Journal of Urology最新文献

Purpose: Resilience, the ability to maintain or restore baseline function following a stressor, remains unexplored in patients with bladder cancer. Our objective was to demonstrate the feasibility of prospectively characterizing baseline resilience, related psychological resources and frailty in patients with bladder cancer and evaluate associations with quality of life and mental health outcomes over time.

Materials and methods: We enrolled patients with bladder cancer (N = 67, September 2020-July 2021) into a prospective observational cohort study. At intake, subjects completed validated assessments of frailty domains and psychological resources (resilience, psychological capital, self-compassion, and thriving, collectively PsyResources). Validated quality of life surveys were completed at 2 weeks, 3- and 6-months post-treatment selection. Correlation matrices were constructed to quantify correlations between baseline PsyResources and frailty measures (reported with Spearman's correlation coefficient [ρ]). Associations between PsyResources and quality of life outcomes were evaluated with linear regression.

Results: Median age was 71 years (83.6% male) and 77.6% had muscle-invasive bladder cancer (cN+: 21%, M1: 7.6%). Baseline PsyResources were inversely correlated with the Geriatric Depression Scale (ρ = -0.50-0.65, P < .0001). Higher baseline PsyResources were associated with improved global symptoms and emotional function and decreased anxiety and depression over time (B: -0.17 to -2.5; P < .05).

Conclusion: We present the first prospective characterization of baseline PsyResources in patients with bladder cancer. We observed positive correlations with improved mental health and quality of life outcomes over time. Ongoing work is exploring the relationship between resilience, frailty domains and their role in functional recovery following treatment. Future work is needed to understand associations between PsyResources and treatment tolerance, recovery trajectories, and oncologic outcomes.

Purpose: This project aims to characterize the incidence of men's health disorders, specifically focusing on the incidence of erectile dysfunction (ED) and testosterone deficiency (TD) in a large, nationwide study of Testicular cancer (TC) survivors treated in a centralized healthcare system.

Patients and methods: We conducted a retrospective cohort study of US Veterans diagnosed with TC from 1990 to 2021. These were compared to an age and race-matched control group of US Veterans without a diagnosis of TC. ED and TD were defined by the presence of diagnosis codes or at least a 6-months prescription for medications treating these conditions or both. Time was measured from date of TC diagnosis (for TC patients, and matched TC patient date for the corresponding non-cancer controls). Impact of chemotherapy among TC survivors on ED and TD was evaluated using multivariable Cox regression models.

Results: The cohort included 1754 patients with TC compared to 7117 non-cancer controls, with a mean age at diagnosis of 42 years. TC patients were significantly more likely than controls to experience ED (hazard ratio 2.97, 95% CI 2.68 to 3.28, P < .001) and TD (hazard ratio 6.71, 95% CI 5.78-7.81, P < .001). However, within the TC group, there was no significant difference in the incidence of ED and TD when stratified by receipt of chemotherapy (P = .9 and P = .066, respectively).

Conclusions: Men's health disorders arise commonly in the lives of TC survivors. It is important for treating physicians to identify these and conduct sexual health assessments as part of survivorship care.

Purpose: Testosterone therapy (TTh) in men with T deficiency who have undergone radical prostatectomy (RP) for prostate cancer remains controversial. We aimed to assess the impact of TTh on biochemical recurrence (BCR) rates after RP in men with low-intermediate organ-confined disease.

Materials and methods: This study included men who underwent an RP at our institution for organ-confined prostate cancer and had grade groups 1 to 3 on RP pathology. A Cox model was created for time to BCR with T use included as a time-dependent covariate, adjusted for age, pre-operative PSA, grade group at RP and the presence of comorbidities. A landmark analysis was used: patients were included in the analysis if their last PSA in the 18 weeks post-operatively was undetectable and they had not had BCR or been lost to follow-up by that point, and follow-up for BCR began at 18 weeks. BCR was defined as a PSA ≥ 0.1 ng/mL post-RP with a second confirmatory rise ≥ 0.1 ng/mL.

Results: The study population included 5199 men post-RP, with 198 patients receiving T at any point after RP and 5001 not receiving T. The median age was 59 (IQR 55, 65) and 61 (IQR 56, 66) years, respectively. Men in the T group tended to present with more vascular comorbidities. For those receiving T, clomiphene citrate was prescribed in 49% of men, 32% received transdermal T, and 19% intramuscular T. We found a non-significantly decreased risk of BCR associated with the use of T after RP (HR 0.84, 95% CI 0.48, 1.46; P = .5), and overall rates of BCR were low, with probability of BCR at 5 years less than 2% in both groups.

Conclusions: TTh can be given to select men after RP. We found no evidence that administration of TTh after RP causes BCR.

Purpose: To assess safety and feasibility of percutaneous MR-guided placement of an implantable microdevice (IMD) to evaluate in situ intratumor response to multiple pharmacologic agents in men with intermediate- and high-risk localized prostate cancer.

Materials and methods: Biocompatible IMDs measuring 750um in diameter and 5 mm in length were prepared with 20 reservoirs containing candidate drug and drug combinations including second-generation androgen inhibitors, PARP inhibitors, PD-1 inhibitors and conventional chemotherapy. Men with intermediate- or high-risk localized prostate cancer and MRI-visible lesions were enrolled. Up to 4 IMDs were placed via transperineal approach into MRI-visible tumors two days before planned radical prostatectomy. After radical prostatectomy, the IMDs and a small segment of surrounding tumor tissue were removed and sectioned, stained, and analyzed for tissue drug response by a variety of pharmacodynamic markers.

Results: 14 patients were enrolled, 7 (50%) with intermediate-risk and 7 (50%) with high-risk localized prostate cancer. A total of 53 IMDs were implanted (mean 3.8 per patient) and 49 (92%) IMDs were successfully retrieved. All men underwent uncomplicated robotic radical prostatectomy and bilateral pelvic lymph node dissection 2 days after IMD placement. There were no severe adverse events. Pathological examination of the tissues adjacent to the IMDs demonstrated differential drug response within patients and between patients. Limitations include small sample size.

Conclusions: A multi-drug IMD can be safely placed percutaneously into MRI-visible lesions before radical prostatectomy, enabling assessment of tumor-specific local response to multiple agents simultaneously within the tumor's normal stromal environment to guide targeted systemic therapy.

Purpose: Urologists encounter multiple challenges in managing ureteral stones with ureteroscopic laser lithotripsy. This meta-analysis assesses the effectiveness of alternative surgical positioning, Reverse Trendelenburg (RevTren) and Trendelenburg (Tren), in reducing stone migration and enhancing outcomes compared to standard dorsal lithotomy positioning.

Materials and methods: A systematic review was conducted following PRISMA guidelines, searching Medline, Embase, Scopus, Cochrane, and WoS up to March 2024. The review focused on studies evaluating RevTren or Tren positioning during ureteroscopic lithotripsy compared to standard dorsal lithotomy, analyzing endpoints such as stone migration, conversion rates, success rates, complications, and operative time.

Results: Out of 137 studies identified, 8 met the inclusion criteria, encompassing 1374 patients. RevTren significantly reduced ureteral stone migration (odds ratio [OR] 0.20, 95% confidence interval [CI] [0.08, 0.47]), lowered the need for conversion to a flexible ureteroscope (OR 0.28, 95% CI [0.12, 0.67]), and improved success rates (OR 2.90, 95% CI [1.88, 4.48]). Tren increased migration of ureteral and calyceal stones towards upper renal calyces (OR 2.12, 95% CI [1.48, 3.04]) and achieved a higher success rate (OR 3.56, 95% CI [2.15, 5.92]). Complications were comparable across all positions.

Conclusion: Adjusting patient positioning during ureteroscopic laser lithotripsy can enhance procedure outcomes. RevTren effectively reduces ureteral stone migration and the necessity for flexible ureteroscopes, while Tren facilitates ureteral and calyceal stone migration towards upper calyces, increasing success rates. Both positioning techniques offer significant advantages over standard positioning and can be safely adopted in clinical practice without compromising patient safety.