Pub Date : 2022-05-16DOI: 10.1177/20514158221094636
J. Greenberg, Joseph Kim, J. Pincus, M. Sandberg, B. Dick, Rachel Greenberg, O. Raheem, W. Hellstrom
Management options for Peyronie’s disease (PD) are determined by the phase of the condition. Experts counsel against surgical intervention during the active phase of PD. Patients with chronic phase of PD are offered either collagenase injections or surgical intervention. Accurately characterising a patient’s phase of PD is crucial in determining the appropriate treatment option. To investigate neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) as possible predictors for the determination of acute or chronic phase of PD. This study retrospectively queried all patients who presented for initial diagnosis of PD from 2016 to 2020 and had complete blood count (CBC) laboratory values before initial therapy. PD phase was defined per the American Urological Association guidelines. The active phase of PD was defined as a changing penile curvature and/or growing palpable plaque. The chronic phase of PD was defined as a stabilised penile curvature. All statistical analyses were two-tailed, using a significance level of 0.05. One hundred nine patients met inclusion: 27 (25%) active phase and 82 (75%) chronic phase patients. Demographic and erectile characteristics were not statistically different between the two groups. NLR and PLR values between active and chronic phase patients were comparable ( p > 0.05). A linear regression evaluated correlations between the duration of PD and either NLR or PLR. Neither NLR nor PLR was correlated with PD duration on Spearman, Pearson, or Kandall tests. In addition, NLR and PLR were not noted to be predictors of PD phase on multiple logistic regression. Finally, a receiver operator characteristic curve was generated. NLR and PLR yielded an area under curve of 58% and 57.8%, respectively. Two recent studies suggested NLR and PLR could be used to predict the phases of PD. However, after evaluating a cohort of 109 men from our institution, our data do not support the use of peripheral blood PLR or NLR to determine the phase of PD.
{"title":"Are neutrophil–lymphocyte and platelet–lymphocyte ratios useful for determining active phase of Peyronie’s disease?","authors":"J. Greenberg, Joseph Kim, J. Pincus, M. Sandberg, B. Dick, Rachel Greenberg, O. Raheem, W. Hellstrom","doi":"10.1177/20514158221094636","DOIUrl":"https://doi.org/10.1177/20514158221094636","url":null,"abstract":"Management options for Peyronie’s disease (PD) are determined by the phase of the condition. Experts counsel against surgical intervention during the active phase of PD. Patients with chronic phase of PD are offered either collagenase injections or surgical intervention. Accurately characterising a patient’s phase of PD is crucial in determining the appropriate treatment option. To investigate neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) as possible predictors for the determination of acute or chronic phase of PD. This study retrospectively queried all patients who presented for initial diagnosis of PD from 2016 to 2020 and had complete blood count (CBC) laboratory values before initial therapy. PD phase was defined per the American Urological Association guidelines. The active phase of PD was defined as a changing penile curvature and/or growing palpable plaque. The chronic phase of PD was defined as a stabilised penile curvature. All statistical analyses were two-tailed, using a significance level of 0.05. One hundred nine patients met inclusion: 27 (25%) active phase and 82 (75%) chronic phase patients. Demographic and erectile characteristics were not statistically different between the two groups. NLR and PLR values between active and chronic phase patients were comparable ( p > 0.05). A linear regression evaluated correlations between the duration of PD and either NLR or PLR. Neither NLR nor PLR was correlated with PD duration on Spearman, Pearson, or Kandall tests. In addition, NLR and PLR were not noted to be predictors of PD phase on multiple logistic regression. Finally, a receiver operator characteristic curve was generated. NLR and PLR yielded an area under curve of 58% and 57.8%, respectively. Two recent studies suggested NLR and PLR could be used to predict the phases of PD. However, after evaluating a cohort of 109 men from our institution, our data do not support the use of peripheral blood PLR or NLR to determine the phase of PD.","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43747680","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}
Pub Date : 2022-05-16DOI: 10.1177/20514158221095662
Mia Ivos, Christopher Wilhelm, Pranav Sharma
Robotic radical prostatectomy (RARP) is a well-established treatment for localised prostate adenocarcinoma. The benefits of this minimally invasive technique include shortened operative time and improved patient recovery. However, the development of inguinal hernia (IH) before, during, and following RARP has been reported. The aim of this study is to evaluate the incidence, management, and recurrence of IHs in patients undergoing RARP for prostate cancer. A literature search was conducted using the PubMed database from August 2007 to October 2020 using the keywords ‘robotic prostatectomy’ and ‘inguinal hernia’. Studies evaluating the incidence and recurrence of IH in patients undergoing RARP were identified and included. The initial search identified 77 articles. After excluding one duplicate, six case reports, three editorial comments, four articles not in English, eight review articles, and 14 studies that did not mention hernia incidence, 41 studies were included in our final literature review. Concomitant IH repair (IHR) during RARP resulted in decreased symptomatic hernia recurrence during the follow-up period. When compared to patients who had not undergone hernia repair, the patients who underwent IHR during RARP did not experience greater complications in the postoperative period. Patients that undergo an intraoperative IHR during RARP did not experience significant adverse postoperative complications. Although operative time can slightly increase compared to RARP alone, we recommend a thorough preoperative physical examination in all patients scheduled to undergo RARP to evaluate for IH in addition to a thorough discussion with the patient of the risks and benefits of intraoperative repair. Not applicable
{"title":"Evaluating the incidence, management, and recurrence of inguinal hernia during robotic prostatectomy: A literature review","authors":"Mia Ivos, Christopher Wilhelm, Pranav Sharma","doi":"10.1177/20514158221095662","DOIUrl":"https://doi.org/10.1177/20514158221095662","url":null,"abstract":"Robotic radical prostatectomy (RARP) is a well-established treatment for localised prostate adenocarcinoma. The benefits of this minimally invasive technique include shortened operative time and improved patient recovery. However, the development of inguinal hernia (IH) before, during, and following RARP has been reported. The aim of this study is to evaluate the incidence, management, and recurrence of IHs in patients undergoing RARP for prostate cancer. A literature search was conducted using the PubMed database from August 2007 to October 2020 using the keywords ‘robotic prostatectomy’ and ‘inguinal hernia’. Studies evaluating the incidence and recurrence of IH in patients undergoing RARP were identified and included. The initial search identified 77 articles. After excluding one duplicate, six case reports, three editorial comments, four articles not in English, eight review articles, and 14 studies that did not mention hernia incidence, 41 studies were included in our final literature review. Concomitant IH repair (IHR) during RARP resulted in decreased symptomatic hernia recurrence during the follow-up period. When compared to patients who had not undergone hernia repair, the patients who underwent IHR during RARP did not experience greater complications in the postoperative period. Patients that undergo an intraoperative IHR during RARP did not experience significant adverse postoperative complications. Although operative time can slightly increase compared to RARP alone, we recommend a thorough preoperative physical examination in all patients scheduled to undergo RARP to evaluate for IH in addition to a thorough discussion with the patient of the risks and benefits of intraoperative repair. Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48898570","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}
Pub Date : 2022-05-16DOI: 10.1177/20514158221088683
M. Shahait, Amihay Nevo, J. El-Asmar, N. Siripong, N. Khater, Jordan Denk, S. Jackman, T. Averch, M. Semins
To study 24-hour urine metabolic abnormalities in patients with obstructive sleep apnea syndrome (OSAS), diagnosed by polysomnography. The purpose was to identify whether OSAS is independently associated with a distinctive set of 24-hour urine studies in a cohort of stone formers. Using our institutional stone database (2013–2017), 1132 consecutive patients with 24-hour urine collections were identified. After applying our exclusion criteria, the final cohort consisted of 376 patients of which 45 patients had OSAS. Descriptive statistics were used to compare 24-hour urine parameters between patients with and without OSAS. Logistic regression models were used to assess the association between OSAS and 24-hour urine parameters. On univariate analysis, patients with OSAS were older (57.7 versus 48.2, p < 0.001) with a higher body mass index (BMI) (35 versus 27.8, p < 0.001), and higher likelihood of diabetes mellitus (DM) (57.8 versus 10.6%, p < 0.001) and hypertension (HTN) (60% versus 23.9%, p < 0.001). Patients with OSAS had higher 24-hour total amount of urine volume (2018 versus 1818 ml, p = 0.03), calcium (279.7 versus 208 mg, p = 0.02), oxalate (41.6 versus 31.3 mg, p < 0.001), yet lower 24-hour urine pH (5.75 versus 6.03, p = 0.001). On multivariable linear regression analysis, OSAS did not affect any of the 24-hour urinary parameters. OSAS is a prevalent comorbidity among nephrolithiasis patients. We found no major differences in 24-hour urine parameters between nephrolithiasis patients with OSAS and those without OSAS. Further study is needed to determine whether the severity of OSAS and compliance with treatment play a role in the pathogenesis of stone formation. 2b
{"title":"Twenty-four hour urine parameters in nephrolithiasis patients with obstructive sleep apnea syndrome","authors":"M. Shahait, Amihay Nevo, J. El-Asmar, N. Siripong, N. Khater, Jordan Denk, S. Jackman, T. Averch, M. Semins","doi":"10.1177/20514158221088683","DOIUrl":"https://doi.org/10.1177/20514158221088683","url":null,"abstract":"To study 24-hour urine metabolic abnormalities in patients with obstructive sleep apnea syndrome (OSAS), diagnosed by polysomnography. The purpose was to identify whether OSAS is independently associated with a distinctive set of 24-hour urine studies in a cohort of stone formers. Using our institutional stone database (2013–2017), 1132 consecutive patients with 24-hour urine collections were identified. After applying our exclusion criteria, the final cohort consisted of 376 patients of which 45 patients had OSAS. Descriptive statistics were used to compare 24-hour urine parameters between patients with and without OSAS. Logistic regression models were used to assess the association between OSAS and 24-hour urine parameters. On univariate analysis, patients with OSAS were older (57.7 versus 48.2, p < 0.001) with a higher body mass index (BMI) (35 versus 27.8, p < 0.001), and higher likelihood of diabetes mellitus (DM) (57.8 versus 10.6%, p < 0.001) and hypertension (HTN) (60% versus 23.9%, p < 0.001). Patients with OSAS had higher 24-hour total amount of urine volume (2018 versus 1818 ml, p = 0.03), calcium (279.7 versus 208 mg, p = 0.02), oxalate (41.6 versus 31.3 mg, p < 0.001), yet lower 24-hour urine pH (5.75 versus 6.03, p = 0.001). On multivariable linear regression analysis, OSAS did not affect any of the 24-hour urinary parameters. OSAS is a prevalent comorbidity among nephrolithiasis patients. We found no major differences in 24-hour urine parameters between nephrolithiasis patients with OSAS and those without OSAS. Further study is needed to determine whether the severity of OSAS and compliance with treatment play a role in the pathogenesis of stone formation. 2b","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43406103","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}
Pub Date : 2022-05-13DOI: 10.1177/20514158221088452
D. Golomb, A. Shvero, Hamad Mahajna, O. Levi, H. Goldberg, S. Tapiero, Y. Stabholz, Paz Lotan, A. Darawsha, Y. Ehrlich, N. Kleinmann, V. Khasminsky, D. Zilberman, H. Winkler, D. Lifshitz
To compare long-term results following ureteroscopic stone fragmentation and removal versus stone dusting. We conducted a retrospective analysis of patients who underwent ureteroscopy for renal calculi at two high-volume tertiary centres between 2012 and 2013, therefore allowing long-term follow-up. The surgeons differed in their technique, some performing dusting for the most part and the others fragmentation. Inclusion criteria were stone free at the first follow-up and the sole use of laser lithotripsy is either by dusting or by fragmentation. Operative and post-operative data as well as re-treatment rates were compared between the groups. Stone-free rates and long-term stone recurrence rates were analysed by a single radiologist blinded to the treatment technique. Between 2012 and 2013, 669 ureteroscopies were performed at both centres. The study group included 100 patients, which met the inclusion criteria, equally distributed between dusting and fragmentation. The cumulative stone diameter in patients treated with dusting was significantly larger (12.7 mm versus 17 mm, p = 0.006). Operative time was shorter in patients treated with dusting (56 minutes versus 47.2 minutes, p = 0.6). The mean follow-up was 58.9 (standard deviation (SD) 17.2) and 69.4 (SD 13.8) months for the fragmentation and dusting-treated patients, respectively( p = 0.06). The long-term recurrence rate in the fragmentation group was 22% compared to 38% in the dusting group ( p = 0 .08). Most of the patients in the dusting group required a repeat ureteroscopy during their follow-up (28% versus 6%, p = 0.003). A multivariable logistic regression analysis revealed that the fragmentation was not associated with a lower stone recurrence rate when compared to dusting (OR 0.6, 95% CI 0.199-1.810, p = 0.3). The recurrence rate of renal stones was not significantly influenced by the choice of surgical techniques. However, dusting was associated with a greater need for repeat ureteroscopy than fragmentation with removal. Not applicable
{"title":"Comparison of long-term results following ureteroscopic stone fragmentation with removal versus stone dusting without removal","authors":"D. Golomb, A. Shvero, Hamad Mahajna, O. Levi, H. Goldberg, S. Tapiero, Y. Stabholz, Paz Lotan, A. Darawsha, Y. Ehrlich, N. Kleinmann, V. Khasminsky, D. Zilberman, H. Winkler, D. Lifshitz","doi":"10.1177/20514158221088452","DOIUrl":"https://doi.org/10.1177/20514158221088452","url":null,"abstract":"To compare long-term results following ureteroscopic stone fragmentation and removal versus stone dusting. We conducted a retrospective analysis of patients who underwent ureteroscopy for renal calculi at two high-volume tertiary centres between 2012 and 2013, therefore allowing long-term follow-up. The surgeons differed in their technique, some performing dusting for the most part and the others fragmentation. Inclusion criteria were stone free at the first follow-up and the sole use of laser lithotripsy is either by dusting or by fragmentation. Operative and post-operative data as well as re-treatment rates were compared between the groups. Stone-free rates and long-term stone recurrence rates were analysed by a single radiologist blinded to the treatment technique. Between 2012 and 2013, 669 ureteroscopies were performed at both centres. The study group included 100 patients, which met the inclusion criteria, equally distributed between dusting and fragmentation. The cumulative stone diameter in patients treated with dusting was significantly larger (12.7 mm versus 17 mm, p = 0.006). Operative time was shorter in patients treated with dusting (56 minutes versus 47.2 minutes, p = 0.6). The mean follow-up was 58.9 (standard deviation (SD) 17.2) and 69.4 (SD 13.8) months for the fragmentation and dusting-treated patients, respectively( p = 0.06). The long-term recurrence rate in the fragmentation group was 22% compared to 38% in the dusting group ( p = 0 .08). Most of the patients in the dusting group required a repeat ureteroscopy during their follow-up (28% versus 6%, p = 0.003). A multivariable logistic regression analysis revealed that the fragmentation was not associated with a lower stone recurrence rate when compared to dusting (OR 0.6, 95% CI 0.199-1.810, p = 0.3). The recurrence rate of renal stones was not significantly influenced by the choice of surgical techniques. However, dusting was associated with a greater need for repeat ureteroscopy than fragmentation with removal. Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49494614","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}
Pub Date : 2022-05-13DOI: 10.1177/20514158221086692
J. Santiapillai, Luke Foster, P. Allchorne, James S.A. Green, Haboon Mohamud, A. Almushatat, P. Patki, Hussain Nawaz, M. Stevens, P. Rajan
COVID-19 has challenged diagnostic and surveillance pathways for suspected and known bladder transitional cell cancer (TCC). Exclusion of high-grade/invasive TCC by molecular urine testing could risk stratify patients for priority flexible cystoscopy and transurethral resection (TUR). We evaluated ADXBladder (ArquerDx), which has a high negative predictive value (NPV) for high-grade and ⩾ pT1 TCC. Prospective cohort study of patients referred with haematuria for diagnostics or on TCC surveillance (Dec 2020–Feb 2021). Patients underwent ADXBladder testing, flexible cystoscopy and imaging (for haematuria), followed by TUR/biopsy as necessary. Clinico-radiological/pathology findings were compared with ADXBladder results. Of 117 eligible patients, 39 and 78 had positive and negative ADXBladder tests, respectively. Of 15 suspected TCC on cystoscopy, eight were confirmed on TUR/biopsy. Overall ADXBladder NPV was 96.2% (CI: 91.0–98.4). NPV for high-grade and ⩾pT1 TCC was 97.4% (CI: 94.4–98.8) and 98.7% (CI: 95.0–99.7), respectively. Our ‘real world’ evaluation confirmed a high NPV for high grade and ⩾pT1 TCC using ADXBladder. Further larger studies are required to determine whether a negative ADXBladder test combined with negative imaging and patient risk factors may justify patient downgrading on timed diagnostic pathways. IV
{"title":"ADXBladder molecular urine testing to risk stratify and prioritise management of suspected and known bladder cancers during the COVID-19 pandemic","authors":"J. Santiapillai, Luke Foster, P. Allchorne, James S.A. Green, Haboon Mohamud, A. Almushatat, P. Patki, Hussain Nawaz, M. Stevens, P. Rajan","doi":"10.1177/20514158221086692","DOIUrl":"https://doi.org/10.1177/20514158221086692","url":null,"abstract":"COVID-19 has challenged diagnostic and surveillance pathways for suspected and known bladder transitional cell cancer (TCC). Exclusion of high-grade/invasive TCC by molecular urine testing could risk stratify patients for priority flexible cystoscopy and transurethral resection (TUR). We evaluated ADXBladder (ArquerDx), which has a high negative predictive value (NPV) for high-grade and ⩾ pT1 TCC. Prospective cohort study of patients referred with haematuria for diagnostics or on TCC surveillance (Dec 2020–Feb 2021). Patients underwent ADXBladder testing, flexible cystoscopy and imaging (for haematuria), followed by TUR/biopsy as necessary. Clinico-radiological/pathology findings were compared with ADXBladder results. Of 117 eligible patients, 39 and 78 had positive and negative ADXBladder tests, respectively. Of 15 suspected TCC on cystoscopy, eight were confirmed on TUR/biopsy. Overall ADXBladder NPV was 96.2% (CI: 91.0–98.4). NPV for high-grade and ⩾pT1 TCC was 97.4% (CI: 94.4–98.8) and 98.7% (CI: 95.0–99.7), respectively. Our ‘real world’ evaluation confirmed a high NPV for high grade and ⩾pT1 TCC using ADXBladder. Further larger studies are required to determine whether a negative ADXBladder test combined with negative imaging and patient risk factors may justify patient downgrading on timed diagnostic pathways. IV","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42004711","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}
Pub Date : 2022-05-13DOI: 10.1177/20514158221085081
K. Lockhart, Jarad Martin, M. White, A. Raman, Alexander Grant, P. Chong
This study assesses whether fusion or cognitive magnetic resonance imaging (MRI)-guided prostate targeted and systematic transperineal biopsies (TPB) increase detection of clinically significant prostate cancer (csPCa). A retrospective analysis was completed of patients (2018–2020) undergoing 3-Tesla multiparametric prostate MRI informing targeted (either cognitive or MIM software fusion approach) and systematic TPB. ISUP (International Society of Urological Pathology) grade group ⩾ 2 was considered csPCa. A total of 355 cases from 4 urologists were included; 131 were fusion and 224 were cognitive MRI-guided biopsies. Of all csPCa found, 86.8% ( n = 171) of cases were confirmed to be at the MRI-indicated location and 11.6% were found as part of active surveillance. In all, 45.0% of the fusion group were found to have csPCa, compared to 62.05% ( n = 139) in the cognitive group ( p = 0.002). csPCa detection rates varied between urologists (41% to 78%, p < 0.001), so a subgroup analysis was performed on Urologist A; 45.0% of fusion and 41.3% of cognitive biopsies had csPCa ( p = 0.644). Multinomial logistic regression analysis showed that biopsy type, being on active surveillance, number of biopsy cores, iPSA (initial Prostate Specific Antigen) value or PIRADS (Prostate Imaging-Reporting and Data System) score made no significant difference in whether csPCa was found. Cognitive and fusion targeting had similar csPCa detection rates. Further prospective studies would be beneficial to validate these findings. 2b (according to Oxford Centre for Evidence-Based Medicine)
{"title":"Fusion versus cognitive MRI-guided prostate biopsies in diagnosing clinically significant prostate cancer","authors":"K. Lockhart, Jarad Martin, M. White, A. Raman, Alexander Grant, P. Chong","doi":"10.1177/20514158221085081","DOIUrl":"https://doi.org/10.1177/20514158221085081","url":null,"abstract":"This study assesses whether fusion or cognitive magnetic resonance imaging (MRI)-guided prostate targeted and systematic transperineal biopsies (TPB) increase detection of clinically significant prostate cancer (csPCa). A retrospective analysis was completed of patients (2018–2020) undergoing 3-Tesla multiparametric prostate MRI informing targeted (either cognitive or MIM software fusion approach) and systematic TPB. ISUP (International Society of Urological Pathology) grade group ⩾ 2 was considered csPCa. A total of 355 cases from 4 urologists were included; 131 were fusion and 224 were cognitive MRI-guided biopsies. Of all csPCa found, 86.8% ( n = 171) of cases were confirmed to be at the MRI-indicated location and 11.6% were found as part of active surveillance. In all, 45.0% of the fusion group were found to have csPCa, compared to 62.05% ( n = 139) in the cognitive group ( p = 0.002). csPCa detection rates varied between urologists (41% to 78%, p < 0.001), so a subgroup analysis was performed on Urologist A; 45.0% of fusion and 41.3% of cognitive biopsies had csPCa ( p = 0.644). Multinomial logistic regression analysis showed that biopsy type, being on active surveillance, number of biopsy cores, iPSA (initial Prostate Specific Antigen) value or PIRADS (Prostate Imaging-Reporting and Data System) score made no significant difference in whether csPCa was found. Cognitive and fusion targeting had similar csPCa detection rates. Further prospective studies would be beneficial to validate these findings. 2b (according to Oxford Centre for Evidence-Based Medicine)","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41605554","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}
Pub Date : 2022-05-02DOI: 10.1177/20514158211058062
Finín Cotter, N. Sathianathen, Gowribahan Thevarajah, H. Kok, C. Temelcos, O. Niall, Sudheshan Sundaralingam
Seminal vesicle abscess (SVA) is a rare pathology. We review the literature and present the case of a 54-year-old presenting with an SVA treated successfully with percutaneous transgluteal drainage and subsequently, transrectal ultrasound (TRUS)-guided transrectal drainage. Level of evidence: 4
{"title":"Seminal vesicle abscess: A case report and review of the literature","authors":"Finín Cotter, N. Sathianathen, Gowribahan Thevarajah, H. Kok, C. Temelcos, O. Niall, Sudheshan Sundaralingam","doi":"10.1177/20514158211058062","DOIUrl":"https://doi.org/10.1177/20514158211058062","url":null,"abstract":"Seminal vesicle abscess (SVA) is a rare pathology. We review the literature and present the case of a 54-year-old presenting with an SVA treated successfully with percutaneous transgluteal drainage and subsequently, transrectal ultrasound (TRUS)-guided transrectal drainage. Level of evidence: 4","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41806203","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}
Pub Date : 2022-04-30DOI: 10.1177/20514158221081320
E. Zimmermann, Y. Embury-Young, D. Dickerson, A. Manjunath
The European Association of Urology recommends organ-sparing surgery (OSS) for localised penile cancer. We aimed to assess the impact of OSS including glans reconstruction on erectile, sexual and urinary function. Local ethics approval was obtained. Patients coded for glans resurfacing, glansectomy and partial penectomy from 2015 to 2018 were identified across two trusts. Background characteristics, histology, staging and follow-up were recorded. Two questionnaires were used to assess function: a custom questionnaire on patient reported outcomes and the International Index of Erectile Function (IIEF) Questionnaire. Anonymised questionnaires were sent to each patient with prepaid return envelopes included. A total of 28/64 (44%) questionnaires were returned complete. The mean age of participants was 71(35–93) and body mass index (BMI) 28(20–38). There was 1 glans resurfacing, 1 circumcision and wide local excision, 8 glansectomy and 18 partial-penectomy patients (of which 4 and 13 declined reconstruction, respectively). Sexual satisfaction (SS) and erectile function (EF) declined postoperatively while sexual desire was preserved. Subjective glans sensitivity reduced independent of technique. Glans reconstruction reduced the impact on IIEF in glansectomy (13.5 versus 25.3, p < 0.05) but not partial-penectomy (13.4 versus 13.8). SS was worse in partial-penectomy patients undergoing glans reconstruction on patient-reported outcome measures (PROM) (SS change: −4.0/10 with reconstruction versus −0.9/10 without, p < 0.05). Urinary symptoms appear limited to spraying and change of flow of urine, with some patients reporting the need to pass urine sitting down. Sexual and erectile function is impaired post-OSS in penile cancer while sexual desire is preserved. Simultaneous glans reconstruction appears to minimise this impact in glansectomy patients when assessed by IIEF. A validated PROM questionnaire could improve preoperative counselling, and guide postoperative sexual recovery.
{"title":"Sexual and urinary function after organ sparing surgery for penile cancer: A questionnaire study of consecutive patients over a 3-year period in a single region","authors":"E. Zimmermann, Y. Embury-Young, D. Dickerson, A. Manjunath","doi":"10.1177/20514158221081320","DOIUrl":"https://doi.org/10.1177/20514158221081320","url":null,"abstract":"The European Association of Urology recommends organ-sparing surgery (OSS) for localised penile cancer. We aimed to assess the impact of OSS including glans reconstruction on erectile, sexual and urinary function. Local ethics approval was obtained. Patients coded for glans resurfacing, glansectomy and partial penectomy from 2015 to 2018 were identified across two trusts. Background characteristics, histology, staging and follow-up were recorded. Two questionnaires were used to assess function: a custom questionnaire on patient reported outcomes and the International Index of Erectile Function (IIEF) Questionnaire. Anonymised questionnaires were sent to each patient with prepaid return envelopes included. A total of 28/64 (44%) questionnaires were returned complete. The mean age of participants was 71(35–93) and body mass index (BMI) 28(20–38). There was 1 glans resurfacing, 1 circumcision and wide local excision, 8 glansectomy and 18 partial-penectomy patients (of which 4 and 13 declined reconstruction, respectively). Sexual satisfaction (SS) and erectile function (EF) declined postoperatively while sexual desire was preserved. Subjective glans sensitivity reduced independent of technique. Glans reconstruction reduced the impact on IIEF in glansectomy (13.5 versus 25.3, p < 0.05) but not partial-penectomy (13.4 versus 13.8). SS was worse in partial-penectomy patients undergoing glans reconstruction on patient-reported outcome measures (PROM) (SS change: −4.0/10 with reconstruction versus −0.9/10 without, p < 0.05). Urinary symptoms appear limited to spraying and change of flow of urine, with some patients reporting the need to pass urine sitting down. Sexual and erectile function is impaired post-OSS in penile cancer while sexual desire is preserved. Simultaneous glans reconstruction appears to minimise this impact in glansectomy patients when assessed by IIEF. A validated PROM questionnaire could improve preoperative counselling, and guide postoperative sexual recovery.","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46787722","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}
Pub Date : 2022-04-30DOI: 10.1177/20514158221088681
Jennifer K Martin, Naomi Fenton, Paul Carruthers, K. Warren, J. Ash-Miles, H. Burden
The European Association of Urology (EAU) recommends annual upper tract imaging for high-risk (HR), non-muscle invasive bladder cancer (NMIBC). We evaluated the incidence of upper tract recurrence found during imaging surveillance for HR NMIBC and appraised our imaging strategy and patient radiation exposure. Two hundred and eighty-six patients between 2014 and 2019 with HR NMIBC (G3 tumour or T1 tumour or CIS, as per National Institute for Clinical Excellence (NICE) guidelines), were included in the study. The total number of computed tomography (CT) scans performed, the average radiation dose administered and the incidence rate of upper tract disease for each patient were recorded and analysed using a Microsoft Excel database. The incidence rate of upper tract recurrence diagnosed during CT follow-up was 4/286 (1.4%). Three had a successful laparoscopic nephroureterectomy, the fourth was medically unfit for surgery. In total, 2.8% (8/286) were found to have other urological diagnoses. Patients received a CT scan on average every 13 months, with a mean radiation dose of 11.5 mSv. This study found that patients with HR NMIBC have a lower risk of upper tract recurrence than previously reported, which might support a guideline change to eliminate unnecessary radiation exposure during follow-up. Not applicable for this multi-centre audit
{"title":"Upper tract CT urogram for the surveillance of high-risk non-muscle invasive bladder cancer–are we over-screening patients?","authors":"Jennifer K Martin, Naomi Fenton, Paul Carruthers, K. Warren, J. Ash-Miles, H. Burden","doi":"10.1177/20514158221088681","DOIUrl":"https://doi.org/10.1177/20514158221088681","url":null,"abstract":"The European Association of Urology (EAU) recommends annual upper tract imaging for high-risk (HR), non-muscle invasive bladder cancer (NMIBC). We evaluated the incidence of upper tract recurrence found during imaging surveillance for HR NMIBC and appraised our imaging strategy and patient radiation exposure. Two hundred and eighty-six patients between 2014 and 2019 with HR NMIBC (G3 tumour or T1 tumour or CIS, as per National Institute for Clinical Excellence (NICE) guidelines), were included in the study. The total number of computed tomography (CT) scans performed, the average radiation dose administered and the incidence rate of upper tract disease for each patient were recorded and analysed using a Microsoft Excel database. The incidence rate of upper tract recurrence diagnosed during CT follow-up was 4/286 (1.4%). Three had a successful laparoscopic nephroureterectomy, the fourth was medically unfit for surgery. In total, 2.8% (8/286) were found to have other urological diagnoses. Patients received a CT scan on average every 13 months, with a mean radiation dose of 11.5 mSv. This study found that patients with HR NMIBC have a lower risk of upper tract recurrence than previously reported, which might support a guideline change to eliminate unnecessary radiation exposure during follow-up. Not applicable for this multi-centre audit","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45536403","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}
Pub Date : 2022-04-18DOI: 10.1177/20514158221086140
Crystal An, Kirtishri Mishra, L. Bukavina, Itunu Arojo, R. Pope, Shubham Gupta
A major source of complications in vaginoplasty results from injury to the rectum during dissection of the neovaginal cavity. The SpaceOAR™ System is a rectal hydrogel spacer mostly used as a safety technique during prostate cancer treatment. This was a feasibility study performed in a single cadaveric perineum.Methods: Prior to standard cavity dissection, SpaceOAR was injected transperineally into the Denonvilliers’ fascia under guidance of transrectal ultrasound. Dissection of the neovaginal cavity with spacer gel was qualitatively assessed to be significantly easier, allowing for a blunt and quick approach. A satisfactory vaginal length was achieved rapidly and safely. We show that transgender vaginoplasty using this adaptation of SpaceOAR is technically feasible in the cadaveric model and may reduce the incidence of rectal injury or rectovaginal fistula during neovaginal cavity creation. Future experimental endeavours should focus on the reproducibility of this approach and characterise the degree of rectal protection provided. Not applicable
{"title":"Utilisation of a rectal hydrogel spacer for vaginoplasty in a cadaver model","authors":"Crystal An, Kirtishri Mishra, L. Bukavina, Itunu Arojo, R. Pope, Shubham Gupta","doi":"10.1177/20514158221086140","DOIUrl":"https://doi.org/10.1177/20514158221086140","url":null,"abstract":"A major source of complications in vaginoplasty results from injury to the rectum during dissection of the neovaginal cavity. The SpaceOAR™ System is a rectal hydrogel spacer mostly used as a safety technique during prostate cancer treatment. This was a feasibility study performed in a single cadaveric perineum.Methods: Prior to standard cavity dissection, SpaceOAR was injected transperineally into the Denonvilliers’ fascia under guidance of transrectal ultrasound. Dissection of the neovaginal cavity with spacer gel was qualitatively assessed to be significantly easier, allowing for a blunt and quick approach. A satisfactory vaginal length was achieved rapidly and safely. We show that transgender vaginoplasty using this adaptation of SpaceOAR is technically feasible in the cadaveric model and may reduce the incidence of rectal injury or rectovaginal fistula during neovaginal cavity creation. Future experimental endeavours should focus on the reproducibility of this approach and characterise the degree of rectal protection provided. Not applicable","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43594137","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}
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