64 research outputs found
Changes in Ureteral Stone Treatment During COVID-19: A Single-Center Emergency Department Study
No full textAdrian Militaru,1,2 Catalin Andrei Bulai,1,2 Cosmin Victor Ene,1,2 Razvan Ionut Popescu,1,3 Cristian Mares,1,2 Stefan Marian Balacescu,1,2 Razvan Dragos Multescu,1,2 Dragos Adrian Georgescu,1,2 Petrisor Aurelian Geavlete,1,2 Bogdan Florin Geavlete1,2 1Department of Urology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; 2Department of Urology, “Saint John” Clinical Emergency Hospital, Bucharest, Romania; 3Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, Bucharest, RomaniaCorrespondence: Catalin Andrei Bulai, Department of Urology, “Saint John” Clinical Emergency Hospital, 13 Vitan-Barzesti str, Bucharest, 042122, Romania, Tel +40749184205, Email [email protected]: We evaluated the hospitalization rate, length of stay, and management of patients with ureteric lithiasis admitted under emergency conditions at a single institution during the COVID-19 pandemic.Patients and Methods: A retrospective study was conducted on 219 patients with ureteral lithiasis, divided into pre-COVID-19 (1.10.2019– 29.02.2020) and COVID-19 groups (1.10.2020– 29.02.2021). The study examined patient and stone characteristics, hospitalization duration, surgical interventions, creatinine levels, and associated urinary tract infections. It also evaluated the complications related to delayed treatment during the pandemic.Results: The study found a 73.41% reduction in admissions for obstructive ureteral lithiasis during the COVID-19 pandemic compared to the pre-pandemic period. Notable differences were observed in age (61.5 vs 46 years, p=0.000), gender (p=0.046), stone laterality (p=0.024), location (p=0.002), serum creatinine levels (1.59 vs 1.09 mg/dL, p=0.000), and urine cultures (45.65% vs 23.12%, p=0.002). During the pandemic period, the rate of primary stone extraction procedures decreased (32.6% vs 59%, p< 0.001), while operative time (52.89 vs 39.84 minutes, p< 0.001) and hospital stay significantly increased (13.09 vs 3.76 days, p< 0.001).Conclusion: The pandemic resulted in fewer hospitalizations for ureteral lithiasis and an increase in complications, likely due to reduced access to medical care and a greater tendency for upper urinary tract drainage.Keywords: COVID-19, urolithiasis, ureteroscopy, double J stent, ureteral stone, percutaneous nephrostom
Combined MPC and reinforcement learning for traffic signal control in urban traffic networks
No full textIn general, the performance of model-based controllers cannot be guaranteed under model uncertainties or disturbances, while learning-based controllers require an extensively sufficient training process to perform well. These issues especially hold for large-scale nonlinear systems such as urban traffic networks. In this paper, a new framework is proposed by combining model predictive control (MPC) and reinforcement learning (RL) to provide desired performance for urban traffic networks even during the learning process, despite model uncertainties and disturbances. MPC and RL complement each other very well, since MPC provides a sub-optimal and constraint-satisfying control input while RL provides adaptive control laws and can handle uncertainties and disturbances. The resulting combined framework is applied for traffic signal control (TSC) of an urban traffic network. A case study is carried out to compare the performance of the proposed framework and other baseline controllers. Results show that the proposed combined framework outperforms conventional control methods under system uncertainties, in terms of reducing traffic congestion. Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Team Bart De SchutterControl & SimulationDelft Center for Systems and Contro
Comparison of Flexible Ureteroscope Performance between Reusable and Single-Use Models
No full textBackground: Single-use flexible ureteroscopes for urinary retention have been developed in recent years as an alternative to reusable ureteroscopes in order to eliminate the risk of cross-infections and to solve the primary limitations of traditional reusable flexible ureteroscopes for urinary retention. Methods: In this study, we evaluated and contrasted three of the most recent types of flexible ureteroscopes, including two digital reusable versions (Olympus URF-V and Olympus URF-V2) and one single-use model (Pusen Medi-calUscope UE3022), in both ex vivo and in vivo scenarios. The influence of a variety of instruments on the flow of irrigation and its deflection was investigated ex vivo. In the in vivo investigation, a total of 40 patients were treated with retrograde fURS utilizing URF-V, 20 patients were treated with URF-V2, and 20 patients were treated with single-use fURS. The visibility and maneuverability of each fURS were evaluated by the same urologist during the procedures, and the results were compared. Results: Intraoperatively, we compared the image quality of reusable (URF-V and URF-V2) and single-use fURS USCOPE UE3022 cameras and found that there was no statistically significant difference between the two types of camera. The score for maneuverability was the same (4.2) regardless of whether we used the UscopeUE3022 or the URF-V2, but it was significantly lower (3.8, p = 0.03) when we utilized the URF-V. Irrigation was about the same when utilizing reused scopes, whereas employing a single-use scope was more than fifty percent more effective. Conclusions: The findings of our research indicate that reusable and single-use fURs have visibility and maneuverability characteristics that are at least comparable to one another. The possibilities of the single-use type in terms of irrigation flow and deflection are superior
extract in the treatment of benign prostatic hyperplasia
No full textWe are experiencing a revival of interest in phytotherapeutic agents, both in Europe and North America, especially as a consequence of patients’ dissatisfaction with the adverse effects of the medical alternatives. One of the most frequently prescribed and studied such agents is Serenoa repens extract, derived from the berry of the dwarf palm tree. We aimed to review the most important published data regarding this type of treatment for benign prostatic hyperplasia. A review of the existing articles regarding the use of Serenoa repens extracts for benign prostatic hyperplasia was performed. The articles were analysed with regard to their relevance, scientific value and the size of the evaluated series. Multiple mechanisms of action have been attributed to this extract, including antiandrogenic action, an anti-inflammatory/anti-oedematous effect, prolactin signal modulation, and an antiproliferative effect exerted through the inhibition of growth factors. Regarding efficacy, European Association of Urology guidelines state that Serenoa repens extracts significantly reduce nocturia in comparison with placebo. However, the guideline committee is unable to make specific recommendations about phytotherapy of male lower urinary tract symptoms owing to the heterogeneity of the products and the methodological problems associated with meta-analyses. Most of the published trials regarding Serenoa repens phytotherapy demonstrate a significant improvement of urinary status and a favourable safety profile. Also, some authors have credited it with giving a significant improvement in erectile function and decreasing complications following transurethral resection of the prostate, especially bleeding. The results of phytotherapy with Serenoa repens extracts are very promising. More high-quality, randomized, placebo-controlled studies are required in order to demonstrate without doubt the true therapeutic value of these products. Particular attention must be focused on differentiating between registered preparations, which are regulated as drugs, and those considered to be food supplements
Retrograde flexible ureteroscopic approach of upper urinary tract pathology: What is the status in 2014?
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Surgical management of urachal tumors: Can the umbilicus be sparred in localized disease?
No full textUrachal adenocarcinoma represents the third most common histological type of non-urotelial bladder cancer. A very low incidence of this disease and the lack of prospective studies have led to a rich and heterogeneous treatment history. Currently, the standard of care for these patients is represented by partial cystectomy en bloc with resection of the urachal ligament and total omphalectomy. The aim of this article is to present our experience and results in the management of patients with urachal adenocarcinoma. Between 2005 and 2015, 16 patients have undergone surgical treatment for urachal adenocarcinoma in "Fundeni" Clinical Institute and Madrid University Hospital "Infanta Sofia." Partial cystectomy was performed in 11 (68.76%) patients, while radical cystectomy en bloc with omphalectomy was performed in 5 (31.25%) patients, which were not amendable to a limited resection. The Sheldon classification was used, as it provides appropriate disease staging and is the most commonly utilized. Postoperative pathological results showed that 7 (43.75%) patients had localized tumors, and more than one-third (37.5%) of the patients had locally advanced Sheldon III disease, while 3 patients had distant metastasis at the time of surgery. Lymph node involvement was present in 3 patients (18.75%). Mean follow-up time was 2.5 years, ranging from 4 months to 7.6 years. Three patients (18.75%) were lost to follow-up, without any documented signs of local or systemic recurrence and were cancer free at the time of the last evaluation. In cases with lymph node involvement, local recurrence or distant metastasis, patients underwent cisplatin- or 5-fluorouracil-based salvage chemotherapy. Surgical treatment represents the gold standard, while adjuvant chemotherapy has a limited impact on overall survival. The utility of navel resection is questionable due to the rarity of direct invasion or local recurrence
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