Introduction: The Objective Structured Clinical Examination (OSCE) is an attractive tool of competency assessment in a high-stakes summative exam. An advantage of the OSCE is the ability to assess more realistic context, content, and procedures. Each year, the Queen’s Urology Exam Skills Training (QUEST) is attended by graduating Canadian urology residents to simulate their upcoming board exams. The exam consists of a written component and an OSCE. The aim of this study was to determine the inter-observer consistency of scoring between two examiners of an OSCE for a given candidate. Methods: Thirty-nine participants in 2020 and 37 participants in 2021 completed four stations of OSCEs virtually over the Zoom platform. Each candidate was examined and scored independently by two different faculty urologists in a blinded fashion at each station. The OSCE scoring consisted of a checklist rating scale for each question. An intra-class correlation (ICC) analysis was conducted to determine the inter-rater reliability of the two examiners for each of the four OSCE stations in both the 2020 and 2021 OSCEs. Results: For the 2020 data, the prostate cancer station scores were most strongly correlated (ICC 0.746, 95% CI 0.556–0.862, p<0.001). This was followed by the general urology station (ICC 0.688, 95% CI 0.464–0.829, p<0.001, the urinary incontinence station (ICC 0.638, 95% CI 0.403–0.794, p<0.001), and finally the nephrolithiasis station (ICC 0.472, 95% CI 0.183–0.686, p<0.001). For the 2021 data, the renal cancer station had the highest ICC at 0.866 (95% CI 0.754–0.930, p<0.001). This was followed by the nephrolithiasis station (ICC 0.817, 95% CI 0.673–0.901, p<0.001), the pediatric station (ICC 0.809, 95% CI 0.660–0.897, p<0.001), and finally the andrology station (ICC 0.804, 95% CI 0.649–0.895, p<0.001). A Pearson correlation coefficient was calculated for all stations, and all show a positive correlation with global exam scores. It is noteworthy that some stations were more predictive of overall performance, but this did not necessarily mean better ICC scores for these stations. Conclusions: Given a specific clinical scenario in an OSCE exam, inter-rater reliability of scoring can be compromised on occasion. Care should be taken when high-stakes decisions about promotion are made based on OSCEs with limited standardization.
简介客观结构化临床考试（OSCE）是高风险终结性考试中一种极具吸引力的能力评估工具。OSCE 的优势在于能够评估更真实的背景、内容和程序。每年，即将毕业的加拿大泌尿外科住院医师都会参加女王泌尿外科考试技能培训（QUEST），以模拟即将到来的委员会考试。考试包括笔试和 OSCE。本研究旨在确定两名考官对特定考生的 OSCE 评分的观察者间一致性：2020年的39名学员和2021年的37名学员通过Zoom平台虚拟完成了四站OSCE。每站由两名不同的泌尿科教师对每位考生进行独立检查和盲法评分。OSCE 评分包括每个问题的核对表评分。我们进行了类内相关性（ICC）分析，以确定两位考官在 2020 年和 2021 年 OSCE 考试中四个 OSCE 考试站的评分间可靠性：在2020年的数据中，前列腺癌站得分的相关性最强（ICC 0.746，95% CI 0.556-0.862，p<0.001）。其次是普通泌尿科站（ICC 0.688，95% CI 0.464-0.829，p<0.001）、尿失禁站（ICC 0.638，95% CI 0.403-0.794，p<0.001），最后是肾结石站（ICC 0.472，95% CI 0.183-0.686，p<0.001）。在 2021 年的数据中，肾癌站的 ICC 最高，为 0.866（95% CI 0.754-0.930，p<0.001）。其次是肾结石站（ICC 0.817，95% CI 0.673-0.901，p<0.001）、儿科站（ICC 0.809，95% CI 0.660-0.897，p<0.001），最后是肾脏病站（ICC 0.804，95% CI 0.649-0.895，p<0.001）。计算出的皮尔逊相关系数显示，所有观测站都与总体考试成绩呈正相关。值得注意的是，有些站对总体表现的预测性更强，但这并不一定意味着这些站的 ICC 分数更高：结论：鉴于 OSCE 考试中的特定临床情景，评分者之间的评分可靠性有时会受到影响。在标准化程度有限的 OSCE 考试基础上做出高风险的晋升决定时，应谨慎行事。
{"title":"Inter-observer variance of examiner scoring in urology Objective Structured Clinical Examinations (OSCEs)","authors":"N. Touma, Charles Paco, Iain MacIntyre","doi":"10.5489/cuaj.8571","DOIUrl":"https://doi.org/10.5489/cuaj.8571","url":null,"abstract":"Introduction: The Objective Structured Clinical Examination (OSCE) is an attractive tool of competency assessment in a high-stakes summative exam. An advantage of the OSCE is the ability to assess more realistic context, content, and procedures. Each year, the Queen’s Urology Exam Skills Training (QUEST) is attended by graduating Canadian urology residents to simulate their upcoming board exams. The exam consists of a written component and an OSCE. The aim of this study was to determine the inter-observer consistency of scoring between two examiners of an OSCE for a given candidate.\u0000Methods: Thirty-nine participants in 2020 and 37 participants in 2021 completed four stations of OSCEs virtually over the Zoom platform. Each candidate was examined and scored independently by two different faculty urologists in a blinded fashion at each station. The OSCE scoring consisted of a checklist rating scale for each question. An intra-class correlation (ICC) analysis was conducted to determine the inter-rater reliability of the two examiners for each of the four OSCE stations in both the 2020 and 2021 OSCEs.\u0000Results: For the 2020 data, the prostate cancer station scores were most strongly correlated (ICC 0.746, 95% CI 0.556–0.862, p<0.001). This was followed by the general urology station (ICC 0.688, 95% CI 0.464–0.829, p<0.001, the urinary incontinence station (ICC 0.638, 95% CI 0.403–0.794, p<0.001), and finally the nephrolithiasis station (ICC 0.472, 95% CI 0.183–0.686, p<0.001). For the 2021 data, the renal cancer station had the highest ICC at 0.866 (95% CI 0.754–0.930, p<0.001). This was followed by the nephrolithiasis station (ICC 0.817, 95% CI 0.673–0.901, p<0.001), the pediatric station (ICC 0.809, 95% CI 0.660–0.897, p<0.001), and finally the andrology station (ICC 0.804, 95% CI 0.649–0.895, p<0.001). A Pearson correlation coefficient was calculated for all stations, and all show a positive correlation with global exam scores. It is noteworthy that some stations were more predictive of overall performance, but this did not necessarily mean better ICC scores for these stations.\u0000Conclusions: Given a specific clinical scenario in an OSCE exam, inter-rater reliability of scoring can be compromised on occasion. Care should be taken when high-stakes decisions about promotion are made based on OSCEs with limited standardization.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138949577","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}
W. C. I. Janes, Mitchell G. Fagan, J. M. Andrews, David R. Harvey, Geoff M. Warden, Paul H. Johnston, Michael K. Organ
Introduction: Renal cell carcinoma (RCC) is often associated with significant morbidity and mortality, with overall survival contingent on multiple factors — most importantly, disease stage at diagnosis. Disruptions in healthcare delivery during the COVID-19 pandemic have resulted in various reported diagnostic and treatment delays, which have had detrimental impacts on malignancies such as RCC. Methods: Surgically managed cases of RCC at our center were identified using a retrospective chart review of all nephrectomies conducted from March 1, 2018, to February 28, 2023. Examination of disease characteristics in three time period cohorts (before, during, and following the COVID-19 pandemic) was undertaken. Timeframes were consistent with implementation and abolition of public health restrictions in the province of Newfoundland and Labrador. Results: A total of 483 surgically managed RCC cases were identified during the study period. The median age was 65 years (interquartile range [IQR] 56–71), and 62.3% of patients were male. Demographics did not vary across timeframes. Before and during the pandemic, pathologic stage 3 (pT3) disease was reported in 38.9% and 35.4% of cases, respectively, whereas the post-pandemic period saw this presentation in 50.0% of patients. Surgical wait times increased significantly across study timeframes (p=0.003). Conclusions: The first year following the COVID-19 pandemic saw an 11.1% increase in patients presenting with pT3 RCC. These findings are suggestive of a clinically significant stage migration, which paired with prolonged wait times for surgery, provide critical consideration in the urgency of diagnostic and treatment decisions for RCC in the immediate future.
{"title":"Impacts of the COVID-19 pandemic on diagnosis of renal cell carcinoma and disease stage at presentation","authors":"W. C. I. Janes, Mitchell G. Fagan, J. M. Andrews, David R. Harvey, Geoff M. Warden, Paul H. Johnston, Michael K. Organ","doi":"10.5489/cuaj.8519","DOIUrl":"https://doi.org/10.5489/cuaj.8519","url":null,"abstract":"Introduction: Renal cell carcinoma (RCC) is often associated with significant morbidity and mortality, with overall survival contingent on multiple factors — most importantly, disease stage at diagnosis. Disruptions in healthcare delivery during the COVID-19 pandemic have resulted in various reported diagnostic and treatment delays, which have had detrimental impacts on malignancies such as RCC.\u0000Methods: Surgically managed cases of RCC at our center were identified using a retrospective chart review of all nephrectomies conducted from March 1, 2018, to February 28, 2023. Examination of disease characteristics in three time period cohorts (before, during, and following the COVID-19 pandemic) was undertaken. Timeframes were consistent with implementation and abolition of public health restrictions in the province of Newfoundland and Labrador.\u0000Results: A total of 483 surgically managed RCC cases were identified during the study period. The median age was 65 years (interquartile range [IQR] 56–71), and 62.3% of patients were male. Demographics did not vary across timeframes. Before and during the pandemic, pathologic stage 3 (pT3) disease was reported in 38.9% and 35.4% of cases, respectively, whereas the post-pandemic period saw this presentation in 50.0% of patients. Surgical wait times increased significantly across study timeframes (p=0.003).\u0000Conclusions: The first year following the COVID-19 pandemic saw an 11.1% increase in patients presenting with pT3 RCC. These findings are suggestive of a clinically significant stage migration, which paired with prolonged wait times for surgery, provide critical consideration in the urgency of diagnostic and treatment decisions for RCC in the immediate future.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138948776","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}
Jessica Trac, Jonguk Lee, Kai-Ho Fok, Brian Carrillo, Monica A. Farcas
Introduction: Hand/instrument motion-tracking in surgical simulation provides valuable data to improve psychomotor skills and can serve as a formative evaluation tool. Motion analysis has been well-studied in laparoscopic surgery; however, there are essentially no studies looking at motion-tracking for flexible ureteroscopy (fURS), a common surgical procedure requiring hand dexterity and 3D spatial awareness. We aimed to design a synchronized motion-tracking and video capture system for fURS capable of collecting objective metrics for use in surgical skills training. Methods: Motion tracking of the ureteroscope was performed using a motion-tracking platform, inertial measurement units (IMUs), and an optical sensor. Position (x, y, z) and orientation (roll, pitch, yaw) of the ureteroscope handle, lever deflection, and translation of the scope insertion point were collected. Video capture of the operator’s hands was collected with a Raspberry Pi camera. All peripherals were controlled on a Raspberry Pi 4 and synchronized to its system clock. Results: Our system demonstrated good accuracy in detecting translation of the ureteroscope in the x- and y-axes, and yaw, pitch and roll of the ureteroscope at discrete orientations of 0, ±30, ±60, and ±90 degrees. Unique to fURS, deflection of the lever was captured by the difference in IMU static accelerations with good accuracy. The optical sensor detected translation of the ureteroscope at the insertion point with good precision and an average error of 5.51%. Conclusions: We successfully developed a motion-tracking and video-capture system capable of collecting motion-analysis parameters unique to fURS. Future studies will focus on establishing the construct validity of this tool.
介绍：手术模拟中的手部/器械运动跟踪为提高心理运动技能提供了宝贵的数据，并可作为一种形成性评估工具。运动分析在腹腔镜手术中得到了广泛的研究；然而，目前基本上还没有针对柔性输尿管镜检查（fURS）进行运动跟踪的研究，而输尿管镜检查是一种需要手部灵活性和三维空间意识的常见外科手术。我们的目标是为柔性输尿管镜检查设计一套同步运动跟踪和视频捕捉系统，该系统能够收集客观指标，用于手术技能培训：方法：使用运动跟踪平台、惯性测量单元（IMU）和光学传感器对输尿管镜进行运动跟踪。收集了输尿管镜手柄的位置（x、y、z）和方向（滚动、俯仰、偏航）、杠杆偏转以及输尿管镜插入点的平移。使用 Raspberry Pi 摄像头采集操作员双手的视频。所有外设均由 Raspberry Pi 4 控制，并与其系统时钟同步：结果：我们的系统在检测输尿管镜在 x 轴和 y 轴的平移，以及输尿管镜在 0 度、±30 度、±60 度和±90 度离散方向的偏航、俯仰和滚动方面表现出良好的准确性。fURS 独有的功能是通过 IMU 静态加速度的差异来捕捉杠杆的偏转，精确度很高。光学传感器检测到输尿管镜在插入点的平移，精度很高，平均误差为 5.51%：我们成功开发了一种运动跟踪和视频捕捉系统，能够收集 fURS 独有的运动分析参数。未来的研究将侧重于确定该工具的构建有效性。
{"title":"Development of a synchronous motion-tracking and video capture tool for flexible ureteroscopy","authors":"Jessica Trac, Jonguk Lee, Kai-Ho Fok, Brian Carrillo, Monica A. Farcas","doi":"10.5489/cuaj.8530","DOIUrl":"https://doi.org/10.5489/cuaj.8530","url":null,"abstract":"Introduction: Hand/instrument motion-tracking in surgical simulation provides valuable data to improve psychomotor skills and can serve as a formative evaluation tool. Motion analysis has been well-studied in laparoscopic surgery; however, there are essentially no studies looking at motion-tracking for flexible ureteroscopy (fURS), a common surgical procedure requiring hand dexterity and 3D spatial awareness. We aimed to design a synchronized motion-tracking and video capture system for fURS capable of collecting objective metrics for use in surgical skills training.\u0000Methods: Motion tracking of the ureteroscope was performed using a motion-tracking platform, inertial measurement units (IMUs), and an optical sensor. Position (x, y, z) and orientation (roll, pitch, yaw) of the ureteroscope handle, lever deflection, and translation of the scope insertion point were collected. Video capture of the operator’s hands was collected with a Raspberry Pi camera. All peripherals were controlled on a Raspberry Pi 4 and synchronized to its system clock.\u0000Results: Our system demonstrated good accuracy in detecting translation of the ureteroscope in the x- and y-axes, and yaw, pitch and roll of the ureteroscope at discrete orientations of 0, ±30, ±60, and ±90 degrees. Unique to fURS, deflection of the lever was captured by the difference in IMU static accelerations with good accuracy. The optical sensor detected translation of the ureteroscope at the insertion point with good precision and an average error of 5.51%.\u0000Conclusions: We successfully developed a motion-tracking and video-capture system capable of collecting motion-analysis parameters unique to fURS. Future studies will focus on establishing the construct validity of this tool.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138952224","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}
Anastasia MacDonald, Moustafa Fathy, Parsa Nikoufar, A. Hodhod, Ruba Abdul Hadi, Saud Alhelal, Husain Alaradi, A. Zakaria, W. Shahrour, H. Elmansy
Introduction: The objective of our study was to evaluate the efficacy and durability of GreenLight laser prostatectomy for the management of acute urinary retention (AUR) and chronic urinary retention (CUR) and to determine outcomes compared to patients without preoperative urinary retention (UR). Methods: We conducted a retrospective study of prospectively collected data from individuals who underwent GreenLight laser prostatectomy at our institution from May 2018 to 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 GreenLight laser prostatectomy. 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. 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: One hundred sixty-eight males who underwent GreenLight laser prostatectomy were included in our study. The UR group consisted of 88 patients (50 AUR and 38 CUR), and the lower urinary tract symptoms (LUTS) group was comprised of 80 individuals. There were no statistically significant differences between the AUR and CUR subgroups regarding demographics. The UR group had a significantly higher age and a significantly higher postoperative catheterization length (p=0.000 and 0.000, respectively) compared to the LUTS cohort. The CUR subgroup had a significantly higher PVR at one, three, and six months compared to the AUR subgroup, although other outcome measures were similar between the two cohorts. During three- and 6-month followup visits, the UR group had a significantly higher PVR than the LUTS cohort. At 12 months postoperative, the LUTS group had a higher catheter-free rate than the UR group (p=0.001). The successful first trial of void (TOV) rate for the UR and LUTS groups were 83% and 80%, respectively. At 12 months followup, the catheter-free rate for the UR and LUTS cohorts was 87.5% and 100%, respectively. Conclusions: GreenLight laser prostatectomy is an effective and durable treatment for UR with a high catheter-free rate and comparable outcomes when performed to manage LUTS.
{"title":"Efficacy of GreenLight laser prostatectomy in urinary retention","authors":"Anastasia MacDonald, Moustafa Fathy, Parsa Nikoufar, A. Hodhod, Ruba Abdul Hadi, Saud Alhelal, Husain Alaradi, A. Zakaria, W. Shahrour, H. Elmansy","doi":"10.5489/cuaj.8556","DOIUrl":"https://doi.org/10.5489/cuaj.8556","url":null,"abstract":"Introduction: The objective of our study was to evaluate the efficacy and durability of GreenLight laser prostatectomy for the management of acute urinary retention (AUR) and chronic urinary retention (CUR) and to determine outcomes compared to patients without preoperative urinary retention (UR).\u0000Methods: We conducted a retrospective study of prospectively collected data from individuals who underwent GreenLight laser prostatectomy at our institution from May 2018 to 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 GreenLight laser prostatectomy. 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. 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: One hundred sixty-eight males who underwent GreenLight laser prostatectomy were included in our study. The UR group consisted of 88 patients (50 AUR and 38 CUR), and the lower urinary tract symptoms (LUTS) group was comprised of 80 individuals. There were no statistically significant differences between the AUR and CUR subgroups regarding demographics. The UR group had a significantly higher age and a significantly higher postoperative catheterization length (p=0.000 and 0.000, respectively) compared to the LUTS cohort. The CUR subgroup had a significantly higher PVR at one, three, and six months compared to the AUR subgroup, although other outcome measures were similar between the two cohorts. During three- and 6-month followup visits, the UR group had a significantly higher PVR than the LUTS cohort. At 12 months postoperative, the LUTS group had a higher catheter-free rate than the UR group (p=0.001). The successful first trial of void (TOV) rate for the UR and LUTS groups were 83% and 80%, respectively. At 12 months followup, the catheter-free rate for the UR and LUTS cohorts was 87.5% and 100%, respectively.\u0000Conclusions: GreenLight laser prostatectomy 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":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138952534","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}
Melissa J. Huynh, Lawson Eng, Long H. Ngo, Nicholas E. Power, Sophia C. Kamran, Theodore T. Pierce, Andrea C. Lo
Introduction: The study objective was to investigate the incidence of secondary bladder (BCa) and rectal cancers (RCa) after external beam radiotherapy (EBRT) for prostate cancer (PCa) compared to radical prostatectomy (RP) alone, and to compare cancer-specific survival of these secondary neoplasms to their primary counterparts. Methods: This retrospective cohort study included men in the Surveillance, Epidemiology, and End Results cancer registry with a diagnosis of non-metastatic, clinically node-negative PCa treated with either RP or EBRT from 1995–2011 and allowed a minimum five-year lag period for the development of secondary BCa or RCa. Patients were divided into two eras, 1995–2002 and 2003–2011, to examine differences in incidence of secondary malignancies over time. Univariable and multivariable competing risk analyses with Fine-Gray subdistribution hazard and cause-specific hazard models were used to examine the risk of developing a secondary BCa or RCa. Competing risks analyses were used to compare cancer-specific survival of primary vs. secondary BCa and RCa. Results: A total of 198 184 men underwent RP and 190 536 underwent EBRT for PCa. The cumulative incidence of secondary BCa at 10 years was 1.71% for RP, and 3.7% for EBRT (p<0.001), while that of RCa was 0.52% for RP and 0.99% for EBRT (p<0.001). EBRT was associated with approximately twice the risk of developing a secondary BCa and RCa compared to RP. The hazard of secondary BCa following EBRT delivered during 2003–2011 was 20% less than from 1995–2002 (p<0.09, Fine-Gray model), while that of secondary RCa was 31% less (p<0.001) (hazard ratio 0.78, p<0.001) for Fine-Gray and cause-specific hazard models. In the Fine-Gray model, the risk of death from BCa was 27% lower for secondary BCa after RP compared to primary BCa, while the risk of death was 9% lower for secondary BCa after EBRT compared to primary BCa. There was no difference in RCa-specific survival between primary or secondary RCa after RP or EBRT. Conclusions: The risk of BCa and RCa is approximately twice as high for men undergoing EBRT for localized PCa compared to RP, but that risk is declining, likely reflecting advancements in radiation delivery. The development of secondary RCa or BCa does not confer an elevated risk of death compared to their primary counterparts.
{"title":"Incidence and survival of secondary malignancies after external beam radiotherapy for prostate cancer in the Surveillance, Epidemiology, and End Results database","authors":"Melissa J. Huynh, Lawson Eng, Long H. Ngo, Nicholas E. Power, Sophia C. Kamran, Theodore T. Pierce, Andrea C. Lo","doi":"10.5489/cuaj.8508","DOIUrl":"https://doi.org/10.5489/cuaj.8508","url":null,"abstract":"Introduction: The study objective was to investigate the incidence of secondary bladder (BCa) and rectal cancers (RCa) after external beam radiotherapy (EBRT) for prostate cancer (PCa) compared to radical prostatectomy (RP) alone, and to compare cancer-specific survival of these secondary neoplasms to their primary counterparts.\u0000Methods: This retrospective cohort study included men in the Surveillance, Epidemiology, and End Results cancer registry with a diagnosis of non-metastatic, clinically node-negative PCa treated with either RP or EBRT from 1995–2011 and allowed a minimum five-year lag period for the development of secondary BCa or RCa. Patients were divided into two eras, 1995–2002 and 2003–2011, to examine differences in incidence of secondary malignancies over time. Univariable and multivariable competing risk analyses with Fine-Gray subdistribution hazard and cause-specific hazard models were used to examine the risk of developing a secondary BCa or RCa. Competing risks analyses were used to compare cancer-specific survival of primary vs. secondary BCa and RCa.\u0000Results: A total of 198 184 men underwent RP and 190 536 underwent EBRT for PCa. The cumulative incidence of secondary BCa at 10 years was 1.71% for RP, and 3.7% for EBRT (p<0.001), while that of RCa was 0.52% for RP and 0.99% for EBRT (p<0.001). EBRT was associated with approximately twice the risk of developing a secondary BCa and RCa compared to RP. The hazard of secondary BCa following EBRT delivered during 2003–2011 was 20% less than from 1995–2002 (p<0.09, Fine-Gray model), while that of secondary RCa was 31% less (p<0.001) (hazard ratio 0.78, p<0.001) for Fine-Gray and cause-specific hazard models. In the Fine-Gray model, the risk of death from BCa was 27% lower for secondary BCa after RP compared to primary BCa, while the risk of death was 9% lower for secondary BCa after EBRT compared to primary BCa. There was no difference in RCa-specific survival between primary or secondary RCa after RP or EBRT.\u0000Conclusions: The risk of BCa and RCa is approximately twice as high for men undergoing EBRT for localized PCa compared to RP, but that risk is declining, likely reflecting advancements in radiation delivery. The development of secondary RCa or BCa does not confer an elevated risk of death compared to their primary counterparts.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138953618","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}
Fred Saad, S. Hotte, K. Noonan, Shawn Malone, C. Morash, T. Niazi, R. Rendon, B. Shayegan, N. Basappa, I. Cagiannos, B. Danielson, G. Delouya, R. Fernandes, Cristiano Ferrario, A. Finelli, G. Gotto, Robert J. Hamilton, J. Izard, Anil Kapoor, Aly-Khan A. Lalani, L. Lavallée, Michael Ong, Frederic Pouliot, Alan I. So, S. Yip, Kim N Chi
Introduction: The management of prostate cancer (PCa) is rapidly evolving. Treatment and diagnostic options grow annually, however, high-level evidence for the use of new therapeutics and diagnostics is lacking. In November 2022, the Genitourinary Research Consortium held its 3rd Canadian Consensus Forum (CCF3) to provide guidance on key controversial areas for management of PCa. Methods: A steering committee of eight multidisciplinary physicians identified topics for discussion and adapted questions from the Advanced Prostate Cancer Consensus Conference 2022 for CCF3. Questions focused on management of metastatic castration-sensitive prostate cancer (mCSPC); use of novel imaging, germline testing and genomic profiling; and areas of non-consensus from CCF2. Fifty-eight questions were voted on during a live forum, with threshold for “consensus agreement” set at 75%. Results: The voting panel consisted of 26 physicians: 13 urologists/uro-oncologists, nine medical oncologists, and four radiation oncologists. Consensus was reached for 32 of 58 questions (one ad-hoc). Consensus was seen in the use of local treatment, to not use metastasis-directed therapy for low-volume mCSPC, and to use triplet therapy for synchronous high-volume mCSPC (low prostate-specific antigen). Consensus was also reached on sufficiency of conventional imaging to manage disease, use of germline testing and genomic profiling for metastatic disease, and PARP inhibitors for BRCA-positive prostate cancer. Conclusions: CCF3 identified consensus agreement and provides guidance on >30 practice scenarios related to management of PCa and nine areas of controversy, which represent opportunities for research and education to improve patient care. Consensus initiatives provide valuable guidance on areas of controversy as clinicians await high-level evidence.
{"title":"Addressing controversial areas in the management of advanced prostate cancer in Canada","authors":"Fred Saad, S. Hotte, K. Noonan, Shawn Malone, C. Morash, T. Niazi, R. Rendon, B. Shayegan, N. Basappa, I. Cagiannos, B. Danielson, G. Delouya, R. Fernandes, Cristiano Ferrario, A. Finelli, G. Gotto, Robert J. Hamilton, J. Izard, Anil Kapoor, Aly-Khan A. Lalani, L. Lavallée, Michael Ong, Frederic Pouliot, Alan I. So, S. Yip, Kim N Chi","doi":"10.5489/cuaj.8537","DOIUrl":"https://doi.org/10.5489/cuaj.8537","url":null,"abstract":"Introduction: The management of prostate cancer (PCa) is rapidly evolving. Treatment and diagnostic options grow annually, however, high-level evidence for the use of new therapeutics and diagnostics is lacking. In November 2022, the Genitourinary Research Consortium held its 3rd Canadian Consensus Forum (CCF3) to provide guidance on key controversial areas for management of PCa.\u0000Methods: A steering committee of eight multidisciplinary physicians identified topics for discussion and adapted questions from the Advanced Prostate Cancer Consensus Conference 2022 for CCF3. Questions focused on management of metastatic castration-sensitive prostate cancer (mCSPC); use of novel imaging, germline testing and genomic profiling; and areas of non-consensus from CCF2. Fifty-eight questions were voted on during a live forum, with threshold for “consensus agreement” set at 75%.\u0000Results: The voting panel consisted of 26 physicians: 13 urologists/uro-oncologists, nine medical oncologists, and four radiation oncologists. Consensus was reached for 32 of 58 questions (one ad-hoc). Consensus was seen in the use of local treatment, to not use metastasis-directed therapy for low-volume mCSPC, and to use triplet therapy for synchronous high-volume mCSPC (low prostate-specific antigen). Consensus was also reached on sufficiency of conventional imaging to manage disease, use of germline testing and genomic profiling for metastatic disease, and PARP inhibitors for BRCA-positive prostate cancer.\u0000Conclusions: CCF3 identified consensus agreement and provides guidance on >30 practice scenarios related to management of PCa and nine areas of controversy, which represent opportunities for research and education to improve patient care. Consensus initiatives provide valuable guidance on areas of controversy as clinicians await high-level evidence.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138948288","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}
Michael Uy, Cameron Lam, Yanbo Guo, Rahul Bansal, Richard Hae, A. Gangji, Christine Ribic, Shahid Lambe
Introduction: Postoperative imaging for deceased donor renal transplants is often delayed, as these surgeries occur after-hours These delays can be critical in identifying immediate complications. To our knowledge, there are no formal training programs for point-of-care ultrasound (POCUS) in this setting; therefore, we aimed to develop and evaluate a feasible and practical POCUS curriculum for the assessment of a renal transplant graft. Methods: Urology and nephrology transplant physicians completed a three-hour online course, followed by a five-hour hands-on seminar for sonographic scanning. Simulated patients with transplanted kidneys were used. Course material was developed with licensed ultrasound technologists based on Sonography Canada national competency profiles. Pre- and post-course surveys focused on user confidence, while pre- and post-course multiple-choice questionnaires assessed theoretical knowledge. Results: Twelve participants were included, six of whom were urologists. Theoretical knowledge in POCUS improved significantly (p<0.001). Confidence in manipulation of ultrasound controls, Doppler imaging, and POCUS of the transplant kidney also improved (all p<0.001, d>2.0). Participants indicated an increased likelihood of POCUS use in clinical practice and that training should be integrated into a transplant fellowship. Conclusions: We introduced a novel and guideline-based POCUS curriculum that leveraged local ultrasound educators and found improved theoretical knowledge and skill confidence in our cohort of transplant physicians. This course will serve as the first step toward a validated competency-based training system for POCUS use in the immediate post-renal transplant setting, and likely will be incorporated into the training of the modern transplant physician.
{"title":"Point-of-care-ultrasound for the assessment of post-renal transplant recipients","authors":"Michael Uy, Cameron Lam, Yanbo Guo, Rahul Bansal, Richard Hae, A. Gangji, Christine Ribic, Shahid Lambe","doi":"10.5489/cuaj.8531","DOIUrl":"https://doi.org/10.5489/cuaj.8531","url":null,"abstract":"Introduction: Postoperative imaging for deceased donor renal transplants is often delayed, as these surgeries occur after-hours These delays can be critical in identifying immediate complications. To our knowledge, there are no formal training programs for point-of-care ultrasound (POCUS) in this setting; therefore, we aimed to develop and evaluate a feasible and practical POCUS curriculum for the assessment of a renal transplant graft.\u0000Methods: Urology and nephrology transplant physicians completed a three-hour online course, followed by a five-hour hands-on seminar for sonographic scanning. Simulated patients with transplanted kidneys were used. Course material was developed with licensed ultrasound technologists based on Sonography Canada national competency profiles. Pre- and post-course surveys focused on user confidence, while pre- and post-course multiple-choice questionnaires assessed theoretical knowledge.\u0000Results: Twelve participants were included, six of whom were urologists. Theoretical knowledge in POCUS improved significantly (p<0.001). Confidence in manipulation of ultrasound controls, Doppler imaging, and POCUS of the transplant kidney also improved (all p<0.001, d>2.0). Participants indicated an increased likelihood of POCUS use in clinical practice and that training should be integrated into a transplant fellowship.\u0000Conclusions: We introduced a novel and guideline-based POCUS curriculum that leveraged local ultrasound educators and found improved theoretical knowledge and skill confidence in our cohort of transplant physicians. This course will serve as the first step toward a validated competency-based training system for POCUS use in the immediate post-renal transplant setting, and likely will be incorporated into the training of the modern transplant physician.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138950199","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}
Rui Bernardino, R. Sayyid, Ricardo Leão, A. Zlotta, T. H. van der Kwast, Laurence Klotz, N. Fleshner
The interest in broadening the application of active surveillance (AS) has been increasing, encompassing patients who may not strictly adhere to the conventional criteria for low-risk prostate cancer (PCa), particularly those diagnosed with small-volume Gleason grade group 2 disease. Nonetheless, accurately identifying individuals with low-intermediate risk PCa who can safely undergo AS without facing disease progression remains a challenge. This review aims to delve into the progression of this evolving trend specifically within this cohort of men, while also examining strategies aimed at minimizing irreversible disease advancement. Additionally, we address the criteria for patient selection, recommended followup schedules, and the indicators prompting intervention.
人们对扩大主动监测（AS）应用范围的兴趣与日俱增，这包括那些可能并不严格遵守低危前列腺癌（PCa）传统标准的患者，尤其是那些被诊断出患有小体积格里森2级疾病的患者。尽管如此，准确识别哪些中低危 PCa 患者可以安全地接受 AS 治疗而不会面临疾病进展仍是一项挑战。本综述旨在深入探讨这一不断发展的趋势在这一男性群体中的具体进展情况，同时研究旨在最大限度地减少不可逆疾病进展的策略。此外，我们还探讨了选择患者的标准、推荐的随访时间表以及提示干预的指标。
{"title":"Using active surveillance for Gleason 7 (3+4) prostate cancer: A narrative review","authors":"Rui Bernardino, R. Sayyid, Ricardo Leão, A. Zlotta, T. H. van der Kwast, Laurence Klotz, N. Fleshner","doi":"10.5489/cuaj.8539","DOIUrl":"https://doi.org/10.5489/cuaj.8539","url":null,"abstract":"The interest in broadening the application of active surveillance (AS) has been increasing, encompassing patients who may not strictly adhere to the conventional criteria for low-risk prostate cancer (PCa), particularly those diagnosed with small-volume Gleason grade group 2 disease. Nonetheless, accurately identifying individuals with low-intermediate risk PCa who can safely undergo AS without facing disease progression remains a challenge. This review aims to delve into the progression of this evolving trend specifically within this cohort of men, while also examining strategies aimed at minimizing irreversible disease advancement. Additionally, we address the criteria for patient selection, recommended followup schedules, and the indicators prompting intervention.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138949996","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":"Evolution of CUA guidelines","authors":"Rodney H. Breau, D. R. Siemens","doi":"10.5489/cuaj.8643","DOIUrl":"https://doi.org/10.5489/cuaj.8643","url":null,"abstract":"","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139230763","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":"Mental models in practice: The macro view and the cone of influence","authors":"Michael Leveridge","doi":"10.5489/cuaj.8653","DOIUrl":"https://doi.org/10.5489/cuaj.8653","url":null,"abstract":"","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139231131","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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