Urology Practice最新文献

Purpose: To evaluate real-world utility of adding Cxbladder Triage test to microhematuria diagnostic workflow in an integrated healthcare system.

Materials and methods: We conducted a retrospective matched cohort study of microhematuria patients tested with Cxbladder Triage, a urine-based biomarker of mRNA targets and clinical factors to assess urothelial cancer risk. We matched untested controls based on age, encounter date, and hematuria risk index score. The cohort was stratified by Cxbladder Triage result; low probability (<4.00, cystoscopy could be deferred) vs physician-directed protocol (≥4.00, cystoscopy recommended). We evaluated the use of cystoscopy, CT urograms, and new diagnoses of bladder cancer.

Results: We matched 3,353 patients tested with Cxbladder Triage with 3,353 controls according to American Urological Association (AUA) risk (15.7% AUA low risk for cases and controls, p=0.362). Among 3,353 tested patients, 2,670 (79.6%) had low probability of cancer and were less likely to undergo cystoscopy (3.8% vs 46.5% controls, p<0.001). Tested patients with elevated risk for cancer (n=683) were more likely to undergo cystoscopy (73.4% vs 45.7% controls, p<0.001). Similar patterns were seen for CT urogram (7.5% vs 11.7% low probability; 19.5% vs 13.3% physician-directed protocol, both p<0.001). Cancer detection was similar between both groups (0.3% tested vs 0.6% controls, p=0.105) and between tested patients with elevated risk vs untested controls (1.5% physician-directed protocol vs 0.6% controls, p=0.107).

Conclusions: Cxbladder Triage testing decreases burden of cystoscopy and CT urogram use among microhematuria patients. This test maintains similar cancer detection overall and among microhematuria patients at greater risk for underlying malignancy.

Introduction and objectives: The Veterans Affairs (VA) Health System recently implemented the Risk Analysis Index (RAI) to assess frailty prior to surgery. Elevated RAI scores trigger a "surgical pause" and geriatric consultation to reduce short-term morbidity. However, any cancer diagnosis, including localized prostate cancer (PCa), increases RAI, potentially overstating frailty in otherwise healthy patients. We hypothesized that low- or intermediate-risk PCa does not correlate with 30-day morbidity and mortality predicted by RAI.

Methods: We retrospectively reviewed patients with low- or intermediate-risk PCa who underwent radical prostatectomy at a single institution over five years. RAI-A (administrative) scores were calculated with and without including PCa. Thirty-day postoperative complications and mortality were compared to rates predicted by RAI-A using data from the original VASQIP study.

Results: Among 130 patients (median age 61), 53.4% had favorable intermediate-risk, 41.2% unfavorable intermediate-risk, and 5.3% low-risk PCa. Mean RAI-A excluding PCa was 8.58; including PCa it was 24.95. Corresponding VASQIP-predicted complication rates were 4.6% (2.5% grade IV-V) and 11.2% (5.6% grade IV-V). In our cohort, six patients (4.6%) experienced complications, none grade IV-V.

Conclusions: Including localized PCa in RAI-A calculations overestimates frailty and predicted morbidity. Excluding the PCa diagnosis may better reflect surgical risk in low- or intermediate-risk patients, preventing unnecessary delays in treatment.

Introduction: This investigator-initiated, prospective low-intervention phase 3 study evaluated the clinical utility of PSMA PET/CT imaging with ¹⁸F-flotufolastat (formerly ¹⁸F-rhPSMA-7.3) in men with newly diagnosed high-risk prostate cancer and negative conventional imaging. The primary endpoint was the rate of clinical upstaging and its effect on subsequent management.

Methods: A total of 113 treatment-naïve men meeting NCCN high-risk criteria were enrolled; 110 underwent PSMA PET/CT with ¹⁸F-flotufolastat. Prior to imaging, all patients had negative conventional staging, as determined by bone scan and CT or MRI. Imaging was performed 50-70 minutes post-injection of 8 mCi ± 20% ¹⁸F-flotufolastat. Results were interpreted by board-certified nuclear medicine physicians trained in PSMA imaging.

Results: ¹⁸F-flotufolastat identified extraprostatic disease in 36 of 110 patients (32.7%). Among these, 15 of 36 (41.7%) had isolated regional lymph node (N1) involvement, while 21 of 36 (58.3%) demonstrated distant metastatic (M1) disease. Of the patients who were upstaged, 34 of 36 patients (94.4%) had a change in their treatment plan. The most common treatment intensification included the addition of an androgen receptor inhibitor and expanded radiotherapy fields (50.0%). Further, 34.3% received upfront chemotherapy alongside an androgen receptor inhibitor and radiation. A minority (8.6%) proceeded with radical prostatectomy as a first step of a multimodality approach.

Conclusion: PSMA PET/CT with ¹⁸F-flotufolastat led to clinical upstaging in nearly one-third of men with high-risk prostate cancer and negative conventional imaging, resulting in significant treatment change in most patients. These findings support the integration of PSMA-targeted imaging into initial staging pathways for men with high-risk prostate cancer.

Introduction: Ultrasound (US) guided supine percutaneous nephrolithotomy (PCNL) is increasingly being adopted. The aim of this study is to assess the safety and efficacy of lower versus non-lower pole access in supine US-guided PCNL.

Methods: This study is a retrospective cohort analysis of 228 patients who underwent single access US-guided supine PCNL between March 2023 and June 2024 and were categorized into lower (n=162), interpolar (n=42) and upper pole (n=21) access categories. Baseline demographics, stone characteristics and intraoperative details were analyzed and compared between the groups. Safety outcomes, including 30-day postoperative total and major complications (based on Clavien-Dindo classification), as well as pain scores, were compared between lower pole access (LPa) and non-LPa access.

Results: Baseline clinical and stone characteristics were comparable between the groups. Non-LPa was more frequently performed on the right side (p=0.04), above 12th rib (p<0.001), into a posterior calyx (p=0.004), and more often followed by stent placement (p=0.01). Major complications occurred in 14% of the patients with upper pole access compared to 2% with LPa (p=0.03) and 5% with interpolar. Additionally, the LPa group had lower rates of total complications compared to upper pole and interpolar (11% vs 19% and 22% respectively, p=0.05). There were two visceral injuries in the interpolar group. VAS pain scores at the recovery room were not different between the groups.

Conclusion: When performing US-guided supine PCNL, LPa has a superior safety profile, resulting in fewer major and total complications compared to non-LPa.