CENTRUM
UROLOGIE ARTIKELS
ABSTRACT 2
ABSTRACT 1
Rates and predictors of perioperative complications in cytoreductive nephrectomy: analysis of the registry for metastatic renal cell carcinoma.
Office-based approach to urinary tract infections in 50 000 patients: results from the REWIND study. Cai T, Palagin I, Brunelli R, Van Bruwaene S, et al. International Journal of Antimicrobial Agents, 2020, 56(1), DOI: 10.1016/j.ijantimicag.2020.105966
OBJECTIVE The REWIND study sought to describe the real-world clinical and prescribing practices for the management of urinary tract infection (UTI) in Italy, Belgium, Russia and Brazil in order to compare current practices with international, European and national guidelines.
Roussel E, Campi R, Larcher A, Van Bruwaene S, et al. European urology oncology, 2020, 3(4), 523-529
INTRODUCTION Cytoreductive nephrectomy (CN) plays an important role in the treatment of a subgroup of metastatic renal cell carcinoma (mRCC) patients.
OBJECTIVE
MATERIALS/METHODS
We aimed to evaluate morbidity associated with this procedure and identify potential predictors thereof to aid patient selection for this procedure and potentially improve patient outcomes.
An integrated mixed-methods approach was adopted that used information from primary care electronic medical records in longitudinal patient databases available in Italy and Belgium, and surveys of physicians in Russia (general practitioners) and Brazil (gynaecologists).
Data from 736 mRCC patients undergoing CN at 14 institutions were retrospectively recorded in the Registry for Metastatic RCC (REMARCC).
RESULTS In total, 49 548 female patients were included in the study. Antibiotics were the most common management option for UTI in Italy (71.1%, n = 27 600), Belgium (92.4%, n = 7703), Russia (81.9%, n = 1231) and Brazil (82.4%, n = 740). Fosfomycin trometamol was the first-choice antibiotic for the treatment of UTI in all countries. Ciprofloxacin was also commonly prescribed in Italy (24.6%, n = 6796), Belgium (17.8%, n = 1373), Russia (14.9%, n = 184) and Brazil (9.6%, n = 71), while prescription of nitrofurantoin was common in Belgium (24.5%, n = 1890) alone.
CONCLUSION Despite differences in study designs and data sources, fosfomycin trometamol was found to be the most commonly prescribed treatment for UTI in all participating countries. In Belgium, real- world prescribing practices for UTI adhered more closely to European guidelines than national guidelines. Although not recommended in international and European guidelines for lower UTI management, the use of fluoroquinolones was still widespread.
MATERIALS/METHODS
Outcome measurements and statistical analysis: Logistic regression analysis was used to identify predictors for intraoperative, any-grade (AGCs), low-grade, and high-grade (HGCs) postoperative complications (according to the Clavien-Dindo classification) as well as 30-d readmission rates.
RESULTS Intraoperative complications were observed in 69 patients (10.9%). Thrombectomy (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.08-1.75, p = 0.009) and adjacent organ removal (OR 2.7, 95% CI 1.38-5.30) were significant predictors of intraoperative complications at multivariable analysis. Two hundred seventeen patients (29.5%) encountered AGCs, while 45 (6.1%) encountered an HGC, of whom 10 (1.4%) died. Twenty-four (3.3%) patients had multiple postoperative complications. Estimated blood loss (EBL; OR 1.49, 95% CI 1.08-2.05, p = 0.01) was a significant predictor of AGCs at multivariable analysis. CN case load (OR 0.13, 95% CI 0.03-0.59, p = 0.009) and EBL (OR 2.93, 95% CI 1.20-7.15, p = 0.02) were significant predictors solely for HGCs at multivariable analysis. Forty-one patients (11.5%) were readmitted within 30 d of surgery. No significant predictors were identified. Results were confirmed in a subanalysis focusing solely on patients treated in the contemporary targeted therapy era.
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