Urology最新文献

Objective: To utilize patient feedback to identify areas of need for information and ways to improve delivery of education, due to recognition that cystectomy and urinary diversion is a complex operation often overwhelming patients and caregivers.

Methods: We conducted 5 focus groups of bladder cancer patients (separated by gender and diversion type) treated with cystectomy and urinary diversion (n = 17). Questions focused on areas of improvement for patient education. Transcripts were analyzed using the Sort and Sift, Think and Shift method, with insights directing the creation of a flexible codebook. A team of researchers created thematic summaries from individual codes and performed higher level analyses to characterize salient findings.

Results: Patients described ways to improve the content, timing, and format of education. Most patients expressed a desire to receive a list of common patient experiences pre-operatively. Information they wish they had known beforehand included nuances of new urinary routines, sexual dysfunction, complications such as abdominal adhesions or hernias, and details regarding discharge criteria. Patients had differing opinions on what amount of information should be offered before surgery, but most agreed that options for more details available later were ideal. Preferences on formatting of information varied. Overall, an assortment of formats could allow patients to tailor their process to different learning preferences and individual situations.

Conclusion: Patients highlighted key areas for improvement in the breadth, timing, and format of perioperative education. Continued involvement of patients while developing these educational interventions will be pivotal for meeting patient needs and improving outcomes.

Objective: To evaluate the outcomes of robot-assisted tubularized peritoneal vaginoplasty (RATPV) for trans-feminine patients desiring genital gender-affirming surgery (gGAS).

Methods: We retrospectively reviewed all patients (adults ≥18 years old) who underwent RATPV for gGAS at our institution (July 2020-July 2022). Initial technique involved anastomosing the peritoneal flap to the introitus. The updated technique anastomosed the flap intraperitoneally to inverted penile shaft skin. Patient demographics, intraoperative details, and postoperative outcomes are described.

Results: In 33 patients, the median age was 26 years old (IQR:24-37) and BMI 26 (IQR:23-32). Median operative time was 406 minutes (IQR: 370-434) and robotic console time 177 minutes (IQR:154-220). Intraoperatively, the median vaginal depth was 17 cm and diameter 3 +cm. Median length of stay was 7 days. One-third (n = 11) of patients had a complication within 30 days postoperatively (40% Clavien Dindo I and 60% Clavien II). No patient had a Clavien III+ complication. At a median follow-up of 499 days (range: 137-835), some degree of vaginal stenosis occurred in 48% (11/23) of patients with the original approach versus 10% (1/10) of those with the newer approach (P = .05). Median vaginal depth was 11.3 cm. Three patients (9%) required revision vaginoplasty, all of whom had the original approach and had difficulty dilating postoperatively. All had clitoral sensation.

Conclusion: RATPV is a safe and effective option for individuals seeking gender-affirming vaginoplasty that obviates the need for laser hair removal prior to surgery. More research is needed into long-term outcomes of this technique.

Objective: To provide a comprehensive illustration of the newly introduced "topography-guided anatomical reassembly" approach, which has shown promising early results, and to report the midterm outcomes of an extended series.

Methods: This is a prospective cohort study of all patients presenting to the author's facility with distal penile hypospadias without chordee between June 2018 and January 2023. Redo cases, circumcised cases, and cases with non-preservable plates are excluded. The procedure follows the most recently introduced principle of the topography-guided anatomical reassembly approach for distal penile hypospadias, that is, the exclusive zipping-up of the unfolded spongiosal plate.

Results: A subset of 97 boys met the enrollment criteria. The hypospadias meatus was coronal or sub-coronal in 35 boys, distal penile in 45 boys, and mid-penile in 17 boys. The mean age at the time of surgical correction was 8.11 months. The mean operative time was 66.7 minutes. After a mean follow-up of 27 months, 5 urethrocutaneous fistulae were reported as the following: 3 glanular and 2 sub-coronal. Meatal disfigurement with downward stream deviation was reported in 2 more patients. Two more occurrences of meatal recession were identified, yet surgical correction was not necessary. The overall reoperation rate settled at 7%.

Conclusion: The proposed topography-guided anatomical reassembly technique for distal hypospadias is simple, effective, and highly feasible at midterm follow-up of the given series. Maintaining the integrity of well-developed penile tissues eliminates the possibility of unforgivable tissue damage and avoids the need for challenging revision procedures.

Objective: To predict treatment response for overactive bladder (OAB) for a specific patient remains elusive. We sought to develop accurate models using machine learning for prediction of objective and patient-reported treatment response to intravesical botulinum toxin (OBTX-A) injection. We sought to validate the models in a challenging setting using an external dataset of a markedly different patient cohort and dosing regimen. We hypothesized the model would outperform human experts and top available algorithms.

Methods: Algorithms using "operator splitting" designed for accuracy and efficiency even in small training datasets with variable completeness, were trained to predict objective response and patient-reported symptomatic improvement using the ROSETTA trial cohort and validated using the ABC trial cohort of patients who underwent OBTX-A. Areas under the curve (AUC) of algorithms were compared to the top publicly-available machine-learning classifier XGBoost, logistic regression with cross validation, and human expert predictions in the external validation set.

Results: In the validation set, the operator splitting neural network had AUC of 0.66 and outperformed XGBoost with DART (top available machine-learning classifier, AUC: 0.58), logistic regression (AUC 0.55), and human experts (AUC 0.47-0.53) for prediction of clinical responder status. It was similarly accurate in prediction of patient subjective improvement in symptoms following OBTX-A (AUC: 0.64), again outperforming other algorithms and human experts (AUC 0.41-0.62).

Conclusion: The neural network outperformed human experts and other machine-learning approaches in prediction of objective and patient-reported OBTX-A outcomes for OAB in a challenging independent validation cohort. Clinical implementation could improve counseling and treatment selection.