Urology最新文献

Objective: To study the impact of a student-specific urology conference for students considering a career in urology. The first symposium specifically for medical students interested in urology was designed to provide an opportunity to present their research, explore urological subspecialties, and network with faculty members, residents, and other students.

Methods: Medical students and faculty at a U.S. medical school organized the inaugural New England Student Urology Symposium (NESUS). The conference consisted of presentations from faculty members on various urology subspecialties, invited keynote speakers from regional Urology faculty, student poster and oral presentations, a surgical skills fair, and student and faculty panels surrounding the Urology Match and impact on career decision-making. Surveys were administered both before and after the conference to assess student perspectives.

Results: 42 medical students attended the conference, representing 21 medical schools from 15 states across all major U.S. regions. Attending the conference was associated with increased knowledge surrounding the Urology Match for students at schools without urology clinical rotations and decreased certainty about pursuing urology as a specialty along with increased comfort with presenting research for all attendees. 100% of student attendees recommended the conference to medical students interested in urology.

Conclusion: Our study demonstrates that conference attendees found NESUS to be a valuable opportunity to gain confidence in presenting research, strengthen knowledge about the match process and its competitiveness, and network with faculty, residents, and fellow students. Future student-focused conferences in urology and other specialties should be considered at the regional or national level.

Objectives: To evaluate the safety and efficacy of a virtual reality (VR) mask as a distraction tool during minimally invasive functional urological interventions as part of the local anesthesia protocol.

Methods: This is a single-centre prospective observational pilot cohort study which included all consecutive patients undergoing intradetrusor botulinum toxin injection, sacral neuromodulation, and urethral bulking agent injection with combined anesthetic protocol composed by local anesthesia and a VR mask (Hypno VR^TM virtual reality mask, Strasbourg, France). Preoperative and postoperative evaluation included the State-Trait Anxiety Inventory (STAI) index. Intraoperatively, a 4-point Likert anxiety rating scale and a visual analog scale (VAS) pain score were assessed. Vital signs were measured preoperative and intraoperatively. Postoperatively, two questionnaires exploring patient satisfaction were administered. The evaluated outcomes were the tolerability of the device and patient's reported intraoperative pain and anxiety.

Results: Thirty-nine patients were included. Mean age was 64 years. Eleven patients (28%) were affected by neurological conditions. Two patients experienced subjective discomfort. Preoperative and intraoperative mean arterial pressure was 105 and 111 mmHg (p=0.01), respectively. Preoperative and intraoperative mean heart rate was 72 and 75 bpm (p=0.12), respectively. Preoperative and postoperative STAI index were 34.8+-10 and 32.8+-10.3 (p=0.88). Mean Likert anxiety scale value was 2.2+-1.1, mean intraoperative VAS score was 5.3+-2.5. Thirty-four (87%) patients declared themselves satisfied with the surgical procedure and 36 (92.3%) patients would have recommended the same procedure to a relative.

Conclusions: Virtual reality mask may play a role in reducing pain and anxiety in minimally-invasive functional urological interventions.

Objective: To evaluate enteral and parenteral anticoagulant and antiplatelet medications and their associated risks of hematuria-related complications.

Materials and methods: This was a single-institution, retrospective cohort study. Primary outcomes were counts of ED visits, hospital admissions, and urologic procedures to manage gross hematuria that occurred while patients were exposed to anticoagulant/antiplatelet medications. Multivariable negative binomial regression was used to identify incidence density rates and rate ratios for hematuria-related complications associated with each anticoagulant/antiplatelet medication.

Results: Among 119,528 patients in the study cohort, 10,601 were exposed to rivaroxaban and 108,927 were not exposed to rivaroxaban. Patients who were prescribed rivaroxaban were more likely to be male (55.5% vs. 52.0%, p <.001), of white race (95.9% vs. 92.8%, p <.001), and have higher BMIs (median BMI, 29.3 vs. 28.3, p <.001). Those not exposed to rivaroxaban had lower incidence density rates than those exposed to rivaroxaban for any hematuria-related complication (29.4 vs. 39.3). Exposure to enoxaparin compared to rivaroxaban was associated with higher rates of any hematuria-related complication (adjusted risk ratio (aRR) 2.74, 95% CI 2.43-3.10), emergency department visits related to hematuria (aRR 3.34, 95% CI 2.73-4.11), and hematuria-related hospitalizations (aRR 4.58, 95% CI, 3.70-5.70). All other oral anticoagulant and antiplatelet medications studied were associated with lower risk than rivaroxaban for hematuria-related complications.

Conclusions: Among enteral and parenteral anticoagulant and antiplatelet medications studied, enoxaparin is associated with the highest rates of hematuria-related events. Further work is needed to elucidate the mechanisms by which distinct anticoagulant and antiplatelet medications contribute to hematuria.

Objective: To validate the established normal testosterone to estradiol ratio and characterize the distribution of testosterone to estradiol ratios in a large cohort of fertile and subfertile men.

Materials and methods: Retrospective review of adult men (≥18 years of age) presenting for fertility evaluation between 2002 and 2021 who underwent evaluation by a reproductive urologist, had two separate semen analyses and had hormonal testing within six months of their index semen analysis. Men were dichotomized into fertile and subfertile groups based on total motile sperm count on two semen analyses. The subfertile cohort included men with a total motile sperm count <20 million on both semen analyses. The main outcome measures were serum testosterone, serum estradiol, and serum testosterone to estradiol ratio.

Results: Among 816 men, 651 (79.8%) were classified as fertile and 165 (20.2%) as subfertile. Median testosterone (ng/dL) to estradiol (pg/mL) ratios were similar between the groups (14.48 vs 15.00, p=0.5). The 20^th percentile testosterone to estradiol ratio for the fertile group was 9.77.

Conclusions: This is the largest study to date characterizing testosterone to estradiol ratios in men presenting for fertility evaluation. We validated the 10/1 ratio that was previously established as the 20^th percentile for fertile men. We found no difference in testosterone to estradiol ratios between fertile and subfertile men defined by total motile sperm count, highlighting the need for further investigation to better define the cohort of men with infertility who could benefit from aromatase inhibitor therapy.

Objectives: To create a machine learning predictive model combining PI-RADS score, PSA density, and clinical variables to predict clinically significant prostate cancer (csPCa).

Methods: We evaluated a cohort of patients who underwent prostate biopsy for suspected prostate cancer (PCa) in New Zealand, Australia, and Switzerland. We collected data on age, body mass index (BMI), PSA level, prostate volume, PSA density (PSAD), PI-RADS scores, previous biopsy, and corresponding histology results. The dataset was divided into derivation (training) and validation (test) sets using random splits. An independent dataset was obtained from the Harvard Dataverse for external validation. A cohort of 1272 patients was analyzed. We fitted a Lasso model, XGBoost, and LightGBM to the training set and assessed their accuracy.

Results: All models demonstrated ROC AUC values ranging from 0.830 to 0.851. LightGBM was considered the superior model, with an ROC of 0.851 [95%CI: 0.804 - 0.897] in the test set and 0.818 [95% CI: 0.798 - 0.831] in the external dataset. The most important variable was PI-RADS, followed by PSA density, history of previous biopsy, age, and BMI.

Conclusions: We developed a predictive model for detecting csPCa that exhibited a high ROC-AUC value for internal and external validations. This suggests that the integration of the clinical parameters outperformed each individual predictor. Additionally, the model demonstrated good calibration metrics, indicative of a more balanced model than the existing models.

Objective: To discuss the long-term results of our vessel-sparing non-transecting approach (vspEPA) to perform anastomotic urethroplasty at the posterior urethra. We avoid transecting the bulbar arteries to preserve the antegrade vascularization of the urethra. We hypothesize that vspEPA is feasible, safe and not inferior to the traditional transecting technique. Additionally, it may provide benefits if an artificial urinary sphincter (AUS) implantation be required in the future.

Methods: The bulbar urethra was elevated from the corpus cavernosum, released distally, retracted laterally, and approached dorsally at the bulbo-membranous junction. This exposure allows removal of the scar and perform the anastomotic reconstruction as in the standard transecting technique, while avoiding division of the bulbar arteries.

Results: 127 patients, median age 58 years (IQR 35-67), were reconstructed since 2008. Etiology of the stenosis was BPH surgery (n=48), pelvic fracture urethral injury (PFUI) (n=61), prostate cancer treatment (n=14) and instrumentation (n=4). With a median follow-up of 43 months (IQR 17-74) stenosis repair success was observed in 121 patients (95%). High grade complications (Clavien ≥III) occurred in 6 (5%) of cases and overall stress incontinence was observed in 24 (19%) of patients. 14 patients subsequently received an AUS and notably none of them suffered cuff erosion after a median follow up of 36 months, CONCLUSION: Sparing of the bulbar arteries during anastomotic reconstruction of the posterior urethra is feasible and safe. Although slightly more elaborated, it will not compromise the surgical results and may be instrumental to avoid AUS cuff-related erosion in the future.

Objective: To examine the association between male factor infertility and the Rural-Urban continuum.

Materials and methods: Single institution retrospective cohort study using the Utah Population Database (UPDB), which combines demographic, medical, and residential data for patients residing in Utah and links to the Subfertility Health Assisted Reproduction and Environment (SHARE) database, which houses fertility data from 1998-2017. The data was divided by metropolitan (metro-) [large, medium, small], and non-metropolitan (non-metro-) [urban, rural] status, based on United States Department of Agriculture (USDA) rural-urban continuum codes (RUCC).

Results: Non-metro urban/rural males were less likely to be a racial/ethnic minority (91.3% non-Hispanic white vs 85.7%), or use assisted reproductive technology (ART) (13.4% vs 18.5%). Multivariate regression controlling for race/ethnicity, age, semen analysis category (oligozoospermic vs normozoospermic), previous successful fertility outcome, and use of ART, demonstrated complete rurality was associated with decreased likelihood of successful fertility outcome (Hazard Ratio [HR] 0.63, 95% CI 0.44-0.91, n=65). Non-metro urban individuals trended towards lower likelihood of successful fertility outcome ([HR] 0.93, 95% CI 0.85-1.01). Complete rurality was associated with longer time for 50% cohort successful fertility outcome (>60 months vs approximately 34 months both metro). All comparisons p<0.001.

Conclusions: Across the rural-urban continuum, residing in a metro area was associated with higher rates of racial/ethnically diversity, fertility treatment utilization, and successful fertility outcomes (live births). Given approximately 18% of the United States resides with a rural community (12% in Utah), these findings can provide more informed infertility care.