Journal of Urology最新文献

Purpose: Cryoablation (CA) and partial nephrectomy (PN) are effective nephron-sparing treatments for small renal masses. While guidelines list thermal ablation as an option for tumors <3 cm, limited data compare PN and CA in larger tumors. We compared intermediate-term oncologic outcomes between PN and CA in renal masses >3 cm.

Materials and methods: Patients treated with PN or CA for cT1/cT2, N0M0 renal masses >3 cm between 2006 and 2016 were identified. Propensity score matching was performed in a 1:2 ratio for patients undergoing CA or PN based on age, BMI, Charlson Comorbidity Index (CCI), tumor size, and nephrometry score. Disease-free survival (DFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS) were estimated using Kaplan-Meier analysis.

Results: One hundred thirteen and 57 patients underwent PN and CA with median follow-up of 4.5 and 3.8 years, respectively. CA was associated with significantly lower 5-year DFS compared to PN (75% vs. 94%, p<0.001). Local recurrence was more common after CA compared to PN (5.3% vs. 1.8%). Technical failure occurred with 32% of PCA. However, no significant differences were observed in 5-year MFS (100% for CA vs. 96% for PN, p=0.2) or CSS (100% for CA vs. 98% for PN, p=0.4).

Conclusions: CA is associated with lower DFS but similar MFS and CSS compared to PN in renal masses >3 cm. CA is a viable option for well-selected patients with comorbidities or high surgical risk, when combined with salvage ablation as indicated.

Purpose: Adults with low-grade intermediate risk non-muscle-invasive bladder cancer (LG-IR-NMIBC) commonly ask urologists how their routine/responsibilities will be affected by treatments, including the standard of care, transurethral resection of bladder tumor (TURBT). We asked patients in the ENVISION trial (NCT05243550) to compare TURBT to a non-surgical primary treatment (UGN-102 containing mitomycin) for acceptability and impact on their routine/responsibilities.

Materials and methods: ENVISION (NCT05243550) is a phase 3, single arm trial where UGN-102 was administered as six weekly intravesical instillations. Interviews with U.S. patients were conducted at enrollment (before instillations) and 3 months (primary trial endpoint). Transcripts were coded by three coders using the gold standard of content analysis to derive interview themes.

Results: Forty-one U.S. patients from 31 sites were eligible, and 29/41 completed both interviews. Most participants were men (62%), White (83%), and age 65+ (69%). Three themes were derived: 1) Patients perceived that TURBT interfered more with their routine/responsibilities. 2) Urinary symptoms were perceived to be similar, but bleeding, catheter issues, and time to resuming sexual activity lasted longer with TURBT. For UGN-102, uncommon reports were internal itching and difficulty keeping gel in the bladder during instillations. 3) Patients would recommend UGN-102 to other patients because it was perceived to be less invasive, painful, and time-consuming than TURBT.

Conclusion: Patients perceived UGN-102 to be a favorable primary treatment alternative to traditional surgical resections for LG-IR-NMIBC. By focusing on the underexplored area of patient perceptions, this study provides key information urologists will need to conduct shared decision-making conversations.