Urology最新文献

Objective: To characterize the prevalence of fear of cancer recurrence (FCR) and examine demographic, clinical, and psychosocial factors associated with high FCR among low-income, racially and ethnically diverse prostate cancer survivors treated with definitive therapy for localized disease.

Methods: We conducted a retrospective, cross-sectional analysis of 150 participants enrolled in the Men's Health Study (2001-2007) who completed the FCR Survey at baseline. High FCR was defined as a score ≤14 (lower tertile). Demographic, clinical, and patient-reported outcomes were assessed, including health-related quality of life (SF-12v2), prostate-specific quality of life (PCI-SF), symptom distress, spirituality, patient-physician interaction (PEPPI), and treatment regret.

Results: High FCR was reported by 28% of participants. Sociodemographic and clinical variables-including age, race/ethnicity, treatment, clinical T stage, grade, PSA, and comorbidities-were not associated with FCR. High FCR correlated strongly with poorer mental health, lower SF-12 mental composite scores, and emotional limitations. Treatment regret was significantly more prevalent among those with high FCR (95.2% vs. 28.7%, P<0.001). Physical health and prostate-specific quality of life did not differ by FCR level.

Conclusions: Nearly one-third of uninsured, underrepresented prostate cancer survivors experienced high FCR, driven by emotional distress and decisional regret rather than objective clinical risk, underscoring the need for equitable, patient-centered survivorship care that supports psychological well-being and promoting patient informed decision-making.

Objectives: To compare effects of secondary vs. primary diversion on kidney and bladder function in infants with posterior urethral valves (PUV). Although primary valve ablation is considered the gold standard, it is controversial and typically reserved for severe cases with valve ablation being the gold standard. In cases that fail to improve, secondary diversion may be offered-after a delay that likely had a detrimental impact on renal reserve.

Methods: A retrospective review of our institutional database between 2000-2024 identified 81 patients with diversion. After exclusion of patients > 1 year at initial presentation(n=8), other LUTO diagnoses(n=11) and deceased patients(n=1),61 patients were included. Data were summarized as mean + standard deviation(SD) for continuous variables.

Results: A total of 45 patients underwent primary and 16 secondary diversions. Mean follow-up was 4.9 + 4.7 years for primary and 8.9 + 5.9 years for secondary diversion, respectively. There was no difference in creatinine levels at presentation(p=0.7609), at 30 days(p=0.3748), 1 year postoperatively(p=0.4487), at 1 year of age(p=0.6158),time to nadir (p=0.2109) and nadir creatinine levels(p=0.8708).Secondary diversion was associated with higher likelihood of persistent high-grade hydronephrosis(p=0.0146) and transplantation(p=0.0252). While secondary diversion had an impact on CIC rates(p=0.0028) and creatinine levels at last follow-up(p=0.0064), risk of progression to ESKD(p=0.1159) and UTI rates(p=0.3207) were not impacted.

Conclusions: There was no impairment in short-term renal function; however, children with marginal baseline function deteriorated early(elevated creatinine levels, progression to transplantation). In carefully selected patients, primary diversion appears advantageous over salvage diversion after failed ablation and should be favored to protect long-term kidney function.

Prenatal testicular torsion (PTT) is very rare and poses a unique challenge as the contralateral testis cannot be easily monitored in utero. Delays to induction or delivery could increase risk of testicular loss and anorchia due to contralateral torsion. We present a case of unilateral PTT in a near-term fetus managed with elective induction who underwent orchiectomy of the ipsilateral testis and septopexy of the contralateral testis, with a specific focus on multispecialty discussion weighing the maternal fetal risk of early delivery with the risk of contralateral torsion.

Health literacy (HL) is defined by the National Institute of Health as the degree to which individuals can find, understand, and use information and services to inform health-related decisions and actions for themselves and others. Poor HL is prevalent among the general population of the United States (US), with only 12% of US adults possessing proficient HL to understand and utilize information delivered by healthcare providers. Furthermore, HL is a quantifiable metric that impacts oncologic outcomes in various malignancies. Given widespread deficits in HL, providers must assess patients' understanding of their health and tailor their discussion of diagnoses, management, and potential complications of management so that patients can make informed decisions. To date, literature examining HL, and its' impact on urologic oncology outcomes, is sparse. Therefore, we conducted a narrative review examining publicly available information on HL in urologic oncology and propose future avenues for research endeavors.