{"title":"2024 Canadian Urological Association endorsement of an expert report: Kidney involvement in tuberous sclerosis complex","authors":"Ross J. Mason, Patrick O. Richard","doi":"10.5489/cuaj.8925","DOIUrl":"https://doi.org/10.5489/cuaj.8925","url":null,"abstract":"<jats:p>NA</jats:p>","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":"134 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141810939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION: Previous studies have demonstrated the feasibility of bedside placement of ureteric stents; however, they have traditionally required two skilled operators and were associated with some stent malposition especially for proximal ureteric obstruction. We sought to investigate the efficacy and safety of a modified technique for ultrasound-assisted bedside ureteric stent insertion without the presence of a skilled assist. METHODS: A single institution prospective study was performed from April-August 2023. Indications for stenting included infection, renal insufficiency, or intractable colic. Exclusion criteria included age <18 years, hemodynamic instability, and patients with history of chronic pain. Point-of-care ultrasound (POCUS) was used to confirm wire placement in the kidney and presence of a hydronephrotic drip from a 5 French ureteric catheter was used to confirm placement beyond the level of obstruction. RESULTS: Of 28 patients, all patients underwent successful bedside ureteric stent placement. Mean age was 64.9 years and mean body mass index (BMI) was 33.2. Proximal ureter obstruction was present in 52% of patients and mid/distal obstruction in 48%. In cases with obstructing stones, the mean stone size was 8.1 mm with a range of 4–15 mm. Infection was the indication for stent placement in most patients (71%), followed by pain (4%) and acute kidney injury (AKI) (4%). All patients who underwent successful stent placement had presence of hydronephrotic drip from the ureteric catheter. CONCLUSIONS: Ultrasound-assisted bedside ureteric stent insertion without a skilled assist is a safe and feasible option for management of acute ureteral obstruction. Presence of hydronephrotic drip can indicate successful access beyond the level of obstruction as an alternative to POCUS.
{"title":"Safety and efficacy of ultrasound-assisted bedside ureteric stent placement","authors":"David Chung, Ryan Ramjiawan, Gregory Hosier","doi":"10.5489/cuaj.8880","DOIUrl":"https://doi.org/10.5489/cuaj.8880","url":null,"abstract":"INTRODUCTION: Previous studies have demonstrated the feasibility of bedside placement of ureteric stents; however, they have traditionally required two skilled operators and were associated with some stent malposition especially for proximal ureteric obstruction. We sought to investigate the efficacy and safety of a modified technique for ultrasound-assisted bedside ureteric stent insertion without the presence of a skilled assist.\u0000METHODS: A single institution prospective study was performed from April-August 2023. Indications for stenting included infection, renal insufficiency, or intractable colic. Exclusion criteria included age <18 years, hemodynamic instability, and patients with history of chronic pain. Point-of-care ultrasound (POCUS) was used to confirm wire placement in the kidney and presence of a hydronephrotic drip from a 5 French ureteric catheter was used to confirm placement beyond the level of obstruction.\u0000RESULTS: Of 28 patients, all patients underwent successful bedside ureteric stent placement. Mean age was 64.9 years and mean body mass index (BMI) was 33.2. Proximal ureter obstruction was present in 52% of patients and mid/distal obstruction in 48%. In cases with obstructing stones, the mean stone size was 8.1 mm with a range of 4–15 mm. Infection was the indication for stent placement in most patients (71%), followed by pain (4%) and acute kidney injury (AKI) (4%). All patients who underwent successful stent placement had presence of hydronephrotic drip from the ureteric catheter.\u0000CONCLUSIONS: Ultrasound-assisted bedside ureteric stent insertion without a skilled assist is a safe and feasible option for management of acute ureteral obstruction. Presence of hydronephrotic drip can indicate successful access beyond the level of obstruction as an alternative to POCUS.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":"59 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141810672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fostering the continued growth of our association","authors":"Ricardo A. Rendon","doi":"10.5489/cuaj.8938","DOIUrl":"https://doi.org/10.5489/cuaj.8938","url":null,"abstract":"","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":"133 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141811572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roseanne Ferreira, Dean Elterman, M. Rickard, Max Freeman, Natasha Brownrig, A. Varghese, M. Chua, A. Lorenzo, J. Dos Santos
INTRODUCTION: Refractory bladder and bowel dysfunction (BBD) significantly affects the health and quality of life of children and their caregivers, emphasizing the need for effective and minimally invasive treatments. This study aims to present the inaugural Canadian experience using sacral neuromodulation (SNM) as a therapeutic option for children with refractory BBD. METHODS: Patients <18 years old with refractory BBD were prospectively followed from 2018 to the present. Preoperative evaluation included spinal MRI and video urodynamics. Two-stage SNM implantation was executed with a minimum two-week stage 1 trial. Functional outcomes and complication rates were measured following validated questionnaires. RESULTS: Six patients completed staged implantation at a median age of 10.8 years (range 8.2–18). The median baseline Dysfunctional Voiding Scoring System (DVSS) score was 12.5 (10–22). At six months of followup, only one patient required adjunct bladder medication. Median DVSS at one-year followup was 5.5 (0–7). Symptomatic resolution was noted in three patients at six months, sustained over one year. Early surgical complications were reported in one (infection) and late complications in three (lead fracture, battery depletion, non-traumatic malfunction), requiring reimplantation at a median of 37.5 (1–49) months. Post-SNM reimplantation, oral medication and rectal therapy decreased, and DVSS scores improved by 30% (0–63.6) at six months. CONCLUSIONS: SNM is feasible and offers promising results for refractory pediatric BBD in Canada. The significant improvement of symptoms highlights the treatment’s potential, which must be balanced against the high need for revision detected at three years, possibly related to patients’ growth and high activity level.
{"title":"Sacral neuromodulation in pediatric refractory bladder and bowel dysfunction","authors":"Roseanne Ferreira, Dean Elterman, M. Rickard, Max Freeman, Natasha Brownrig, A. Varghese, M. Chua, A. Lorenzo, J. Dos Santos","doi":"10.5489/cuaj.8881","DOIUrl":"https://doi.org/10.5489/cuaj.8881","url":null,"abstract":"INTRODUCTION: Refractory bladder and bowel dysfunction (BBD) significantly affects the health and quality of life of children and their caregivers, emphasizing the need for effective and minimally invasive treatments. This study aims to present the inaugural Canadian experience using sacral neuromodulation (SNM) as a therapeutic option for children with refractory BBD.\u0000METHODS: Patients <18 years old with refractory BBD were prospectively followed from 2018 to the present. Preoperative evaluation included spinal MRI and video urodynamics. Two-stage SNM implantation was executed with a minimum two-week stage 1 trial. Functional outcomes and complication rates were measured following validated questionnaires.\u0000RESULTS: Six patients completed staged implantation at a median age of 10.8 years (range 8.2–18). The median baseline Dysfunctional Voiding Scoring System (DVSS) score was 12.5 (10–22). At six months of followup, only one patient required adjunct bladder medication. Median DVSS at one-year followup was 5.5 (0–7). Symptomatic resolution was noted in three patients at six months, sustained over one year. Early surgical complications were reported in one (infection) and late complications in three (lead fracture, battery depletion, non-traumatic malfunction), requiring reimplantation at a median of 37.5 (1–49) months. Post-SNM reimplantation, oral medication and rectal therapy decreased, and DVSS scores improved by 30% (0–63.6) at six months.\u0000CONCLUSIONS: SNM is feasible and offers promising results for refractory pediatric BBD in Canada. The significant improvement of symptoms highlights the treatment’s potential, which must be balanced against the high need for revision detected at three years, possibly related to patients’ growth and high activity level.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":"135 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141811073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"PGY2040: Beyond the digital hum","authors":"Ioana Fugaru","doi":"10.5489/cuaj.8889","DOIUrl":"https://doi.org/10.5489/cuaj.8889","url":null,"abstract":"","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":"5 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141813941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Papadopoulos, Andy Kin On Wong, Sharon Hiu Ching Law, L. Zhang, H. Breunis, U. Emmenegger, S. Alibhai
Introduction: Sarcopenia is a predictor of clinical outcomes in men with metastatic castrate-resistant prostate cancer (mCRPC); however, correlates and predictors of sarcopenia are poorly understood in this population. The aim of this study was to examine correlates and predictors of sarcopenia in men with mCRPC prior to treatment. Methods: A secondary analysis of an observational study was performed. Participants were receiving care for mCRPC at the Princess Margaret Cancer Centre. Sarcopenia was assessed prior to treatment and was defined as the combination of low grip strength (<35.5 kg), low gait speed (<0.8 m/s), and computed tomography-derived low muscle mass or density. Participants’ sociodemographic and clinical characteristics, comorbidity information, and clinically relevant blood markers were collected prior to treatment and were used to identify correlates and predictors of sarcopenia through Spearman correlations and multivariable logistic regression, respectively. Results: In total, 110 men had complete data on sarcopenia measures and were included in the analysis. Sarcopenia was identified in 30 (27.3%) participants. Pre-treatment sarcopenia was moderately correlated with dependence in one or more instrumental activities of daily living (IADLs) (r=0.412), Vulnerable Elders Survey-13 (r=0.404), and a lower hemoglobin (r=0.407 per 10 g/L decrease). In adjusted logistic regression, dependence in one or more IADLs (odds ratio [OR] 4.37, 95% confidence interval [CI] 1.37–13.86, p=0.012), and a 10 g/L decrease in hemoglobin (OR 1.70, 95% CI 1.13–2.57, p=0.012) were significantly associated with sarcopenia. Conclusions: In settings where assessment of sarcopenia is not feasible, evaluation of IADLs and hemoglobin may be used to identify high-risk patients that can benefit from supportive care strategies aiming to improve muscle mass and function.
{"title":"Correlates and predictors of sarcopenia among men with metastatic castrate-resistant prostate cancer","authors":"E. Papadopoulos, Andy Kin On Wong, Sharon Hiu Ching Law, L. Zhang, H. Breunis, U. Emmenegger, S. Alibhai","doi":"10.5489/cuaj.8803","DOIUrl":"https://doi.org/10.5489/cuaj.8803","url":null,"abstract":"Introduction: Sarcopenia is a predictor of clinical outcomes in men with metastatic castrate-resistant prostate cancer (mCRPC); however, correlates and predictors of sarcopenia are poorly understood in this population. The aim of this study was to examine correlates and predictors of sarcopenia in men with mCRPC prior to treatment.\u0000Methods: A secondary analysis of an observational study was performed. Participants were receiving care for mCRPC at the Princess Margaret Cancer Centre. Sarcopenia was assessed prior to treatment and was defined as the combination of low grip strength (<35.5 kg), low gait speed (<0.8 m/s), and computed tomography-derived low muscle mass or density. Participants’ sociodemographic and clinical characteristics, comorbidity information, and clinically relevant blood markers were collected prior to treatment and were used to identify correlates and predictors of sarcopenia through Spearman correlations and multivariable logistic regression, respectively.\u0000Results: In total, 110 men had complete data on sarcopenia measures and were included in the analysis. Sarcopenia was identified in 30 (27.3%) participants. Pre-treatment sarcopenia was moderately correlated with dependence in one or more instrumental activities of daily living (IADLs) (r=0.412), Vulnerable Elders Survey-13 (r=0.404), and a lower hemoglobin (r=0.407 per 10 g/L decrease). In adjusted logistic regression, dependence in one or more IADLs (odds ratio [OR] 4.37, 95% confidence interval [CI] 1.37–13.86, p=0.012), and a 10 g/L decrease in hemoglobin (OR 1.70, 95% CI 1.13–2.57, p=0.012) were significantly associated with sarcopenia.\u0000Conclusions: In settings where assessment of sarcopenia is not feasible, evaluation of IADLs and hemoglobin may be used to identify high-risk patients that can benefit from supportive care strategies aiming to improve muscle mass and function.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":"51 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141644704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jainik Shah, M. Fidel, Dhiraj S. Bal, A. Kharazi, Connor Roque, Yool Ko, K. Sidhom, David Bouhadana, Francis Petrella, Premal Patel
Introduction: Restorative therapies (RT(s)), including low-intensity shockwave therapy (Li-SWT) and platelet-rich plasma (PRP), aim to restore natural erectile function. Many clinics offer these therapies for erectile dysfunction (ED) and Peyronie’s disease (PD) with direct-to-consumer (DTC) marketing. This study sought to investigate the landscape of RTs within Canadian clinics. Methods: Online searches were made to identify clinics offering Li-SWT and/or PRP as an RT for treating ED and PD in Canada. Public websites were analyzed, followed by calling clinics for data on cost, treatment protocols, clinic ownership, success rates, and adjunctive therapies. Results: A total of 107 clinics were identified online, with a 68.2% call response rate (n=73). Of the respondents, 56 and 40 clinics provided Li-SWT and PRP therapies, respectively, with 23 clinics offering both. All clinics reported using RTs for ED, with 21 clinics offering Li-SWT and 22 clinics providing PRP for PD. Forty-three clinics provided costs and protocols for Li-SWT, while 33 clinics did so for PRP. The average cost + standard deviation (CAD) of six sessions of Li-SWT was $2167.24+936.11 and one shot of PRP was $1478.68+591.98. Most (60.3%, n=44) clinics reported physician ownership, with a majority (n=28) being family medicine trained. Seven clinics did not provide data and 22 were non-MD-owned. Ten clinics provided success rates, with an average of 87.3%. Conclusions: Despite limited data supporting their routine clinical use, many clinics across Canada offer RTs for ED and PD with varying treatment protocols and increased costs. Further research is required to evaluate the efficacy of RT for ED and PD.
{"title":"An overview of the Canadian landscape on the use of restorative therapies for erectile dysfunction and Peyronie’s disease","authors":"Jainik Shah, M. Fidel, Dhiraj S. Bal, A. Kharazi, Connor Roque, Yool Ko, K. Sidhom, David Bouhadana, Francis Petrella, Premal Patel","doi":"10.5489/cuaj.8804","DOIUrl":"https://doi.org/10.5489/cuaj.8804","url":null,"abstract":"Introduction: Restorative therapies (RT(s)), including low-intensity shockwave therapy (Li-SWT) and platelet-rich plasma (PRP), aim to restore natural erectile function. Many clinics offer these therapies for erectile dysfunction (ED) and Peyronie’s disease (PD) with direct-to-consumer (DTC) marketing. This study sought to investigate the landscape of RTs within Canadian clinics.\u0000Methods: Online searches were made to identify clinics offering Li-SWT and/or PRP as an RT for treating ED and PD in Canada. Public websites were analyzed, followed by calling clinics for data on cost, treatment protocols, clinic ownership, success rates, and adjunctive therapies.\u0000Results: A total of 107 clinics were identified online, with a 68.2% call response rate (n=73). Of the respondents, 56 and 40 clinics provided Li-SWT and PRP therapies, respectively, with 23 clinics offering both. All clinics reported using RTs for ED, with 21 clinics offering Li-SWT and 22 clinics providing PRP for PD. Forty-three clinics provided costs and protocols for Li-SWT, while 33 clinics did so for PRP. The average cost + standard deviation (CAD) of six sessions of Li-SWT was $2167.24+936.11 and one shot of PRP was $1478.68+591.98. Most (60.3%, n=44) clinics reported physician ownership, with a majority (n=28) being family medicine trained. Seven clinics did not provide data and 22 were non-MD-owned. Ten clinics provided success rates, with an average of 87.3%.\u0000Conclusions: Despite limited data supporting their routine clinical use, many clinics across Canada offer RTs for ED and PD with varying treatment protocols and increased costs. Further research is required to evaluate the efficacy of RT for ED and PD.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":"54 31","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141644500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicholas S. Dean, Patrick Albers, A. Senthilselvan, Alexandra Bain, Matthew Mancuso, Ryan Mclarty, Trevor Schuler, T. Wollin, Shubha K. De
Introduction: We sought to identify predictors of failed retrograde ureteric stent (FRS) placement in the setting of obstructing ureteric calculi. In addition to patient- and stone-specific characteristics, we also considered computed tomography (CT) measures of ureteric wall thickness (UWT), as it has shown clinical potential in predicting outcomes of shockwave lithotripsy, ureteroscopy, and spontaneous stone passage. Methods: We performed a retrospective, case-control study comparing patients who had successful retrograde stent (SRS) insertions with those who failed stent placement and ultimately required nephrostomy tube (NT) insertion (2013–2019). Patients were identified using administrative data from a shared electronic medical record (capturing all urology patients in our geographic area) and a prospective database capturing all institutional interventional radiology procedures. Patient demographics, as well as clinical and stone characteristics were then collected, and imaging manually reviewed. Statistical analysis was performed using univariate and multivariate logistic regression analysis in collaboration with a statistician. Results: A total of 109 patients met inclusion for analysis (34 FRS, 75 SRS). The most common indication for stent insertion included sepsis (79%). On multivariate analysis both acute kidney injury as primary indication for stent insertion (odds ratio [OR] 9.16, 95% confidence interval [CI] 1.91–44.00, p=0.006) and UWT (OR 0.34, 95% CI 0.15–0.74, p=0.007) were found to be significantly associated with failed retrograde stent placement. A receiver operator characteristic curve analysis demonstrates an optimal UWT cutoff of 3.2 mm (sensitivity 60.6%, specificity 83.3%). Conclusions: Elevated UWT and acute kidney injury as an indication for urgent urinary decompression in the setting of obstructing ureteric stones are predictive of failed retrograde stent placement. These patients may benefit from upfront nephrostomy tube insertion.
{"title":"Ureteric wall thickness as a novel predictor for failed retrograde ureteric stent placement","authors":"Nicholas S. Dean, Patrick Albers, A. Senthilselvan, Alexandra Bain, Matthew Mancuso, Ryan Mclarty, Trevor Schuler, T. Wollin, Shubha K. De","doi":"10.5489/cuaj.8845","DOIUrl":"https://doi.org/10.5489/cuaj.8845","url":null,"abstract":"Introduction: We sought to identify predictors of failed retrograde ureteric stent (FRS) placement in the setting of obstructing ureteric calculi. In addition to patient- and stone-specific characteristics, we also considered computed tomography (CT) measures of ureteric wall thickness (UWT), as it has shown clinical potential in predicting outcomes of shockwave lithotripsy, ureteroscopy, and spontaneous stone passage.\u0000Methods: We performed a retrospective, case-control study comparing patients who had successful retrograde stent (SRS) insertions with those who failed stent placement and ultimately required nephrostomy tube (NT) insertion (2013–2019). Patients were identified using administrative data from a shared electronic medical record (capturing all urology patients in our geographic area) and a prospective database capturing all institutional interventional radiology procedures. Patient demographics, as well as clinical and stone characteristics were then collected, and imaging manually reviewed. Statistical analysis was performed using univariate and multivariate logistic regression analysis in collaboration with a statistician.\u0000Results: A total of 109 patients met inclusion for analysis (34 FRS, 75 SRS). The most common indication for stent insertion included sepsis (79%). On multivariate analysis both acute kidney injury as primary indication for stent insertion (odds ratio [OR] 9.16, 95% confidence interval [CI] 1.91–44.00, p=0.006) and UWT (OR 0.34, 95% CI 0.15–0.74, p=0.007) were found to be significantly associated with failed retrograde stent placement. A receiver operator characteristic curve analysis demonstrates an optimal UWT cutoff of 3.2 mm (sensitivity 60.6%, specificity 83.3%).\u0000Conclusions: Elevated UWT and acute kidney injury as an indication for urgent urinary decompression in the setting of obstructing ureteric stones are predictive of failed retrograde stent placement. These patients may benefit from upfront nephrostomy tube insertion.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":"28 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141645478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David Chung, Ryan Ramjiawan, Dhiraj S. Bal, Robert Wightman, Jasmir G. Nayak, Jeffrey W. Saranchuk, Rahul K. Bansal, Ardalan E. Ahmad
Introduction: Accurate diagnostic staging of upper tract urothelial cancer (UTUC) is challenging. Endoscopic staging is limited by its ability to provide adequate sampling of deeper layers of the ureter and renal pelvis. Further ability to accurately predict invasive disease would aid in better selecting the appropriate treatment for patients. We aimed to analyze the ability of preoperative cross-sectional radiologic findings to predict pathologic outcomes, including tumor grade, muscle-invasive disease, and presence of lymphovascular invasion (LVI). Methods: All patients diagnosed with localized UTUC (cN0M0) who underwent nephroureterectomy between February 2012 and December 2018 in Manitoba, Canada, were identified. Preoperative radiologic characteristics, including the presence and severity of hydronephrosis, as well as tumor location were recorded. Patients’ and pathologic characteristics were also recorded. Logistic regression analysis was used to assess the association between radiologic variables and pathologic outcomes at radical surgery. Results: A total of 112 pathology reports of patients with UTUC were obtained. The median age was 70 years (range 50–87), and 58.8% of patients were men. On univariate analysis, ureteric location on computed tomography (odds ratio [OR] 2.240, 95% confidence interval [CU] 1.049–4.783, p=0.037) and presence of hydronephrosis (OR 2.455, 95% CI 1.094–5.506, p=0.0029) were each independently associated with locally invasive disease (>pT2). No radiologic variables were found to be a predictor of adverse pathology on multivariable analysis. Only the presence of hydronephrosis was associated with high-grade disease on univariate analysis (OR 2.533, 95% CI 1.083–5.931, p=0.032). Conclusions: Our findings suggest a limited role for cross-sectional imaging in predicting the presence of high-grade disease, LVI, or locally advanced disease in UTUC.
导言：对上尿路尿道癌（UTUC）进行准确诊断分期具有挑战性。内窥镜分期受限于其对输尿管和肾盂深层进行充分取样的能力。进一步提高准确预测浸润性疾病的能力将有助于更好地为患者选择合适的治疗方法。我们旨在分析术前横断面放射学检查结果预测病理结果的能力，包括肿瘤分级、肌肉浸润性疾病和淋巴管侵犯（LVI）的存在：对加拿大马尼托巴省2012年2月至2018年12月期间所有确诊为局部UTUC（cN0M0）并接受肾切除术的患者进行鉴定。记录了术前放射学特征，包括肾积水的存在和严重程度以及肿瘤位置。同时还记录了患者和病理特征。采用逻辑回归分析评估放射学变量与根治术病理结果之间的关联：结果：共获得112份UTUC患者的病理报告。中位年龄为 70 岁（50-87 岁不等），58.8% 的患者为男性。单变量分析显示，计算机断层扫描显示的输尿管位置（几率比[OR]2.240，95% 置信区间[CU]1.049-4.783，P=0.037）和肾积水（OR 2.455，95% CI 1.094-5.506，P=0.0029）均与局部浸润性疾病（>pT2）独立相关。在多变量分析中，没有发现任何放射学变量可预测不良病理结果。在单变量分析中，只有肾积水与高级别疾病相关（OR 2.533，95% CI 1.083-5.931，p=0.032）：我们的研究结果表明，横断面成像在预测UTUC是否存在高级别疾病、LVI或局部晚期疾病方面作用有限。
{"title":"Radiographic predictors of muscle-invasive upper tract urothelial cancer","authors":"David Chung, Ryan Ramjiawan, Dhiraj S. Bal, Robert Wightman, Jasmir G. Nayak, Jeffrey W. Saranchuk, Rahul K. Bansal, Ardalan E. Ahmad","doi":"10.5489/cuaj.8817","DOIUrl":"https://doi.org/10.5489/cuaj.8817","url":null,"abstract":"Introduction: Accurate diagnostic staging of upper tract urothelial cancer (UTUC) is challenging. Endoscopic staging is limited by its ability to provide adequate sampling of deeper layers of the ureter and renal pelvis. Further ability to accurately predict invasive disease would aid in better selecting the appropriate treatment for patients. We aimed to analyze the ability of preoperative cross-sectional radiologic findings to predict pathologic outcomes, including tumor grade, muscle-invasive disease, and presence of lymphovascular invasion (LVI).\u0000Methods: All patients diagnosed with localized UTUC (cN0M0) who underwent nephroureterectomy between February 2012 and December 2018 in Manitoba, Canada, were identified. Preoperative radiologic characteristics, including the presence and severity of hydronephrosis, as well as tumor location were recorded. Patients’ and pathologic characteristics were also recorded. Logistic regression analysis was used to assess the association between radiologic variables and pathologic outcomes at radical surgery.\u0000Results: A total of 112 pathology reports of patients with UTUC were obtained. The median age was 70 years (range 50–87), and 58.8% of patients were men. On univariate analysis, ureteric location on computed tomography (odds ratio [OR] 2.240, 95% confidence interval [CU] 1.049–4.783, p=0.037) and presence of hydronephrosis (OR 2.455, 95% CI 1.094–5.506, p=0.0029) were each independently associated with locally invasive disease (>pT2). No radiologic variables were found to be a predictor of adverse pathology on multivariable analysis. Only the presence of hydronephrosis was associated with high-grade disease on univariate analysis (OR 2.533, 95% CI 1.083–5.931, p=0.032).\u0000Conclusions: Our findings suggest a limited role for cross-sectional imaging in predicting the presence of high-grade disease, LVI, or locally advanced disease in UTUC.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":"6 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141647927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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