Queen's University Belfast, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368113.

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Eliasson, Mona, and Erika Karlsson. "Mannens ensak eller bådas angelägenhet : Prostatacancers påverkan på den heterosexuella relationen." Thesis, Halmstad University, School of Social and Health Sciences (HOS), 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-3819.

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När en man diagnostiseras med prostatacancer innebär det en psykisk påfrestning för mannen och hans kvinnliga partner. Reaktioner som chock, meningsförlust, ensamhet och ångest är vanligt förekommande. Syftet med denna litteraturstudie var att beskriva hur det vardagliga livet upplevs och påverkas hos par där mannen lever med diagnostiserad prostatacancer. Resultaten i studien baseras på tio vetenskapliga artiklar med fokus på parens erfarenheter av sjukdomen. Impotens, inkontinens och fatigue var symtom som drabbade mannen till följd av sjukdomen. Dessa förändringar inverkade på parets vardag och relation. Förändringarna var psykiskt påfrestande för parets hälsa och både mannens och kvinnans livskvalitet försämrades på grund av cancersjukdomen. Psykiska problem som depression, oro, ångest och skuld var dock mer förekommande hos kvinnan. Trots att paren var i stort behov av information upplevde de att hälso- och sjukvården inte uppmärksammade deras behov. Tydligare riktlinjer inom sjukvården för hur par som lever med prostatacancer ska bemötas efterlyses. På så sätt kan sjuksköterskan lättare tillgodose parets behov av information och stöd. Sjuksköterskan bör uppmärksamma och bemöta kvinnans individuella önskemål samt visa en öppenhet gentemot de sexuella problem som kan drabba paren. Mer forskning, speciellt i Skandinavien, efterlyses för att få en klarare bild över hur både en homosexuellt och heterosexuell relation påverkas av prostatacancer.

When a man is diagnosed with prostate cancer it implies a psychological strain for the man and his female partner where reactions such as shock, loss of meaning, loneliness and anxiety are common. The purpose of this literature review was to describe how everyday life is perceived and influenced in couples where the man has been diagnosed with prostate cancer. The results of the study are based on ten scientific articles focused on exploring couple’s experiences of the disease and how they are affected by the situation. Symptoms such as impotence, incontinence and fatigue were changes that affected the couple’s everyday life and their relationship. These changes were psychologically trying for the couple’s health and their quality of life decreased because of the cancer. Psychological problems like depression, anxiety and guilt were more common for the woman. Despite the fact that the couples were in great need of information, they felt that health care providers were not attentive to these needs. Clearer guidelines are needed within the health-care system for how couples living with prostate cancer should be treated. The nurse would thereafter be better equipped to meet the couple’s needs for information and support. The nurse should highlight and approach women’s individual needs and show openness towards the sexual problems that can befall couples. More research is needed, particularly in Scandinavia, in order to get a clearer picture of how a homosexual and heterosexual relationship is affected by prostate cancer.

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Aksenov, Alexey V. [Verfasser]. "Extended salvage pelvic lymph nodes dissection in patients with recurrent prostate cancer. Data base of the Department of urology and pediatric urology, University Hospital Schleswig-Holstein, Campus Kiel / Alexey V. Aksenov." Kiel : Universitätsbibliothek Kiel, 2015. http://d-nb.info/107184329X/34.

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Borges, Cláudio Ferreira 1980. "Avaliação nacional da exposição ocupacional à radiação por urologistas brasileiros." [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312456.

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Orientador: Adriano Fregonesi
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-26T20:23:11Z (GMT). No. of bitstreams: 1 Borges_ClaudioFerreira_D.pdf: 1990683 bytes, checksum: 1a75e1725e18e65f74c600f93224b4bb (MD5) Previous issue date: 2015
Resumo: Objetivo: Foi realizada uma pesquisa de âmbito nacional com urologistas brasileiros a fim de estudar seu comportamento frente à exposição à radiação e ao uso de equipamentos de proteção e monitoramento. Material e Métodos: Um questionário com 13 perguntas foi enviado por e-mail para urologistas brasileiros; as questões abordavam temas como características demográficas, a exposição à radiação, bem como a utilização de dispositivos de proteção e dosímetros. As razões pelas quais esses dispositivos não foram utilizados também foram investigadas. Resultados: Um total de 332 questionários foi preenchido completamente e analisado; a idade média dos entrevistados foi de 43,3 ± 10,8 anos. Aventais de chumbo e protetores de tireoide são utilizados em cada procedimento por 84,4% e 53,89% dos entrevistados, respectivamente. Óculos de proteção nunca são utilizados por 72,12% dos entrevistados. Urologistas mais velhos são mais propensos a não usar proteção adequada. Dos urologistas que responderam, 76,42% nunca usam dosímetros. Conclusão: Este estudo mostra uma utilização insatisfatória dos dispositivos de proteção contra radiação e dosímetros, revelando uma baixa adesão ao ALARA (as low as reasonably achievable) entre urologistas brasileiros
Abstract: Purpose: We performed a nationwide survey of Brazilian urologists to study behaviors toward radiation exposure and the use of protective and monitoring equipment. Material and Methods: A 13-question e-mail questionnaire was sent to Brazilian urologists; the questions addressed demographic characteristics, radiation exposure, and the utilization of shielding devices and dosimeters. The reasons why these devices were not used were also investigated. Results: A total of 332 completed questionnaires were analyzed; the median age of the respondents was 43.3 ± 10.8 years. Lead aprons and thyroid protection are utilized in every procedure by 84.4% and 53.89% of respondents, respectively. Protective eyeglasses are never used by 72.12% of the respondents. Older urologists were more likely not to use adequate protection. Of the urologists who responded, 76.42% never use dosimeters. Conclusion: This study shows an unsatisfactory utilization of radiation-shielding devices and dosimeters, revealing a low compliance to the ALARA (as low as reasonably achievable) principle among Brazilian urologists
Doutorado
Fisiopatologia Cirúrgica
Doutor em Ciências

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Nóbrega, Jessica Cavalcante da. "Dimetilarginina simétrica (SDMA) em gatos com doença do trato urinário inferior obstrutiva." Botucatu, 2019. http://hdl.handle.net/11449/191094.

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Orientador: Priscylla Tatiana Chalfun Guimarães Okamoto
Resumo: A doença do trato urinário inferior de felinos (DTUIF) corresponde a uma série de afecções que podem acometer a bexiga e a uretra desses animais. A forma obstrutiva é a consequência mais prevalente e mais grave dentre outras DTUIF, podendo levar o animal a azotemia pós-renal, redução da taxa de filtração glomerular (TFG) e a lesão renal aguda (LRA), que caso não seja tratada de forma eficiente, pode evoluir para doença renal crônica (DRC), uma doença frequente na população geriátrica felina. A creatinina sérica (sCr) é o biomarcador de TFG mais utilizado na clínica veterinária, porém apresenta baixa sensibilidade e diversos fatores que podem afetar seus valores. A dimetilarginina simétrica (SDMA) é um biomarcador mais recente na medicina veterinária que vem apresentado maior precocidade na detecção da perda da função renal e menor interferência de fatores extrarrenais, porém poucos são os trabalhos que determinam valores de SDMA em lesão renal de gatos. Este trabalho visou avaliar os valores de SDMA e compará-los com a sCr, ureia, dados hemogasométricos, escore clínico e tempo de obstrução de gatos com DTUIF obstrutiva. Os animais foram alocados em dois grupos experimentais, sendo 17 animais do grupo obstruído (GO) e 13 animais sadios para grupo controle (GC). As amostras foram coletadas antes da desobstrução (M0) e durante o tratamento clínico, nos momentos 12, 24 e 48 horas (M12, M24 e M48). Resultados obtidos demonstraram que no M48 do GO, 50% dos gatos obstruídos apresent... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Feline lower urinary tract disease (FLUTD) is a series of conditions that can affect the bladder and urethra of these animals. The obstructive form is the most prevalent and most serious consequence among other FLUTD, which can lead to post-renal azotemia and reduced glomerular filtration rate (GFR) and acute kidney injury (AKI), which if not treated effectively, can progress to chronic kidney disease (CKD), a common disease in the feline geriatric population. Serum creatinine (sCr) is the biomarker of GFR most commonly used in veterinary pratice, but it has low sensitivity and there are several factors that may affect its values. Symmetrical dimethylarginine (SDMA) is a newer biomarker in veterinary medicine that has been shown to be more precocious in detecting loss of renal function and less interference of extrarenal factors, but there are few studies determining SDMA values in feline kidney injury. This work aimed to evaluate SDMA values and to correlate them with sCr, urea, hemogasometric data, clinical score and duration of obstruction of felines with obstructive DTUIF. The animals were allocated into two experimental groups, 17 animals from the obstructed group (GO) and 13 healthy animals for control group (GC). Samples were collected before clearance (M0) and during clinical treatment at 12, 24 and 48 hours (M12, M24 and M48). The results obtained were that in GO M48, 50% of obstructed cats had SDMA values above normal, while for sCr only 29.41% of cats were elevated... (Complete abstract click electronic access below)
Mestre

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Jiang, Chong-He. "Prolonged Modulation of the Micturition Reflex by Electrical Stimulation." Doctoral thesis, Linköpings universitet, Cellbiologi, 1999. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-4989.

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Intravesical electrical stimulation (IVES) has been used in treatment of patients with urinary bladder dysfunctions for more than four decades. While some investigators have reported excellent results others have observed less convincing effects or outright failures. The discrepancies may reflect differences in patient selection or stimulation procedure. A better theoretical understanding of the IVES working mechanism might help to improve the success rate of the treatment. The aims of the present study were to provide such information. Experiments were performed on adult female cats and rats under /alpha/-chloralose anesthesia. IVES was delivered by a catheter electrode in the bladder. At proper intensity and frequency, IVES evoked reflex detrusor contractions that were abolished by bilateral rhizotomy of sacral dorsal roots. Stimulation parameters and response characteristics revealed that bladder mechanoreceptor A/delta/ afferents were activated by the IVES, the same afferents that drive the normal micturition reflex. Five minutes of continues IVES at 20 Hz induced a prolonged, significant decrease in the micturition threshold volume of anesthetized rats. Similarly, selective bladder A/delta/ afferent stimulation induced a long-lasting enhancement of micturition reflex discharges in cats. A comparable prolonged inhibitory effect on the micturition reflex was demonstrated after ano-genital afferent stimulation. Both modulatory effects occurred without changes in response sensitivity of stimulated afferents. The IVES induced modulation was prevented by transient exposure of the bladder to a local anesthetic and by systemic administration of a glutamate NMDA receptor antagonist. In conclusion, IVES induces a prolonged modulation of the micturition reflex by an LTP like enhancement of excitatory synaptic transmission in the central micturition reflex pathway. The findings provide an experimental explanation for the neuronal mechanisms underlying the curative effect of IVES in patients with bladder evacuation problems.
On the day of the public defence the status of article V was: Accepted.

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Lundström, Karl-Johan. "Outcomes and complications in surgical and urological procedures." Doctoral thesis, Umeå universitet, Institutionen för kirurgisk och perioperativ vetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-135046.

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Background: Minor procedures in surgery and urology such as groin hernia and hydrocele repair, as well as prostate biopsies are very frequently done in routine practice. Complications and insufficient outcomes thus affecting many patients and the cumulative effect of this are of major importance in a population perspective. Aim: To explore complications and outcomes of surgical or diagnostic procedures and possible risk factors or predictors for adverse effects. Methods: By using both national quality and administrative registers, and by complementing registers with patient reported outcome measures, examine outcomes such as complications, persistent pain and recurrences. Also, in the case of hydro and spermatoceles, report incidence numbers. Further, by using a randomized trial, explore minimally invasive procedure such as sclerotheraphy compared to conventional surgery in respect to cure and adverse events. Results: When comparing with the open anterior mesh repair, endoscopic technique is advantageous in respect to the patient reported outcome of persistent pain. The drawback was an increased risk of postoperative complications and reoperation for recurrence. Incidence numbers for hydro and spematocele were 100/100000 men. Aspiration (± sclerotherapy) had a significantly lower rate of complications as compared to conventional surgery. In the interim analysis of the randomized trial, comparing sclerotherapy to Lord´s procedure for hydroceles, the cure rate was similar between treatments. Definite conclusions cannot be made due to the risk of type 2 errors, and the study will thus continue. In the case of trans-rectal prostate biopsy, the rates increased every year during the study time frame, up to an approximate risk of two per cent in 2012 for hospital readmission within 30 days, without an increased mortality within 30 days. Conclusions: The open anterior mesh procedure is still the preferred method for groin hernia repair in routine surgical practice. Hydro and spermatocele surgery is associated with high rates of complications, and the indication for repair should be scrutinized. The rates of infection after prostate biopsy is increasing and methods to reduce unnecessary biopsies as well as improved prophylaxis should be investigated.

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Söderberg, Daniel. "The Contribution of Innate Immunity to the Pathogenesis of ANCA-associated Vasculitis." Doctoral thesis, Linköpings universitet, Avdelningen för läkemedelsforskning, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-132327.

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Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) constitute a group of vasculitides characterized by neutrophil-rich necrotizing inflammation of small vessels and the presence of ANCA in the circulation. Dying neutrophils surrounding the walls of small vessels are a histological hallmark of AAV. Traditionally it has been assumed that these neutrophils die by necrosis, but neutrophil extracellular traps (NETs) have recently been visualized at the sites of vasculitic lesions. NETs were first described to be involved in capture and elimination of pathogens but dysregulated production and/or clearance of NETs are thought to contribute to vessel inflammation in AAV; directly by damaging endothelial cells and indirectly by acting as a link between the innate and adaptive immune system through the generation of pathogenic PR3-ANCA and MPO-ANCA that can activate neutrophils. ANCA can, however, be found in all individuals and are therefore suggested to belong to the repertoire of natural antibodies produced by innate-like B cells, implying that not all ANCA are pathogenic. In paper I, we found neutrophils in patients to be more prone to undergo NETosis/necrosis spontaneously compared with neutrophils in healthy controls (HC), as well as that active patients possessed elevated levels of NETs in the circulation. Our results also suggest that ANCA during remission could contribute to the clearance of NETs as we observed an inverse relation between ANCA and NETs. In paper II, we observed neutrophils in patients to be more easily activated upon ANCA stimulation as they produced more ROS than neutrophils in HC. In paper III, we showed for the first time that cells of adaptive immunity (B and T cells) in addition to cells of innate immunity can release ET-like structures, in this case consisting of mitochondrial (mt) DNA. mtDNA can act as a damage-associated pattern molecule (DAMP) and promote inflammation, and increased levels of mtDNA has been observed in AAV. Our finding broadens our perspective of the possible roles of T and B cells in immunological responses, and should be further investigated in AAV. In paper IV, we observed reduced frequencies of MZ-like B cells, considered to be innate-like B cells that produce natural antibodies, and of the proposed regulatory B (Breg) cell populations CD24highCD27+ and CD25+CD27+ B cells in patients, particularly in those with active disease. We also observed the phenotypes of these different Breg cell populations to be different from the corresponding cells in HC. We hypothesize that the increased activation potential by neutrophils in AAV to produce ROS and undergo NETosis/necrosis contribute to the excessive inflammation as well as an increased antigen load of PR3 and MPO, and that this in combination with dysregulation of innate-like B cells and Breg cells could lead to break of tolerance to these antigens and production of pathogenic autoantibodies. ANCA can in turn activate neutrophils to release NETs, suggesting a vicious circle in disease development.

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Weißenfels, Paul. "Verankerungselemente im urethralen Kontinenzapparat des Mannes." Doctoral thesis, Universitätsbibliothek Leipzig, 2011. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-77137.

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Die Belastungsinkontinenz des Mannes ist eine häufige Komplikation der radikalen Prostatovesikulektomie. Abgewandelte Operationstechniken und Rekonstruktions-verfahren führen zu verbesserten postoperativen Kontinenzraten und weisen auf die Bedeutung einzelner Komponenten am urethralen Verschlussmechanismus hin. Im Vergleich zum weiblichen ist der männliche Harnkontinenzmechanismus nur ansatzweise verstanden. In der vorliegenden Arbeit werden die am urethralen Verschluss beteiligten Komponenten und ihre Verbindungen zu angrenzenden Strukturen makroskopisch und mikroskopisch analysiert und auf ihre funktionelle Bedeutung untersucht. Zehn konservierte Leichname wurden für Untersuchungen des männlichen Urogenitaltraktes genutzt, aus drei Becken wurden Organpakete für die Erstellung von mikroskopischen Schnittpräparaten entnommen. Die histologischen Untersuchungen konnten zeigen, dass die Form des Musculus sphincter urethrae externus im Transversalschnitt von der Schnitthöhe abhängig ist. Seine Fasern strahlen in die Faszie des Musculus levator ani ein. Auch die Fasern des Corpus perineale inserieren in die Faszie dieses Muskels. Anhand dieser Ergebnisse wird die zentrale Rolle des Musculus levator ani im männlichen Harnkontinenzapparat deutlich. Der eigentliche Verschlussdruck wird demnach durch den Musculus levator ani aufgebaut und durch das Corpus perineale von dorsal auf die Urethra übertragen. Die Aufgabe des Musculus sphincter urethrae externus wird nicht als primär aktiv, sondern als dynamisches Widerlager für die membranöse Urethra beschrieben. Außerdem geht die Arbeit auf die noch wenig erforschte Mediatorfunktion der glatten Muskulatur im männlichen Urogenitaltrakt ein. Diese Ergebnisse präzisieren die Vorstellung des Kontinenzmechanismus des Mannes als Zusammenspiel von unterschiedlichen Komponenten und geben Anlass, aktuelle Standardtechniken der Beckenchirurgie zu überdenken und den Fokus auf schonende bzw. rekonstruktive Operationsverfahren zu richten.

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Лобода, Андрій Миколайович, Андрей Николаевич Лобода, Andrii Mykolaiovych Loboda, Т. О. Лобода, and В. Д. Ставчий. "Ефективність застосування лазеропунктури в комплексному лікуванні енурезу у дітей." Thesis, Видавництво СумДУ, 2004. http://essuir.sumdu.edu.ua/handle/123456789/8973.

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Masarovičová, Martina. "Statistické srovnání výsledků perkutánních, ureteroskopických a robotických operací pro obstrukci ureteropelvické junkce." Master's thesis, Vysoká škola ekonomická v Praze, 2008. http://www.nusl.cz/ntk/nusl-76990.

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The aim of this diploma thesis is statistical processing of a sample of patients that have been hospitalized and treated for ureteropelvic junction obstruction at the urological department of ÚNV Prague in last 20 years and to determine the optimal treatment method. Evaluation of surgical techniques from the surgical and economical point of creates a comprehensive image of advantages and disadvantages connected with application of a particular method and enables all participating subjects to decide in case of doubt. In this case the statistical analysis is a proper instrument, leading to find answers, however, it also gives an opportunity for discussion.

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Türk, Ingolf. "Bedeutung laparoskopischer Operationen in der Urologie unter besonderer Berücksichtigung ihres Stellenwertes in der Therapie onkologischer Erkrankungen." Doctoral thesis, Humboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité, 2002. http://dx.doi.org/10.18452/13830.

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Die Laparoskopischen Operationsverfahren haben sich einen festen Platz im operativen Spektrum der Urologie erobert. Unstrittig ist ihr Einsatz im Rahmen der Therapie nicht maligner Erkrankungen, wie Hodensuche, Nephrektomie, Adrenalektomie oder der plevinen Lymphadenektomie. Hier kommen die entscheidenden Vorteile der Laparoskopie, eine deutlich reduzierte intra- und postoperative Morbidität im Vergleich zu den konventionell offenen Operationen mit kürzerer Krankenhausverweildauer und schnellerer Rekonvaleszens zum Tragen. Auch geringere postoperative Schmerzen, ein besseres kosmetisches Ergebnis und schnellere Rückkehr zum Alltagsleben sind Gründe, weshalb Patienten laparoskopische Techniken gegenüber konventionell offenen Operationen bevorzugen. Noch Gegenstand der Diskussion in der Deutschen Urologie ist der Einsatz der Laparoskopie in der Therapie urologischer Tumoren. Akzeptiert ist die laparoskopische radikale Tumornephrektomie, wohingegen Operationen wie die laparoskopische retropertioneale Lymphadenektomie, die laparoskopische Nierenteilresektion, die laparoskopische radikale Prostatektomie oder die Zystektomie mit Harnableitung teilweise als experimetell angesehen werden. Unsere bisherigen Erfahrungen mit diesen Eingriffen zeigen jedoch, dass die onkologischen Ergebnisse durch die Anwendung der Laparoskopie nicht kompromitiert werden. Auch die funktionellen Resultate nach laparoskopischer Prostatektomie oder Zystektomie mit Harnableitung sind überzeugend und mit denen nach konventionell offener Operation vergleichbar. Langzeitergebnisse bleiben jedoch abzuwarten. Die mit der Laparoskopie verbundene geringere Invasivität und das geringere perioperative Trauma führen zu einer weniger ausgeprägten postoperativen Immundepression. Möglicherweise führt das zu besseren Überlebensraten. Sollte sich diese Theorie bestätigen würde das den Stellenwert der Laparoskopie bei der Behandlung maligner Erkrankungen in der Urologie nachhaltig verändern. Nach wie vor sind der überwiegende Teil urologisch laparoskopischer Operationen mit einer steilen Lernkurve verbunden. Das unkritische Ausüben laparoskopischer Operationen führt zu einer unnötig hohen Komplikationsrate. Einem stufenweisen Ausbildungsprogramm mit schrittweiser Annäherung an technisch komplizierte Manöver muß grösste Aufmerksamkeit geschenkt werden. Mit der technischen Weiterentwicklung und der Integration von Manipulatoren und Robotern wird die Erlernbarkeit und Reproduzierbarkeit von komplexen und komplizierten laparoskopischen Eingriffen erleichtert. Dieser Entwicklung gehört die Zukunft in der minimal invasiven Chirurgie.
In the last 10 years, laparoscopic surgery became an accepted alternative in the treatment of urological diseases. In many situations such as undescended testes, simple nephrectomy, adrenalectomy, and pelvic lymph node dissection, the laparoscopic approach is often the standard of care. Advantages of the laparoscopic approach include reduced peri-operative morbidity, reduced post-operative pain, shorter hospital stay, shorter recovery time after hospital discharge, superior cosmesis, and faster return to work. In the field of urological malignancies, however, laparoscopy is controversial. Laparoscopic radical nephrectomy for renal cell carcinoma is an accepted oncologic procedure. However, laparoscopic approaches to procedures such as retroperitoneal lymph node dissection for testicular cancer, partial nephrectomy, radical prostatectomy and radical cystectomy with urinary diversion are still considered experimental. Our experiences so far with these kinds of procedures have shown that the use of the laparoscopic approach does not compromise the oncological results. Even the functional results after laparoscopic prostatectomy or urinary diversions are comparable with those after conventional open surgery. Long-term follow up, of course, is needed for any final judgements. The minimal invasiveness of the laparoscopic approach together with the reduced trauma of the surgery may translate into reduced postoperative depression of the immune system. This finding might have the potential to benefit the long-term survival of cancer patients. If this theory were confirmed, it would change the role of laparoscopy as a treatment option for urologic malignancies. Unfortunately, most urologic laparoscopic procedures are associated with a steep learning curve, and any haphazard or overzealous use of laparoscopic techniques will cause unnecessarily high complication rates. Therefore, a step-by-step learning program will be crucial for surgeons to become proficient with complicated urologic laparoscopic procedures. With technical advances, we can expect the introduction of manipulators and robots in the field that will improve the learning and execution of complex laparoscopic cases. Surgical robots may, indeed, become the future of minimally invasive surgery.

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Сікора, Володимир Віталійович, Владимир Витальевич Сикора, Volodymyr Vitaliiovych Sikora, and М. М. Соловйова. "Переваги лазеротерапії в лікуванні хворих урологічного профілю над іншими методами лікування." Thesis, Видавництво СумДУ, 2012. http://essuir.sumdu.edu.ua/handle/123456789/27311.

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44

Stranne, Johan. "Inguinal hernia after urologic surgery in males with special reference to radical retropubic prostatectomy : a clinical, epidemiological and methodological study /." Göteborg : Department of Urology, Institute of Clinical Sciences, The Sahlgrenska Academy at Göteborg University, Sahlgrenska University Hospital, 2006. http://hdl.handle.net/2077/706.

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45

Сікора, Володимир Віталійович, Владимир Витальевич Сикора, Volodymyr Vitaliiovych Sikora, and О. В. Артеменко. "Клініко-діагностичні й лікувальні аспекти каменів простати." Thesis, Видавництво СумДУ, 2011. http://essuir.sumdu.edu.ua/handle/123456789/15217.

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Slind, Olsen Renate. "Circulating and genetic factors in colorectal cancer : Potential factors for establishing prognosis?" Doctoral thesis, Linköpings universitet, Avdelningen för läkemedelsforskning, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-136841.

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Colorectal cancer (CRC) is defined as a cancer appearing in the colon or in the rectum. In Sweden, ~ 6300 individuals were diagnosed with the disease in 2014 and ~ 2550 individuals diagnosed with CRC die each year due to their cancer. Surgery is the main treatment option of CRC and a survival rate of ~ 10 % is estimated if distant metastases have developed. It is therefore of importance to find factors that may be useful together with tumour, node, metastasis (TNM) stage to establish early CRC diagnosis, prognosis and follow-up of CRC patients. The aim of this thesis was to study the possible association of CD93, PLA2G4C, PDGF-D and inflammatory cytokines with CRC disease progression. In a prospective study approach CD93 and PLA2G4C single nucleotide polymorphisms (SNPs) were of potential importance in CRC prognosis. The T/T genotype of CD93 was associated with an increased CD93 expression in CRC tissue. Further, CRC patients carrying this genotype were associated with disseminated CRC at diagnosis and a lower recurrence-free survival after surgery. The A allele of a SNP of PLA2G4C was a stronger predictor for CRC-specific mortality than the conventional risk factors used in the clinic for selection of TNM stage II patients for adjuvant treatment. This indicates that the T/T genotype of CD93 and the A allele of PLA2G4C may be potential genetic factors related to disease severity and spread. Furthermore, they distinguish CRC patients that may benefit from a more comprehensive follow-up and adjuvant treatment. To study the putative involvement of PDGF-D in CRC the effects of PDGF-D signalling was studied in vitro. PDGF-D signalling altered the expression of genes of importance in CRC carcinogenesis and proliferation which was blocked by imatinib, a tyrosine kinase inhibitor. This indicates that PDGF-D signalling may be an important pathway in CRC progression and a potential target in CRC treatment. The analysis of various inflammatory cytokines in plasma at diagnosis showed an association between high levels and increased total- or CRC-specific mortality two years after surgery. High levels of CCL1 and CCL24 was the only cytokines strongly correlated with a worse CRC prognosis after statistical adjustments and may be of interest for further evaluation. In conclusion, this thesis presents circulating and genetic factors such as CD93, PLA2G4C, PDGF-D, CCL1 and CCL24 that may be of importance in CRC progression and may be of clinical value together with TNM stage in establishing prognosis.
Kolorektal cancer är en tumör i kolon eller rektum. I Sverige diagnosticerades år 2014 ca6300 individer med denna cancertyp och ca 2550 personer dör årligen till följd av kolorektalcancer. Operation är det huvudsakliga behandlingsalternativet för kolorektal cancer och vidfjärrmetastaser är överlevnaden < 10 %. Det är därför viktigt att hitta markörer somtillsammans med TNM-stadium kan ge tidig information om sjukdomens prognos och lämpliguppföljning av patienter. Utveckling av kolorektal cancer sker genom ackumulering av genetiska mutationer ochepigenetisk nedreglering av tumörsuppressorgener. Därutöver spelar interaktionen mellantumören och dess närmaste omgivning, innehållande tillväxt- och inflammatoriska faktorer,en viktig roll i tumörens utveckling och metastasering. Syftet med avhandlingen var att studera associationen mellan CD93, PLA2G4C, PDGF-D samtinflammatoriska cytokiner och kolorektal cancer progression. En prospektiv studie visade att CD93 och PLA2G4C SNP var potentiellt viktiga förbedömningav kolorektal cancer prognos. T/T genotypen av SNP rs2749817 i CD93 var associerad medhögre uttryck av CD93 i kolorektal cancer vävnad, främst bland patienter i stadium IV.Därutöver observerades fler återfall efter operation hos patienter med T/T genotypen. Aallelen hos PLA2G4C SNP rs1549637 är en möjligtvis bättre markör för cancerspecifiköverlevnad vid stadium II än faktorer som idag används för att selektera patienter tilladjuvant behandling. Sammantaget antyder detta att T/T genotypen av CD93 och A allelenav PLA2G4C kan vara genetiska markörer relaterade till allvarlig tumörsjukdom ochspridning. Därutöver kan de eventuellt selektera patienter som kräver tätare uppföljning ochadjuvant behandling. För att studera den förmodade inblandningen av PDGF-D i kolorektal cancer undersöktesdess effekt på PDGF-D signalering in vitro. PDGF-D signaleringen förändradegenexpressionen av gener involverade i tumörutveckling och spridning, vilken kundeblockeras av tyrosinkinashämmaren imatinib. Det antyder att PDGF-D signalering kan vara enviktig faktor vid kolorektal cancer progression och ett potentiellt mål för behandling. Analysen av ett flertal inflammatoriska cytokiner visade en korrelation mellan högacytokinnivåer och ökad cancerspecifik och total dödlighet två år efter operation. Höga CCL1och CCL24 nivåer var de enda faktorerna som förblev signifikant associerade medcancerspecifik mortalitet vid fördjupad statistisk analys och bör studeras vidare. Sammanfattningsvis presenterar denna avhandling cirkulerande och genetiska faktorersåsom CD93, PLA2G4C, PDGF-D, CCL1 and CCL24 som eventuellt är viktiga vid bedömning avkolorektal cancer progression tillsammans med TNM stadium.

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Байло, О. В. "Малоінвазивне лікування звужень сечівника." Thesis, Видавництво СумДУ, 2011. http://essuir.sumdu.edu.ua/handle/123456789/15264.

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Хсино, Исса. "Опыт внедрения и применения лапароскопических операций в урологии на базе ЦГКБ № 1." Thesis, Сумский государственный университет, 2015. http://essuir.sumdu.edu.ua/handle/123456789/42191.

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В урологии оперативная лапароскопия стала внедряться сравнительно поздно и не столь широко, как в других разделах хирургии. Это связано скорее всего с тем, что изначально лапароскопические операции разрабатывались для органов брюшной полости и требовалось время для осознания возможностей данной технологии для вмешательств на других органах, в частности на органах забрюшинного пространства. Анатомически и технически наиболее рациональны лапароскопические операции в урологии при варикоцеле и кистах почек. При этой патологии объекты операции находятся в непосредственной близости от брюшины или предлежат к ней, что существенно облегчает проведение вмешательства. С другой стороны известно, что традиционные операции при этих нозологиях не являются абсолютно эффективными и дают определённый процент рецидивов и осложнений, а при люмботомии несравненно более тяжёлую операционную травму.

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Сікора, Володимир Віталійович, Владимир Витальевич Сикора, Volodymyr Vitaliiovych Sikora, Ю. М. Шевцова, and М. Г. Сівер. "Лапароскопічні операції в урології." Thesis, Видавництво СумДУ, 2010. http://essuir.sumdu.edu.ua/handle/123456789/5548.

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Grant, Joshua Ford. "Electrospun Blends of Polydioxanone and Fibrinogen for Urological Applications." VCU Scholars Compass, 2007. http://scholarscompass.vcu.edu/etd/891.

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The need for tissue and organ replacements cannot be satisfied by autograft and allografts alone. The purpose of this study was to investigate the feasibility of electrospinning a blend of polydioxanone and fibrinogen to produce an engineered tissue scaffold. Fiber diameter and pore size of blends were characterized, as well as mechanical strength. Cell proliferation assays for 1 and 7 day cultures were preformed, and a histological evaluation was performed to determine how favorable the various blends were to cell infiltration and proliferation. Some ratios of blends were identified that contained both acceptable mechanical properties and properties that facilitated cell infiltration. These findings pave the way for future refinement and use of these scaffolds for a variety of tissue engineered targets.

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Dissertations / Theses on the topic 'Urology'

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