Ryan Boudreau, Moustafa Fathy, Amr Hodhod, Rabail Siddiqui, Husain Alaradi, Saud Alhelal, Loay Abbas, Amer Alaref, A. Zakaria, H. Elmansy
Introduction: We aimed to investigate the factors impacting stone clearance following retrograde intrarenal surgery (RIRS) for lower pole kidney stones and to determine whether there is a significant relationship between the infundibular pelvic angle (IPA) of the kidney's lower pole and stone fragment clearance. Methods: We retrospectively reviewed patients who underwent flexible ureteroscopy (f-URS) for lower pole renal calculi between December 2020 and July 2023 at our institution. Patient demographics and stone parameters were recorded, including stone size, number, volume, density, and IPA. Intraoperative data, including total operative time, lasing time, type of laser used, and stone composition, were collected and analyzed. All patients underwent a computed tomography (CT) scan at three months followup. We recorded the presence of residual stones and the percentage of stone volume reduction. Patients with a stone size 3 mm were deemed stone-free. All patients were discharged home on the same operative day. Results: A total of 123 patients were included in the study: 71 in the stone-free group (group 1) and 52 in the residual stones group (group 2). On univariate analysis, there were significant differences between the two groups in terms of stone size, IPA, and the type of ureteroscopy used. At three months followup, 96% (24/25) of patients with an IPA <30° had residual stones, compared to 28.6% (28/98) of patients with an IPA >30° (p<0.001). There was no significant difference in the intraoperative or postoperative complications between the two groups. On multivariate analysis, IPA and stone size were the only predictive factors for the presence of residual stones. Twelve patients (23.1%) from group 2 required retreatment. Conclusions: RIRS is an effective treatment option for the management of lower pole kidney stones. IPA, in conjunction with stone size, appears to dictate the stone clearance rates of RIRS for lower pole stones.
{"title":"Factors predicting stone-free rates after retrograde intrarenal surgery for lower pole kidney stones","authors":"Ryan Boudreau, Moustafa Fathy, Amr Hodhod, Rabail Siddiqui, Husain Alaradi, Saud Alhelal, Loay Abbas, Amer Alaref, A. Zakaria, H. Elmansy","doi":"10.5489/cuaj.8807","DOIUrl":"https://doi.org/10.5489/cuaj.8807","url":null,"abstract":"Introduction: We aimed to investigate the factors impacting stone clearance following retrograde intrarenal surgery (RIRS) for lower pole kidney stones and to determine whether there is a significant relationship between the infundibular pelvic angle (IPA) of the kidney's lower pole and stone fragment clearance.\u0000Methods: We retrospectively reviewed patients who underwent flexible ureteroscopy (f-URS) for lower pole renal calculi between December 2020 and July 2023 at our institution. Patient demographics and stone parameters were recorded, including stone size, number, volume, density, and IPA. Intraoperative data, including total operative time, lasing time, type of laser used, and stone composition, were collected and analyzed. All patients underwent a computed tomography (CT) scan at three months followup. We recorded the presence of residual stones and the percentage of stone volume reduction. Patients with a stone size 3 mm were deemed stone-free. All patients were discharged home on the same operative day.\u0000Results: A total of 123 patients were included in the study: 71 in the stone-free group (group 1) and 52 in the residual stones group (group 2). On univariate analysis, there were significant differences between the two groups in terms of stone size, IPA, and the type of ureteroscopy used. At three months followup, 96% (24/25) of patients with an IPA <30° had residual stones, compared to 28.6% (28/98) of patients with an IPA >30° (p<0.001). There was no significant difference in the intraoperative or postoperative complications between the two groups. On multivariate analysis, IPA and stone size were the only predictive factors for the presence of residual stones. Twelve patients (23.1%) from group 2 required retreatment.\u0000Conclusions: RIRS is an effective treatment option for the management of lower pole kidney stones. IPA, in conjunction with stone size, appears to dictate the stone clearance rates of RIRS for lower pole stones.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":"33 31","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141645443","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}
Francis Simard, C. McMartin, Daphnée Bédard-Tremblay, S. L'esperance, Renée Drolet, M. Coulombe, A. Nourissat, M. Rhainds, B. Turcotte, Jonathan Cloutier
Introduction: Breakages and repairs related to flexible digital reusable ureteroscopes (flURS) are expensive. Thus, we aimed to assess the cost-effectiveness of single-use flexible digital ureteroscopes (SUDFU). Methods: We conducted a literature review on MEDLINE and EMBASE until September 19, 2018. Systematic reviews and guidelines were assessed for methodologic quality by using standardized grids (R-AMSTAR and AGREE-II). Original studies were analyzed according to local customized grids. The CAPS (Critical Appraisal Skills Program) tool enabled the assessment of the economic aspects in the literature. We also collected local data over a year in 2017–2018 and conducted an economic evaluation by cost minimization, comparing SUDFU and flURS in our center. By generating different flURS breakage reduction scenarios, we aimed to demonstrate the budgetary impact that would have SUFDU introduction in our center. Results: Five economic studies were included. Data on flURS showed breakage rates between 6.4% and 13.2%, and mean numbers of interventions before breakage between 7.5 and 14.4. Four of the five economic analyses suggested a higher cost per intervention with SUDFU. Our local data demonstrated similar results (6.4% and 11.8 cases) and enabled us to estimate the annual number of ureteroscopies for which SUDFU would become profitable: 11–26 (depending on the chosen device). Furthermore, we illustrated how selective use of SUFDU can reduce annual costs by avoiding breakages in different scenarios. Conclusions: The mean cost per intervention with SUDFU is usually higher than with flURS in high-volume centers and exclusive use becomes unprofitable from a small number of cases.
{"title":"Assessment of the economic relevance of the use of single-use digital flexible ureteroscopes","authors":"Francis Simard, C. McMartin, Daphnée Bédard-Tremblay, S. L'esperance, Renée Drolet, M. Coulombe, A. Nourissat, M. Rhainds, B. Turcotte, Jonathan Cloutier","doi":"10.5489/cuaj.8798","DOIUrl":"https://doi.org/10.5489/cuaj.8798","url":null,"abstract":"Introduction: Breakages and repairs related to flexible digital reusable ureteroscopes (flURS) are expensive. Thus, we aimed to assess the cost-effectiveness of single-use flexible digital ureteroscopes (SUDFU).\u0000Methods: We conducted a literature review on MEDLINE and EMBASE until September 19, 2018. Systematic reviews and guidelines were assessed for methodologic quality by using standardized grids (R-AMSTAR and AGREE-II). Original studies were analyzed according to local customized grids. The CAPS (Critical Appraisal Skills Program) tool enabled the assessment of the economic aspects in the literature. We also collected local data over a year in 2017–2018 and conducted an economic evaluation by cost minimization, comparing SUDFU and flURS in our center. By generating different flURS breakage reduction scenarios, we aimed to demonstrate the budgetary impact that would have SUFDU introduction in our center.\u0000Results: Five economic studies were included. Data on flURS showed breakage rates between 6.4% and 13.2%, and mean numbers of interventions before breakage between 7.5 and 14.4. Four of the five economic analyses suggested a higher cost per intervention with SUDFU. Our local data demonstrated similar results (6.4% and 11.8 cases) and enabled us to estimate the annual number of ureteroscopies for which SUDFU would become profitable: 11–26 (depending on the chosen device). Furthermore, we illustrated how selective use of SUFDU can reduce annual costs by avoiding breakages in different scenarios.\u0000Conclusions: The mean cost per intervention with SUDFU is usually higher than with flURS in high-volume centers and exclusive use becomes unprofitable from a small number of cases.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":"22 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141648052","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}
Elyse Potvin, Kelsey Adams, Diego Barrieras, Stephane Bolduc, Caroline Quach
Introduction: Given the potential consequences associated with urinary tract infections (UTI), it has become standard practice to use continuous antibiotic prophylaxis (CAP) in children, even if controversial. We reviewed the effectiveness of CAP on recurrent UTI in a pediatric population to determine if equipoise remains and allow for a placebo control group to study the effectiveness of the vaccine MV140. Method: We completed a rapid review. We searched Medline, Embase and the Cochrane Library and data extraction was completed by a single reviewer. Our search criteria were 2005–2022, English and French language, randomized controlled trials (RCTs) and systematic reviews only. The population was 19 years and younger, including: vesicoureteral reflux (VUR), congenital anomalies of the kidneys and urinary tracts (CAKUT), and bladder and bowel dysfunction (BBD). Results: Three RCTs and three systematic reviews found a benefit for CAP, mostly for a population with VUR, and those with severe VUR have more benefit. Most studies were not able to show a difference in the rate of UTIs or new renal scars (NRS). Three RCTs found a deleterious effect with CAP. Other studies were able to prove a benefit for patients with dilatation of the urinary tract without obstruction and high-grade VUR combined with BBD. The major adverse event found was antimicrobial resistance. Conclusions: High-risk patients benefit from CAP. The potential consequences of UTIs makes it unethical to use a placebo-only control group for them; however, CAP use seems difficult to justify in a low-risk population.
导言：鉴于泌尿道感染（UTI）的潜在后果，在儿童中使用持续抗生素预防（CAP）已成为标准做法，即使存在争议。我们回顾了 CAP 在儿童群体中对复发性 UTI 的有效性，以确定是否仍存在等效性，并通过安慰剂对照组来研究 MV140 疫苗的有效性：我们完成了一项快速综述。我们检索了 Medline、Embase 和 Cochrane 图书馆，并由一名审稿人完成了数据提取。我们的搜索标准是 2005-2022 年、英语和法语、随机对照试验 (RCT) 和系统综述。研究对象为 19 岁及以下人群，包括：膀胱输尿管反流（VUR）、先天性肾脏和尿路异常（CAKUT）以及膀胱和肠道功能障碍（BBD）：结果：三项研究性试验和三项系统综述发现 CAP 有益，主要是对膀胱尿道返流患者而言，重度膀胱尿道返流患者受益更大。大多数研究未能显示尿毒症或新肾疤痕（NRS）发生率的差异。三项研究发现，CAP 会产生有害影响。其他研究则证明，尿路扩张但无梗阻的患者以及合并 BBD 的高位 VUR 患者可从中获益。发现的主要不良反应是抗菌药耐药性：结论：高危患者可从 CAP 中获益。尿毒症的潜在后果使得对其使用仅有安慰剂的对照组是不道德的；然而，在低风险人群中使用 CAP 似乎难以自圆其说。
{"title":"Impact of antibiotic prophylaxis on urinary tract infection recurrence in children","authors":"Elyse Potvin, Kelsey Adams, Diego Barrieras, Stephane Bolduc, Caroline Quach","doi":"10.5489/cuaj.8678","DOIUrl":"https://doi.org/10.5489/cuaj.8678","url":null,"abstract":"Introduction: Given the potential consequences associated with urinary tract infections (UTI), it has become standard practice to use continuous antibiotic prophylaxis (CAP) in children, even if controversial. We reviewed the effectiveness of CAP on recurrent UTI in a pediatric population to determine if equipoise remains and allow for a placebo control group to study the effectiveness of the vaccine MV140.\u0000Method: We completed a rapid review. We searched Medline, Embase and the Cochrane Library and data extraction was completed by a single reviewer. Our search criteria were 2005–2022, English and French language, randomized controlled trials (RCTs) and systematic reviews only. The population was 19 years and younger, including: vesicoureteral reflux (VUR), congenital anomalies of the kidneys and urinary tracts (CAKUT), and bladder and bowel dysfunction (BBD).\u0000Results: Three RCTs and three systematic reviews found a benefit for CAP, mostly for a population with VUR, and those with severe VUR have more benefit. Most studies were not able to show a difference in the rate of UTIs or new renal scars (NRS). Three RCTs found a deleterious effect with CAP. Other studies were able to prove a benefit for patients with dilatation of the urinary tract without obstruction and high-grade VUR combined with BBD. The major adverse event found was antimicrobial resistance.\u0000Conclusions: High-risk patients benefit from CAP. The potential consequences of UTIs makes it unethical to use a placebo-only control group for them; however, CAP use seems difficult to justify in a low-risk population.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":"24 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141646049","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}
M. Fidel, Jainik Shah, Dhiraj S Bal, Yool Ko, Connor Roque, Harliv Dhillon, David Chung, Alagarsamy Pandian, Jasmir G. Nayak, Premal Patel
Introduction: We aimed to investigate the surgical outcomes following inguinal and subinguinal urological procedures under deep intravenous sedation (DIVS) with multimodal local anesthesia (LA). Methods: We conducted a retrospective cohort study from September 2022 to December 2023 including adult patients deemed eligible for day surgery (American Society of Anesthesiologist score 1–3) undergoing radical orchiectomy (RO), microscopic varicocelectomy (MV), or microscopic denervation of spermatic cords (MDSC). All procedures were performed at a single urologic ambulatory surgical center and outpatient clinic, and by a single surgeon (PP). Procedures were performed through a subinguinal or inguinal approach with DIVS and adjunctive multimodal LA. We evaluated intraoperative complications and relevant surgical outcomes and parameters. Results: A total of 103 patients were included in the analysis with a mean age ± standard deviation of 37.3±9.6. This included 25 patients who underwent RO, 54 patients who underwent MV, and 24 patients who underwent MDSC. All procedures were completed successfully without intraoperative complications. Oncologic outcomes were preserved, fertility outcomes improved, and pain scores reduced similar to the expected rates in the literature. Conclusions: Our preliminary results demonstrate the safety, effectiveness, and feasibility of performing inguinal and subinguinal urologic procedures under DIVS with LA. These findings suggest that this technique preserves high-quality care while avoiding unnecessary risks of general or spinal anesthesia, representing an opportunity to transfer these cases outside of hospitals’ operating rooms into outpatient ambulatory centers.
{"title":"Outcomes following inguinal and subinguinal urologic procedures under deep intravenous sedation","authors":"M. Fidel, Jainik Shah, Dhiraj S Bal, Yool Ko, Connor Roque, Harliv Dhillon, David Chung, Alagarsamy Pandian, Jasmir G. Nayak, Premal Patel","doi":"10.5489/cuaj.8841","DOIUrl":"https://doi.org/10.5489/cuaj.8841","url":null,"abstract":"Introduction: We aimed to investigate the surgical outcomes following inguinal and subinguinal urological procedures under deep intravenous sedation (DIVS) with multimodal local anesthesia (LA).\u0000Methods: We conducted a retrospective cohort study from September 2022 to December 2023 including adult patients deemed eligible for day surgery (American Society of Anesthesiologist score 1–3) undergoing radical orchiectomy (RO), microscopic varicocelectomy (MV), or microscopic denervation of spermatic cords (MDSC). All procedures were performed at a single urologic ambulatory surgical center and outpatient clinic, and by a single surgeon (PP). Procedures were performed through a subinguinal or inguinal approach with DIVS and adjunctive multimodal LA. We evaluated intraoperative complications and relevant surgical outcomes and parameters.\u0000Results: A total of 103 patients were included in the analysis with a mean age ± standard deviation of 37.3±9.6. This included 25 patients who underwent RO, 54 patients who underwent MV, and 24 patients who underwent MDSC. All procedures were completed successfully without intraoperative complications. Oncologic outcomes were preserved, fertility outcomes improved, and pain scores reduced similar to the expected rates in the literature.\u0000Conclusions: Our preliminary results demonstrate the safety, effectiveness, and feasibility of performing inguinal and subinguinal urologic procedures under DIVS with LA. These findings suggest that this technique preserves high-quality care while avoiding unnecessary risks of general or spinal anesthesia, representing an opportunity to transfer these cases outside of hospitals’ operating rooms into outpatient ambulatory centers.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":" 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141365999","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: Nonagenarians represent a rapidly growing patient population in Canada with unique health concerns. With the goal of preparing urologists to manage this complicated patient populations in the future, we sought to characterize referral patterns, diagnoses, investigations, treatments, and associated complications in a cohort of nonagenarians. Our second goal was to review anticholinergic burden (ACB) and rates of anticoagulation in this patient population and to assess the risk of hematuria in those who were anticoagulated. Methods: This was a single-center, retrospective chart review of a sample of nonagenarians referred to our tertiary care centre between 2009 and 2017. Demographic information, referral patterns, investigations, treatment plans, and outcomes were assessed. We assessed medication lists to calculate ACB scores at the time of referral, in addition to rates of anticoagulation use. Results: Data was collected for 154 nonagenarians. Hematuria was the most common reason for referral (n=43, 27.9%). Urinary retention and lower urinary tract symptoms (LUTS) were seen in 22 and 36 patients, respectively. The majority of patients underwent routine investigations; however, treatment decisions were frequently based on age and frailty. Mild, moderate and severe ACB scores were seen in 76.6%, 9.33%, and 14.0%, respectively. Of those referred for hematuria, 78.1% were on anticoagulation therapy. Conclusions: The most common reasons for urologic referral of nonagenarians include hematuria and LUTS. Most nonagenarians are offered routine investigations, and many are offered minor interventions for common benign and malignant urologic diagnoses. When treating nonagenarians, an individualized patient-centered care approach is likely most appropriate.
{"title":"Urologic care of nonagenarians","authors":"Emily Chedrawe, Anj Lobo, Tarek Lawen, Ashley Cox","doi":"10.5489/cuaj.8763","DOIUrl":"https://doi.org/10.5489/cuaj.8763","url":null,"abstract":"Introduction: Nonagenarians represent a rapidly growing patient population in Canada with unique health concerns. With the goal of preparing urologists to manage this complicated patient populations in the future, we sought to characterize referral patterns, diagnoses, investigations, treatments, and associated complications in a cohort of nonagenarians. Our second goal was to review anticholinergic burden (ACB) and rates of anticoagulation in this patient population and to assess the risk of hematuria in those who were anticoagulated.\u0000Methods: This was a single-center, retrospective chart review of a sample of nonagenarians referred to our tertiary care centre between 2009 and 2017. Demographic information, referral patterns, investigations, treatment plans, and outcomes were assessed. We assessed medication lists to calculate ACB scores at the time of referral, in addition to rates of anticoagulation use.\u0000Results: Data was collected for 154 nonagenarians. Hematuria was the most common reason for referral (n=43, 27.9%). Urinary retention and lower urinary tract symptoms (LUTS) were seen in 22 and 36 patients, respectively. The majority of patients underwent routine investigations; however, treatment decisions were frequently based on age and frailty. Mild, moderate and severe ACB scores were seen in 76.6%, 9.33%, and 14.0%, respectively. Of those referred for hematuria, 78.1% were on anticoagulation therapy.\u0000Conclusions: The most common reasons for urologic referral of nonagenarians include hematuria and LUTS. Most nonagenarians are offered routine investigations, and many are offered minor interventions for common benign and malignant urologic diagnoses. When treating nonagenarians, an individualized patient-centered care approach is likely most appropriate.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":" 351","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141364382","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}
C. Bayley, David B. Hogarth, Ryan Mclarty, Shubha De, Trevor Schuler
Introduction: Non-contrast computed tomography (CT) is the gold-standard diagnostic test for urolithiasis. Little is published regarding which information needs to be included in the report for it to be most useful to the healthcare team for efficient triage and high-quality patient care. This study aimed to assess the quality and variability of CT scan reporting at a single Canadian tertiary academic medical center. Methods: We completed a retrospective review of 100 consecutive renal colic CT scans. Descriptive statistics were used to report the frequency with which specific elements commonly used by urologists to triage and treat patients were included in radiology reports. Results: Our sample had a mean age of 51.4±13.1 years. Stone size was universally reported for obstructing stones but was less frequently reported for non-obstructing stones (100% vs. 86.8%). A similar trend was observed for the exact stone number (100% vs. 93.4%). Non-obstructing stones were more likely than obstructing stones to be reported in one dimension (77.5% vs. 47%). Obstructing stones were reported in three dimensions 27% of the time. CT reports commonly include the presence or absence of hydronephrosis status (98%) but are less likely to include renal size (32%) and periureteral stranding (16%). Hounsfield units (HU) were reported in 3% of the reports, but skin-to-stone distance (SSD) and radiation dose were never reported. Conclusions: Reports routinely included assessments of stone size, location, and number (although not uniformly). HU, SSD, and radiation dose were rarely reported. This provides insight into opportunities for standardized reporting to optimize knowledge transfer that may result in clinical efficiency and improved quality of patient care.
{"title":"Are renal stone protocol computed tomography reports giving us enough information?","authors":"C. Bayley, David B. Hogarth, Ryan Mclarty, Shubha De, Trevor Schuler","doi":"10.5489/cuaj.8739","DOIUrl":"https://doi.org/10.5489/cuaj.8739","url":null,"abstract":"Introduction: Non-contrast computed tomography (CT) is the gold-standard diagnostic test for urolithiasis. Little is published regarding which information needs to be included in the report for it to be most useful to the healthcare team for efficient triage and high-quality patient care. This study aimed to assess the quality and variability of CT scan reporting at a single Canadian tertiary academic medical center.\u0000Methods: We completed a retrospective review of 100 consecutive renal colic CT scans. Descriptive statistics were used to report the frequency with which specific elements commonly used by urologists to triage and treat patients were included in radiology reports.\u0000Results: Our sample had a mean age of 51.4±13.1 years. Stone size was universally reported for obstructing stones but was less frequently reported for non-obstructing stones (100% vs. 86.8%). A similar trend was observed for the exact stone number (100% vs. 93.4%). Non-obstructing stones were more likely than obstructing stones to be reported in one dimension (77.5% vs. 47%). Obstructing stones were reported in three dimensions 27% of the time. CT reports commonly include the presence or absence of hydronephrosis status (98%) but are less likely to include renal size (32%) and periureteral stranding (16%). Hounsfield units (HU) were reported in 3% of the reports, but skin-to-stone distance (SSD) and radiation dose were never reported.\u0000Conclusions: Reports routinely included assessments of stone size, location, and number (although not uniformly). HU, SSD, and radiation dose were rarely reported. This provides insight into opportunities for standardized reporting to optimize knowledge transfer that may result in clinical efficiency and improved quality of patient care.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":" 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141363348","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}
J. Lorentz, Julia Woollcombe, D. A. Loblaw, Stanley Liu, Danny Vesprini
Individuals at increased risk for prostate cancer (PCa) are inconsistently defined in national and international guidelines. The National Comprehensive Cancer Network (NCCN) defines people at increased risk for PCa to include those with a concerning family history, Black/African American individuals, and those who have germline mutations in known PCa-related genes. Recommendations for screening are also inconsistently defined in national and international guidelines. The NCCN and American Urological Association state individuals at increased risk for PCa be screened with prostate-specific antigen and digital rectal exam starting at age 40. Defining increased risk groups and defining lifetime risk is an ongoing academic process that can be facilitated through patient-registries of these cohorts at academic centers.
{"title":"Screening guidelines for people at increased risk for prostate cancer","authors":"J. Lorentz, Julia Woollcombe, D. A. Loblaw, Stanley Liu, Danny Vesprini","doi":"10.5489/cuaj.8710","DOIUrl":"https://doi.org/10.5489/cuaj.8710","url":null,"abstract":"Individuals at increased risk for prostate cancer (PCa) are inconsistently defined in national and international guidelines. The National Comprehensive Cancer Network (NCCN) defines people at increased risk for PCa to include those with a concerning family history, Black/African American individuals, and those who have germline mutations in known PCa-related genes. Recommendations for screening are also inconsistently defined in national and international guidelines. The NCCN and American Urological Association state individuals at increased risk for PCa be screened with prostate-specific antigen and digital rectal exam starting at age 40. Defining increased risk groups and defining lifetime risk is an ongoing academic process that can be facilitated through patient-registries of these cohorts at academic centers.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":"121 50","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141361670","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}
Karim Sidhom, Dhiraj S Bal, Ryan Ramjiawan, Premal Patel
Reproductive medicine has made significant advancement over the last 70 years, much of it in the way of female contraception. Reliable male contraception continues to be restricted to condoms and vasectomy. The purpose of this narrative review is to provide an overview of the contemporary usage of male contraceptive methods, including ethical and political standpoints, as well as, to summarize the current and future studies being done on male hormonal and non-hormonal contraceptive options.
{"title":"The landscape of male contraception","authors":"Karim Sidhom, Dhiraj S Bal, Ryan Ramjiawan, Premal Patel","doi":"10.5489/cuaj.8728","DOIUrl":"https://doi.org/10.5489/cuaj.8728","url":null,"abstract":"Reproductive medicine has made significant advancement over the last 70 years, much of it in the way of female contraception. Reliable male contraception continues to be restricted to condoms and vasectomy. The purpose of this narrative review is to provide an overview of the contemporary usage of male contraceptive methods, including ethical and political standpoints, as well as, to summarize the current and future studies being done on male hormonal and non-hormonal contraceptive options.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":" 847","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141364104","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}
Saud Alhelal, Parsa Nikoufar, Amr Hodhod, Prashidhi Pathak, Abdalla Bazazo, Husain Alaradi, Ruba Abdul Hadi, Loay Abbas, A. Kotb, A. Zakaria, H. Elmansy
Introduction: Our study aimed to assess the efficacy and durability of holmium laser enucleation of the prostate (HoLEP) in managing acute urinary retention (AUR), neurogenic chronic urinary retention (NCUR), and non-neurogenic chronic urinary retention (NNCUR). We also sought to compare outcomes in patients with preoperative urinary retention (UR) to those without. Methods: We conducted a retrospective analysis using prospectively gathered data from men who underwent HoLEP at our institution between October 2017 and July 2022. Patient demographics and outcome measures were recorded, including indications for the procedure, median urinary volume drained, or median postvoid residual urine volume (PVR) before catheterization or HoLEP. Chronic urinary retention (CUR) was defined as PVR 300 mL in males able to void and initial catheter drainage >1000 mL in males unable to void, in the absence of pain. NCUR and NNCUR were differentiated based on the presence of any significant illness or injury with a neurologic impact on the bladder. All patients had postoperative followup visits at one, three, six, and 12 months. Our evaluation included the International Prostate Symptom Score (IPSS), quality-of-life (QoL) assessment, maximum urinary flow rate (Qmax), PVR, and catheter-free status. Results: Three hundred sixty-eight males who underwent HoLEP were included in our study. The UR group consisted of 189 patients (70 AUR, 42 NCUR, and 77 NNCUR), and the lower urinary tract symptoms (LUTS) group was comprised of 179 individuals. There were no statistically significant differences between the NCUR and NNCUR subgroups regarding demographics and outcomes. At 12 months postoperative, the AUR group had a higher catheter-free rate than the CUR group (p=0.04), and other outcome variables were comparable between the two cohorts. The UR group had a significantly lower QoL score at one month (p=0.01) and a significantly lower IPSS score at one and 12 months (p=0.034 and p=0.018, respectively) than the LUTS cohort. During all followup visits, the UR group had a significantly higher PVR than the LUTS cohort. The successful first trial of void (TOV) rate for the UR and LUTS groups was 81% and 83.2%, respectively. At 12 months postoperative, the catheter-free rate for the UR and LUTS cohorts was 96.3% and 99.4%, respectively. Conclusions: HoLEP is an effective and durable treatment for UR with a high catheter-free rate and comparable outcomes when performed to manage LUTS.
{"title":"Efficacy and durability of holmium laser enucleation of the prostate (HoLEP) in the management of acute and chronic urinary retention","authors":"Saud Alhelal, Parsa Nikoufar, Amr Hodhod, Prashidhi Pathak, Abdalla Bazazo, Husain Alaradi, Ruba Abdul Hadi, Loay Abbas, A. Kotb, A. Zakaria, H. Elmansy","doi":"10.5489/cuaj.8756","DOIUrl":"https://doi.org/10.5489/cuaj.8756","url":null,"abstract":"Introduction: Our study aimed to assess the efficacy and durability of holmium laser enucleation of the prostate (HoLEP) in managing acute urinary retention (AUR), neurogenic chronic urinary retention (NCUR), and non-neurogenic chronic urinary retention (NNCUR). We also sought to compare outcomes in patients with preoperative urinary retention (UR) to those without.\u0000Methods: We conducted a retrospective analysis using prospectively gathered data from men who underwent HoLEP at our institution between October 2017 and July 2022. Patient demographics and outcome measures were recorded, including indications for the procedure, median urinary volume drained, or median postvoid residual urine volume (PVR) before catheterization or HoLEP. Chronic urinary retention (CUR) was defined as PVR 300 mL in males able to void and initial catheter drainage >1000 mL in males unable to void, in the absence of pain. NCUR and NNCUR were differentiated based on the presence of any significant illness or injury with a neurologic impact on the bladder. All patients had postoperative followup visits at one, three, six, and 12 months. Our evaluation included the International Prostate Symptom Score (IPSS), quality-of-life (QoL) assessment, maximum urinary flow rate (Qmax), PVR, and catheter-free status.\u0000Results: Three hundred sixty-eight males who underwent HoLEP were included in our study. The UR group consisted of 189 patients (70 AUR, 42 NCUR, and 77 NNCUR), and the lower urinary tract symptoms (LUTS) group was comprised of 179 individuals. There were no statistically significant differences between the NCUR and NNCUR subgroups regarding demographics and outcomes. At 12 months postoperative, the AUR group had a higher catheter-free rate than the CUR group (p=0.04), and other outcome variables were comparable between the two cohorts. The UR group had a significantly lower QoL score at one month (p=0.01) and a significantly lower IPSS score at one and 12 months (p=0.034 and p=0.018, respectively) than the LUTS cohort. During all followup visits, the UR group had a significantly higher PVR than the LUTS cohort. The successful first trial of void (TOV) rate for the UR and LUTS groups was 81% and 83.2%, respectively. At 12 months postoperative, the catheter-free rate for the UR and LUTS cohorts was 96.3% and 99.4%, respectively.\u0000Conclusions: HoLEP is an effective and durable treatment for UR with a high catheter-free rate and comparable outcomes when performed to manage LUTS.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":"105 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141362225","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: Generative artificial intelligence (AI) has proven to be a powerful tool with increasing applications in clinical care and medical education. CHATGPT has performed adequately on many specialty certification and knowledge assessment exams. The objective of this study was to assess the performance of CHATGPT 4 on a multiple-choice exam meant to simulate the Canadian urology board exam. Methods: Graduating urology residents representing all Canadian training programs gather yearly for a mock exam that simulates their upcoming board-certifying exam. The exam consists of written multiple-choice questions (MCQs) and an oral objective structured clinical examination (OSCE). The 2022 exam was taken by 29 graduating residents and was administered to CHATGPT 4. Results: CHATGPT 4 scored 46% on the MCQ exam, whereas the mean and median scores of graduating urology residents were 62.6%, and 62.7%, respectively. This would place CHATGPT's score 1.8 standard deviations from the median. The percentile rank of CHATGPT would be in the sixth percentile. CHATGPT scores on different topics of the exam were as follows: oncology 35%, andrology/benign prostatic hyperplasia 62%, physiology/anatomy 67%, incontinence/female urology 23%, infections 71%, urolithiasis 57%, and trauma/reconstruction 17%, with ChatGPT 4’s oncology performance being significantly below that of postgraduate year 5 residents. Conclusions: CHATGPT 4 underperforms on an MCQ exam meant to simulate the Canadian board exam. Ongoing assessments of the capability of generative AI is needed as these models evolve and are trained on additional urology content.
{"title":"Performance of artificial intelligence on a simulated Canadian urology board exam","authors":"N. Touma, Jessica E. Caterini, Kiera Liblk","doi":"10.5489/cuaj.8800","DOIUrl":"https://doi.org/10.5489/cuaj.8800","url":null,"abstract":"Introduction: Generative artificial intelligence (AI) has proven to be a powerful tool with increasing applications in clinical care and medical education. CHATGPT has performed adequately on many specialty certification and knowledge assessment exams. The objective of this study was to assess the performance of CHATGPT 4 on a multiple-choice exam meant to simulate the Canadian urology board exam.\u0000Methods: Graduating urology residents representing all Canadian training programs gather yearly for a mock exam that simulates their upcoming board-certifying exam. The exam consists of written multiple-choice questions (MCQs) and an oral objective structured clinical examination (OSCE). The 2022 exam was taken by 29 graduating residents and was administered to CHATGPT 4.\u0000Results: CHATGPT 4 scored 46% on the MCQ exam, whereas the mean and median scores of graduating urology residents were 62.6%, and 62.7%, respectively. This would place CHATGPT's score 1.8 standard deviations from the median. The percentile rank of CHATGPT would be in the sixth percentile. CHATGPT scores on different topics of the exam were as follows: oncology 35%, andrology/benign prostatic hyperplasia 62%, physiology/anatomy 67%, incontinence/female urology 23%, infections 71%, urolithiasis 57%, and trauma/reconstruction 17%, with ChatGPT 4’s oncology performance being significantly below that of postgraduate year 5 residents.\u0000Conclusions: CHATGPT 4 underperforms on an MCQ exam meant to simulate the Canadian board exam. Ongoing assessments of the capability of generative AI is needed as these models evolve and are trained on additional urology content.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":" 550","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141364057","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：