392 research outputs found
Where do urologists stand in the era of novel coronavirus-2019 disease
No full textPurpose of reviewThe novel coronavirus-2019 disease (COVID-19) pandemic has had devastating consequences on healthcare systems globally. The effect this has on urologists and the patients they care for is not fully understood and presents the challenge of prioritizing the most urgent cases. We aim to review the impact on urology services and evaluate strategies to minimize disruption.Recent findingsVarious healthcare systems have been forced to postpone treatment for many urological conditions as resources are dedicated to the treatment of COVID-19. Training has been postponed as staff are reallocated to areas of need. Face-to-face contact is largely minimized and innovative, virtual communication methods are used in the outpatient setting and multidisciplinary team meetings. Surgical practice is changing because of the risks posed by COVID-19 and procedures can be prioritized in a nonurgent, low priority, high priority or emergency category.SummaryAlthough the COVID-19 pandemic will inevitably affect urological services, steps can be taken to mitigate the impact and prioritize the patients most in need of urgent care. Similarly, in future; simulation, e-learning and webinars will allow interaction to share, discuss and debate focused training and education. © 2020 Lippincott Williams and Wilkins. All rights reserved
Prognostic role of pretreatment neutrophil-to-lymphocyte ratio (NLR) in patients with non–muscle-invasive bladder cancer (NMIBC): A systematic review and meta-analysis
No full textObjective: The aim of this study was to summarize and analyze the current evidence regarding the prognostic and predictive value of preoperative neutrophil-to-lymphocyte ratio (NLR) in patients undergoing transurethral resection of bladder tumors (TURBT) for non–muscle-invasive bladder cancer (NMIBC). Material and methods: A systematic search of Web of Science, Medline/PubMed, Google Scholar, and Cochrane library was performed on the 1st of March, 2018. Studies were deemed eligible if they compared NMIBC patients with high vs. low NLR before TURBT to determine its value for prognosticating disease recurrence and progression using multivariable analysis. We performed a formal meta-analysis for both recurrence-free (RFS) and progression-free survival (PFS). Results: Six studies encompassing 2,298 patients (477 [20.7%] females) assessed the prognostic value of NLR in NMIBC patients treated with TURBT. NLR predicted worse RFS (pooled HR = 1.78; 95% CI: 1.32–2.4, P<0.001) and PFS (pooled HR = 2.14; 95% CI: 1.59–2.87, P<0.001). In 4 studies encompassing 599 patients, high pretreatment NLR was associated with decreased RFS (pooled HR = 2.31; 95% CI: 1.27–4.22, P = 0.006) and in 3 of them high pretreatment NLR was associated with decreased PFS (pooled HR = 2.54; 95% CI: 1.36–4.71, P = 0.003) in high-risk NMIBC patients treated with BCG. Conclusion: In this meta-analysis, peripheral blood levels of NLR were associated with an increased risk of disease recurrence and progression in patients who underwent TURBT for NMIBC. Furthermore, NLR was an independent predictor of disease recurrence and progression in NMIBC treated with BCG patients. NLR could be used to improve clinical decision-making regarding treatment and follow-up scheduling
Secretion of severe acute respiratory syndrome coronavirus 2 in urine
No full textPURPOSE OF REVIEW: Despite the plethora of publications discussing the severe respiratory coronavirus 2 (SARS-CoV-2), evidence of viral secretion in urine is sparse. RECENT FINDINGS: We could identify 34 publications including a total of 2172 patients. Among those, 549 patients were tested for SARS-CoV-2 secretion in urine, which was detected in only 38 patients (6.9%). Within the seven studies displaying positive results, the majority of positive patients (86.8%) was from not yet peer-reviewed studies including weak data and heterogeneous techniques for sample testing. Furthermore, none of the studies available in the literature addressed the virulence of detected viral RNA in urine. SUMMARY: Overall, only seven studies were able to detect SARS-CoV-2 secretion in urine, all of them with a considerably low rate of positivity. However, these studies were of rather low quality considering their methodology. Despite this, as SARS-CoV-2 has been detected in urine, it is of importance to discuss safety and urinary hygiene protocols. Until further research provides valid data on viral shedding and virulence in urine, potential risk of transmission through urine cannot be ruled out. Therefore, safety and hygiene measures need to be discussed
Lower urinary tract symptoms are associated with clinically relevant depression, anxiety, and stress symptoms
No full textObjectives: To investigate the correlation between lower urinary tract symptoms (LUTS), erectile dysfunction (ED), and testosterone deficiency (TD) with depressive, stress, and anxiety symptoms. Material and methods: From October 2019 to March 2020, 113 males were included. Inclusion criteria: age 40–75, no clinical suspicion of prostate cancer, no serious cardiovascular comorbidities. All patients completed a set of questionnaires: International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5), and Depression Anxiety Stress Scales (DASS-21). Results: Median age was 62 years (range 40–74), mean IPSS score was 10.94 (SD 7.75), mean IIEF-5 score 13.12 (SD 7.08), and mean DASS-21 score 11.35 (SD 8.24). According to DASS-21 subscales, 28 (24.8%) patients had depressive symptoms, 25 (22.1%) anxiety symptoms, and 25 (22.1%) stress symptoms. Depression was associated with LUTS (14.5 vs. 8 score, p =.002). Similarly, stress symptoms were associated with LUTS (IPSS 15 vs. 7 score, p =.0001) and with ED (IIEF-5 5 vs. 15 score, p =.01). Positive Spearman's rho correlations between LUTS and all three, depression, anxiety, and stress symptoms were found (p values <.001). Conclusions: LUTS is associated with depression, anxiety, and stress symptoms. Screening for these symptoms could help with individual counseling and management
Smoking Reduces the Efficacy of Intravesical Bacillus Calmette-Guérin Immunotherapy in Non-muscle-invasive Bladder Cancer.
No full textSystemic therapy for metastatic renal cell carcinoma in the first-line setting : a systematic review and network meta-analysis
No full textPurpose: Management of metastatic renal cell cancer (mRCC) has undergone a paradigm shift with immune-checkpoint inhibitors (ICI) in the first-line setting. However, direct comparative data are inadequate to inform treatment decisions. Therefore, we aimed to assess first-line therapy for mRCC and indirectly compare the efficacy and safety of currently available treatments. Materials and methods: Multiple databases were searched for articles published before June 2020. Studies that compared overall and/or progression-free survival (OS/PFS) and/or adverse events (AEs) in mRCC patients were considered eligible. Results: Six studies matched our eligibility criteria. For OS, pembrolizumab plus axitinib [hazard ratio (HR) 0.85, 95% credible interval (CrI) 0.73–0.98] and nivolumab plus ipilimumab (HR 0.86, 95% CrI 0.75–0.99) were significantly more effective than sunitinib, and pembrolizumab plus axitinib was probably the best option based on analysis of the treatment ranking. For PFS, pembrolizumab plus axitinib (HR 0.86, 95% CrI 0.76–0.97) and avelumab plus axitinib (HR 0.85, 95% CrI 0.74–0.98) were statistically superior to sunitinib, and avelumab plus axitinib was likely to be the preferred option based on analysis of the treatment ranking, closely followed by pembrolizumab plus axitinib. Nivolumab plus ipilimumab had significantly lower rates of serious AEs than sunitinib. Conclusion: Pembrolizumab plus axitinib seemed to be the most efficacious first-line agents, while nivolumab plus ipilimumab had the most favorable efficacy–tolerability equilibrium. These findings may facilitate individualized treatment strategies and inform future direct comparative trials in an expanding treatment options without direct comparison between approved drugs
Шариатские суды: современная практика и перспективы в России
No full textThe article touches the fundamental principles of shariat judiciary, modern practice of shariat courts activity in Muslim and Western countries as well as the perspectives of their establishment and functioning in Russia. The place which shariat courts occupied in the judicial system of the Muslim state during Middle Ages is shown. The author analyses in general terms the historical evolution of shariat justice institutions. The differences between modern shariat courts and the same structures which existed in the preceding historical periods are mentioned. The role played by modern shariat courts in the Muslim countries depends on the place which Islamic Shariat occupies in their legal systems. Shariat model of judiciary was known in the Western countries from the Middle Ages. Nowadays shariat courts are still functioning in some of them. There are two main forms of such courts. The first one embraces unofficial so called shariat courts as religious and social organizations while the second one consists of shariat courts acting on legal basis and within official legislation. Arbitration tribunals in the UK which apply some concrete shariat norms resolving civil and family disputes are one of the examples of such form. In Russia, shariat institutions of dispute resolution were created in the 19th century. They existed in one or another form in our country to the end of the 1920s. After that, they existed in fact during decades but their decisions did not have any legal force. From the 1990s, shariat courts began to emerge in Russia as religious or civil structures. Russian legislation provides legal basis for establishing shariat institutions of dispute resolution in the form of arbitration court or mediation structure. Such institutions can be an alternative form opposing illegal shariat courts and they could assist securing legal fundamentals and values within Russian Muslims community.Статья посвящена анализу теоретических основ шариатского правосудия, современной практики действия шариатских судов в мусульманских и западных странах, а также обоснованию перспектив их создания и функционирования в России. Показано место шариатских судов в судебной системе средневекового мусульманского государства. В настоящее время шариатские суды заметно отличаются от аналогичных структур, которые существовали в прежние исторические эпохи. Организация и практика функционирования этих институтов позволяют выделить характерные особенности современного шариатского правосудия. Нынешняя роль шариатских судов в мусульманских странах прямо зависит от места шариата в их правовых системах. Шариатская модель правосудия была известна странам Запада еще в Средние века. В настоящее время шариатские суды продолжают функционировать в некоторых из них. Различаются их две основные разновидности. Первая представлена так называемыми неофициальными шариатскими судами, которые являются религиозными или общественными организациями. Их решения, как правило, не обладают юридической силой. Вторую составляют шариатские суды, действующие на основе и в рамках законодательства. Примером таких органов могут служить арбитражные трибуналы в Великобритании, применяющие отдельные нормы шариата при рассмотрении гражданских и семейных споров. В России шариатские институты разрешения споров возникли еще в конце XVIII в., но получили широкое развитие только во второй половине XIX в. В той или иной форме они действовали в нашей стране до конца 20-х годов прошлого столетия. Затем в течение десятилетий они фактически существовали, но их решения не имели юридической силы. С 1990-х годов в России вновь стали возникать шариатские суды в качестве религиозных или общественных организаций. Нередко их практика носит противоправный характер. Российское законодательство создает юридическую базу для образования шариатских институтов разрешения споров в форме третейского суда и института медиации. Такие структуры могут стать альтернативой нелегальным шариатским судам и способствовать утверждению правовых начал в среде российских мусульман
The prognostic role of lymphovascular invasion in urothelial carcinoma of the bladder
No full textOutcome prediction in patients with bladder cancer has improved through the development of nomograms and predictive models. However, integration of further characteristics such as lymphovascular invasion (LVI) might increase the accuracy and clinical utility of these instruments. Assessment and reporting of LVI in specimens from transurethral resection of the bladder tumour (TURBT) or biopsy in patients with non-muscle-invasive bladder cancer (NMIBC) or muscle-invasive bladder cancer (MIBC) might enable improved staging, prognostication and clinical decision-making. In NMIBC, presence of LVI in TURBT and biopsy samples seems to be associated with understaging and increased risks of disease recurrence and progression. In MIBC, presence of LVI is associated with features of aggressive disease and predicts recurrence and survival. Integration of LVI status into predictive models might aid clinical decision-making regarding intravesical instillation schedules and regimens, early radical cystectomy in patients with high-grade T1 disease and perioperative chemotherapy. However, LVI assessment is hampered by insufficient reproducibility and reliability, lack of routine evaluation and limited concordance between findings in TURBT and radical cystectomy specimens. Standardization of the pathological criteria defining LVI is warranted to improve its reporting in routine clinical practice and its utility as a care-changing prognostic marker
Совместим ли шариат с современным российским правом?
No full textThe article is devoted to analysis of the forms of interaction between Shariat and legislation in action as well as compatibility of Shariat with contemporary Russian law in general. The author touches several reasons of increasing interest to the role which Shariat plays in legal development of Russia. Among these reasons he pays attention to the up-going process of renaissance of Islam, social and political activity of Muslim communities outside the regions where Islam is traditionally spread, the existing threat of Islamic extremism, increasing influence of Shariat upon political and legal development of the Muslim world. Also there are numerous conflicts linked with Muslim minorities in the West which contribute a lot to the interest paid to Shariat.
Several modes of referring to Shariat can be differentiated as far as its correlations with positive legislation are concerned. One of them manifests itself in the actions of Muslim separatists and extremists who directly oppose Shariat to the Russian law. Another mode provides for including of Shariat norms in the official legislation. There is one more form of the above mentioned correlation which is related with the action of Shariat as alternative regulator without opposing it to the official state law.
There is no one definite justification for the realization of Shariat provisions. For instance Muslim radicals refer only to religious arguments to fulfil their plans aiming at replacing official legislation by Shariat. Some Rissian scientists call for legalizing of Shariat norms but they do not put down any legal grounds or justification for their proposals. Russian jurists have different approaches to this issue. Some authors elaborate general conceptions which key point is legal recognition of local traditions and customs including Shariat norms. As a rule these theories concern Russian regions of Northern Caucasus.
The author examines several patterns of possible correlation between Shariat and state legislation. The first one is represented by the direct inclusion of Shariat norms into the legislation. The Russian law provides for such implementation under some conditions. The leading one is choosing among Shariat provisions those which meet criteria of legal norm and can be considered as Islamic law in proper sense. The other form of the correlation mentioned above manifests itself in legal acts which refer to the historical and local traditions. It means in indirect form the possibility of implementation of some Shariat norms. Besides that Shariat provisions can be used for solving issues which are provided for by dispositive norms of state legislation. Generally the author gives positive answer to the question put in the title of the article.Статья посвящена анализу форм взаимодействия шариата с действующим законодательством, его совместимости с современным российским правом в целом. Автор анализирует несколько причин возрастающего интереса к роли шариата в правовом развитии России. Среди них — продолжающийся процесс возрождения ислама, социально-политическая активность мусульманских общин за пределами регионов традиционного распространения ислама, сохраняющаяся угроза исламского экстремизма, усиление роли шариата в правовом и политическом развитии мусульманского мира, а также связанные с мусульманскими меньшинствами конфликты в странах Запада. Различаются несколько вариантов обращения к шариату в сопоставлении с законодательством. Один из них представлен действиями мусульманских сепаратистов и экстремистов, которые противопоставляют шариат российскому праву. Другой предполагает включение норм шариата в законодательство. Еще один вариант связан с обращением к шариату в качестве альтернативного регулятора без его противопоставления официальному праву. Обоснование реализации предписаний шариата не отличается единством. Мусульманские радикалы ссылаются лишь на религиозные аргументы в целях замены законодательства шариатом. Некоторые ученые призывают легализовать нормы шариата, но не подкрепляют свои предложения правовыми аргументами. Юристы придерживаются различных взглядов по этому вопросу. Некоторые авторы предлагают концепции законодательного признания местных традиций, включая нормы шариата. Как правило, они касаются регионов Северного Кавказа. Автор выделяет несколько форм возможного взаимодействия шариата и законодательства. Первая представлена прямым включением норм шариата в законодательство. Российское право такую возможность допускает при определенных условиях. Главное из них — выбор среди норм шариата таких предписаний, которые отвечают критериям права и являются исламским правом в точном смысле. Другая форма сводится к включению в законодательство ссылки на исторические или местные традиции, что дает возможность применять отдельные нормы шариата. Кроме того, шариатские предписания могут действовать по вопросам, урегулированным в законодательстве диспозитивными правилами. В целом на поставленный в названии статьи вопрос автор дает положительный ответ
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