Journal of Clinical Urology最新文献

{"title":"Re-evaluating the diagnostic efficacy of PSA as a referral test to detect clinically significant prostate cancer in contemporary MRI-based image-guided biopsy pathways.","authors":"Artitaya Lophatananon,&nbsp;Alexander Light,&nbsp;Nicholas Burns-Cox,&nbsp;Angus Maccormick,&nbsp;Joseph John,&nbsp;Vanessa Otti,&nbsp;John McGrath,&nbsp;Pete Archer,&nbsp;Jonathan Anning,&nbsp;Stuart McCracken,&nbsp;Toby Page,&nbsp;Ken Muir,&nbsp;Vincent J Gnanapragasam","doi":"10.1177/20514158211059057","DOIUrl":"https://doi.org/10.1177/20514158211059057","url":null,"abstract":"<p><strong>Introduction: </strong>Modern image-guided biopsy pathways at diagnostic centres have greatly refined the investigations of men referred with suspected prostate cancer. However, the referral criteria from primary care are still based on historical prostate-specific antigen (PSA) cut-offs and age-referenced thresholds. Here, we tested whether better contemporary pathways and biopsy methods had improved the predictive utility value of PSA referral thresholds.</p><p><strong>Methods: </strong>PSA referral thresholds, age-referenced ranges and PSA density (PSAd) were assessed for positive predictive value (PPV) in detection of clinically significant prostate cancer (csPCa - histological ⩾ Grade Group 2). Data were analysed from men referred to three diagnostics centres who used multi-parametric magnetic resonance imaging (mpMRI)-guided prostate biopsies for disease characterisation. Findings were validated in a separate multicentre cohort. Results: Data from 2767 men were included in this study. The median age, PSA and PSAd were 66.4 years, 7.3 ng/mL and 0.1 ng/mL², respectively. Biopsy detected csPCa was found in 38.7%. The overall area under the curve (AUC) for PSA was 0.68 which is similar to historical performance. A PSA threshold of ⩾ 3 ng/mL had a PPV of 40.3%, but this was age dependent (PPV: 24.8%, 32.7% and 56.8% in men 50-59 years, 60-69 years and ⩾ 70 years, respectively). Different PSA cut-offs and age-reference ranges failed to demonstrate better performance. PSAd demonstrated improved AUC (0.78 vs 0.68, <i>p</i> < 0.0001) and improved PPV compared to PSA. A PSAd of ⩾ 0.10 had a PPV of 48.2% and similar negative predictive value (NPV) to PSA ⩾ 3 ng/mL and out-performed PSA age-reference ranges. This improved performance was recapitulated in a separate multi-centre cohort (<i>n</i> = 541).</p><p><strong>Conclusion: </strong>The introduction of MRI-based image-guided biopsy pathways does not appear to have altered PSA diagnostic test characteristics to positively detect csPCa. We find no added value to PSA age-referenced ranges, while PSAd offers better PPV and the potential for a single clinically useful threshold (⩾0.10) for all age groups.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"16 4","pages":"264-273"},"PeriodicalIF":0.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7614972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10063583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial","authors":"B. Somani","doi":"10.1177/20514158231185185","DOIUrl":"https://doi.org/10.1177/20514158231185185","url":null,"abstract":"","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"16 1","pages":"263 - 263"},"PeriodicalIF":0.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47298365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are single-use flexible cystoscopes environmentally sustainable? A lifecycle analysis","authors":"Amy Wombwell, A. Holmes, R. Grills","doi":"10.1177/20514158231180661","DOIUrl":"https://doi.org/10.1177/20514158231180661","url":null,"abstract":"Single-use flexible cystoscopes provide a safe and cost-effective evolution to current practice. However, the environmental impact of single-use devices needs to be considered in a healthcare system that is being increasingly scrutinised for its carbon footprint. We performed a single-centre simplified lifecycle analysis to compare the carbon footprint of the single-use Ambu® aScope™ 4 Cysto System (Ambu®) with the reusable Olympus CYF-VH flexible video-cystoscope (Olympus). Manufacturing, transportation and waste costs were calculated for the Ambu® cystoscope. Manufacturing costs incorporating the average lifecycle of the reusable cystoscope was included in the carbon footprint calculation for the Olympus reusable cystoscope as were waste costs and re-processing costs using the Soluscope 3 automatic endoscope re-processor that is used in our centre. Results demonstrate that Ambu® cystoscopes are a carbon-friendly alternative to reusable Olympus cystoscopes, with a 36% lower carbon footprint. The carbon footprint of the Ambu® scope is 1.43 kg CO2 compared with 2.22 kg CO2 for the reusable Olympus cystoscope. These results may vary from centre to centre depending on the cystoscope re-processor used. The Ambu® single-use flexible cystoscopes provide a carbon-friendly alternative to Olympus CYF-VH reusable cystoscopes. IV","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42239089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of outcome of prostatic UroLift placement in benign prostatic hyperplasia in a district hospital","authors":"Krishnendu Biswas, Saadat Ahmed, Kasthury Soundararasha, G. Rix, R. Pillai, Z. Maan, S. Keoghane, S. Datta","doi":"10.1177/20514158231182509","DOIUrl":"https://doi.org/10.1177/20514158231182509","url":null,"abstract":"To analyse the outcome of prostatic UroLift (PUL) placement done at our hospital for the treatment of benign prostatic hyperplasia (BPH). Demographic and perioperative data were collected for all patients who underwent PUL placement for BPH at out hospital from December 2017 to January 2020. International prostate symptom score (IPSS), quality of life (QoL), maximum urinary flow rate (Q-max), complications and requirement of auxiliary procedures were noted till date. Mann–Whitney U test was used to compare the pre- and post-operative parameters. A total of 45 patients underwent PUL placement and were followed up for a median period of 26 months (range 14–37 months). The median age of the patients and prostate volume were 76 years (range 54–90 years) and 50 mL (range 30–70 mL), respectively. Five patients had median lobe. An average of 3.2 ± 1.1 clips were placed. The mean IPSS, QoL and Q-max in the pre-operative and latest follow-up period were 19.3 ± 5.9 and 11.1 ± 5.6 ( p < 0.001), 4.3 ± 1.1 and 2.5 ± 1.4 ( p < 0.001), 9.8 ± 5.0 mL/s and 12.8 ± 6.2 mL/s ( p = 0.004), respectively. Complications were dysuria (one patient, 2.2%), urinary tract infection (one patient, 2.2%), haematuria (one patient, 2.2%), transient urinary retention (two patients, 4.4%), post-void dribbling (two patients, 4.4%), bladder stone (one patient, 2.2%) and clip migration (one patient 2.2%). Six patients (13.3%) required auxiliary treatment in follow-up. PUL placement improved the IPSS, QoL and Q-max significantly over a median follow-up of 26 months with retreatment rate of 13.3%. It is a safe procedure with few easily manageable complications. Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48383926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethnic diversity in the English urology workforce and BAUS leadership 2009–2020: A longitudinal study","authors":"K. Adasonla, T. Newman, R. Ellis, M. Parry, N. Shrotri, J. Cresswell, James S.A. Green","doi":"10.1177/20514158231180666","DOIUrl":"https://doi.org/10.1177/20514158231180666","url":null,"abstract":"To assess the impact of existing strategies to promote equitable progression, with respect to ethnicity, in the English urology workforce and British Association of Urological Surgeons (BAUS) leadership between 2009 and 2020. A Freedom of Information (FOI) Act request was made to NHS Digital regarding demographic data of clinicians working in urology between 2009 and 2020. Data were collected on urology consultants, specialist registrars and specialty and associate specialist (SAS) doctors over this period. The ethnicities of British Association of Urological Surgeons (BAUS) Trustees and Council Members were determined over the same period, by review of public profiles. The proportion of consultant urologists identified as White decreased from 65.5% to 53.6% ( p < 0.0001), while the proportion of Asian/Asian British consultants increased over the same period (26.9%–36.6%, p < 0.0001). There was a significant increase in Black/Black British trainees (3.0%–11.0%, p < 0.0001) but a decrease in the proportion of Asian/Asian British trainees. Over half of SAS doctors were Asian/British Asian, but this decreased over time as the proportion of white surgeons increased in this group. There was a decrease in the proportion of White urologists occupying BAUS leadership positions (80.6% to 67.6%, p = 0.5). Trends towards increased ethnic diversity were seen across all groups. This was most marked among consultant and SAS doctors. More limited change was observed in the urology leadership. The significance of this is unclear but may reflect a need to address barriers to progression in the highest echelons of urology leadership. The BAUS Widening Participant Group strategy aims to continue this progress, with its 10-point plan designed to support current trainees and tomorrow’s leaders with their career aims. Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43248025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 on stage migration in bladder cancer: A single-centre retrospective comparative cohort analysis","authors":"K. Haq, E. Whyte, Dimitra Poulopoulou, O. Shannon, Sinclair Couper, Jonathan Lye, Cristina Illinca, Martin Reynolds, R. Veeratterapillay, B. Rai","doi":"10.1177/20514158231177850","DOIUrl":"https://doi.org/10.1177/20514158231177850","url":null,"abstract":"Objectives: To evaluate whether the COVID-19 pandemic has increased the proportion of patients diagnosed with muscle invasive bladder cancer (MIBC) at first presentation and explore potential causes for this hypothesised stage migration. Subjects/Patients and Methods: All patients undergoing first transuretheral resection of bladder tumour (TURBT) between 2 January 2018 and 30 June 2021. The date of the lockdown restrictions was used to divide patients into pre-COVID and COVID cohorts. Data were collated retrospectively from electronic patient records. Variables included demographics data, TNM stage and presentation (emergent/elective). A comparative analysis of the two cohorts was undertaken using the chi-square test to evaluate for statistical significance. A p-value of <0.05 was regarded as significant. Results: A total of 1064 patient underwent a TURBT for a suspected bladder cancer in the study period. The number of patients in the pre-COVID and COVID cohorts was 704 and 360, respectively. Mean age was comparable between cohorts (74.7 vs 74.2 (p = 0.46)) as was sex ratio (F:M (1:2.84 vs 1:2.95) p = 0.80). The proportion of patients with MIBC pre-COVID was 18% compared to 23.6% in the COVID cohort. This represents a 5.6% increase in the prevalence of first presentation MIBC during the COVID era (p = 0.03 [95% confidence interval (CI) = 0.2–10.4]). The odds of a patient presenting with MIBC was 38% higher during the COVID era versus pre-COVID (odds ratio (OR) [95% CI] = 1.38 [1.01–1.85]). A significantly higher proportion of patients had metastases at presentation in the COVID cohort versus pre-COVID (4.4% vs 2.1% (p = 0.034)). Conclusion: Our data would support the hypothesis that the COVID pandemic has precipitated a stage migration in the presentation of bladder cancer towards muscle invasive disease. This has implications in terms of patient outcomes as well as an increased demand on services to provide radial treatment. Potential reasons for the stage migration are patient-related factors and pathway failure due to widespread service disruption caused by COVID-19. Level of evidence: 3","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46172650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant renal angiomyolipomas – Can they be managed safely through minimally invasive selective angioembolisation? Case series and literature review","authors":"A. Combes, Catalina A. Palma, B. March, D. Eisinger, R. Waugh","doi":"10.1177/20514158231180074","DOIUrl":"https://doi.org/10.1177/20514158231180074","url":null,"abstract":"The objective was to determine whether giant renal angiomyolipomas (AMLs) can be managed through selective angioembolisation (SA) and compare outcomes to nephron-sparing surgery (NSS) and nephrectomy. A retrospective case series was compiled from a prospectively maintained database, commenced in 2011 of renal AMLs that underwent SA. We extracted patient demographics, size of AMLs, intervention and outcomes. A literature review of case reports and case series was performed on the management of giant renal AMLs managed through SA, NSS or nephrectomy. Of 30 AMLs that underwent SA, 6 patients met the inclusion criteria. The mean diameter of AMLs prior to embolisation was 14.3 cm. All embolised AMLs decreased in size post-embolisation by an average of 18% (mean: 39-month follow-up). There were no complications in our cohort’s follow-up period, including no rise in any patients’ creatinine associated with SA. Our literature review of 284 articles found 82 articles pertaining to 102 giant renal AMLs. Our review identified SA, NSS and nephrectomy to all be effective management pathways for giant AMLs with minimal complications. Total nephrectomy did result in five patients requiring dialysis post-procedure. SA is an effective intervention for giant AMLs with comparable outcomes to NSS and nephrectomy and should be considered a suitable management option for giant renal AMLs. Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45941306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between lower urinary tract symptoms (LUTS) and prostate cancer: A persistent myth","authors":"M. Al-Zubaidi, C. Hawks, Sunimal Fernando, A. Moe, N. Swarbrick, S. McCombie, Matthew Brown, D. Hayne","doi":"10.1177/20514158231170420","DOIUrl":"https://doi.org/10.1177/20514158231170420","url":null,"abstract":"The presence of lower urinary tract symptoms (LUTS) is described as an early symptom of prostate cancer in some patient guidelines; however, a statistical association has never been established. This study was conducted using a prospective electronic database at a single tertiary institution between January 2015 and November 2017. LUTS were assessed using the International Prostate Symptom Score (IPSS), and prostate cancer was graded according to the International Society of UroPathologists (ISUP) grading system. The association between IPSS and Grade Group was tested using parametric one-way analysis of variance (ANOVA) with post hoc analysis using Tukey’s honestly significant difference (Tukey’s HSD). A total of 611 men attended the One-Stop Prostate Clinic (OSPC) and IPSSs were available for 557 men. Overall, 46% had mild LUTS (IPSS: 1–7), 38% had moderate LUTS (IPSS: 8–19) and 16% had severe LUTS (IPSS: 20–35). Almost 85% proceeded to have transrectal ultrasound (TRUS) prostate biopsies, and clinically significant prostate cancer (CSPC) was detected in 37% with mild LUTS, 35% with moderate LUTS and 42% with severe LUTS. Correlation between histopathology and IPSSs was assessed in all 78.8% of men who had IPSS data available and underwent prostate biopsies. This large series did not establish any correlation between LUTS and prostate cancer in men undergoing investigation for the suspicion of prostate cancer. Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48378572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical video use and preparation for operative procedures among urology residents and fellows: Results from a national survey","authors":"M. Movassaghi, Erick A Garza, G. Badalato, D. Chung","doi":"10.1177/20514158231175301","DOIUrl":"https://doi.org/10.1177/20514158231175301","url":null,"abstract":"The availability of surgical videos has changed the nature of learning outside the operating room. Within urology, there are limited reports on the use of surgical videos during training. This study sought to characterise both the preferred platforms and the utilization patterns of videos among a contemporary cohort of urology trainees. An anonymous survey was distributed by the Society of Academic Urologists to trainees in September 2021. Data prospectively collected included respondent demographics, video platforms utilized, perceived educational value, satisfaction, and overall time spent using videos for case preparation. In total, 169 urology residents and fellows completed the survey (23.6%). Nearly all (96.4%) respondents reported utilizing videos to prepare for cases, with 95.1% reporting videos as helpful for this purpose. YouTube (81.4%) and American Urological Association (AUA) University (16.3%) were the most common sources for video content. Video ‘narration’ was the most valued feature. When stratified by trainee level, 91.5% of senior residents/fellows reported using YouTube, compared with 56.6% of junior residents ( p < 0.005). Overall, approximately 4 out of 5 trainees ultimately recommend YouTube as a video resource, compared with 57% recommending AUA University ( p < 0.05). Most urology trainees report surgical videos as a crucial component of their training, preferring to access videos directly from the YouTube website. As the quality of videos from YouTube varies, finding ways to share quality educational content should remain a priority for the medical education community moving forward. Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48915490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Jo Cresswell Introduction","authors":"J. Cresswell","doi":"10.1177/20514158231172325","DOIUrl":"https://doi.org/10.1177/20514158231172325","url":null,"abstract":"","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"16 1","pages":"2 - 3"},"PeriodicalIF":0.3,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47182250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}