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Identifying Patient-Perpetrated Racial Discrimination among the Urologic Workforce: A cross-sectional cohort study. 识别泌尿科工作人员中患者犯下的种族歧视:一项横断面队列研究。
IF 1.7 Q4 UROLOGY & NEPHROLOGY Pub Date : 2026-01-30 DOI: 10.1097/UPJ.0000000000000979
Helen A Gambrah, Catherine S Nam, Kathleen T Lee, Elizabeth M Viglianti
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引用次数: 0
Editorial Commentary. 编辑评论。
IF 1.7 Q4 UROLOGY & NEPHROLOGY Pub Date : 2026-01-26 DOI: 10.1097/UPJ.0000000000000965
Reza Ghavamian
{"title":"Editorial Commentary.","authors":"Reza Ghavamian","doi":"10.1097/UPJ.0000000000000965","DOIUrl":"10.1097/UPJ.0000000000000965","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000965"},"PeriodicalIF":1.7,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031094","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}
引用次数: 0
Editorial Commentary. 编辑评论。
IF 1.7 Q4 UROLOGY & NEPHROLOGY Pub Date : 2026-01-26 DOI: 10.1097/UPJ.0000000000000964
Richard J Boxer
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引用次数: 0
Real-World Utility of Cxbladder Triage for Patients with Microhematuria: A Matched Cohort Study. 膀胱分诊对微血尿患者的实际应用:一项匹配队列研究。
IF 1.7 Q4 UROLOGY & NEPHROLOGY Pub Date : 2026-01-20 DOI: 10.1097/UPJ.0000000000000972
Christopher P Filson, Jeffrey M Slezak, Tiffany Q Luong, Tamer Aboushwareb, Ronald K Loo

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.

目的:评估在综合医疗保健系统中将膀胱分诊试验加入到微量血尿诊断工作流程中的实际效用。材料和方法:我们进行了一项回顾性匹配队列研究,对微血尿患者进行了膀胱分诊测试,这是一种基于尿液的mRNA靶点和临床因素的生物标志物,用于评估尿路上皮癌风险。我们根据年龄、相遇日期和血尿风险指数评分对未测试的对照组进行匹配。根据膀胱分诊结果对队列进行分层;结果:我们将3353例接受膀胱分诊的患者与3353例根据美国泌尿协会(AUA)风险进行匹配的对照组(15.7%的病例和对照组的AUA风险低,p=0.362)。在3353例接受检测的患者中,2670例(79.6%)患癌症的可能性较低,且较少接受膀胱镜检查(3.8% vs 46.5%对照)。结论:膀胱分诊检查减轻了微量血尿患者膀胱镜检查和CT尿图使用的负担。该检测在总体上和潜在恶性肿瘤风险较高的微血尿患者中保持相似的癌症检测。
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引用次数: 0
Does the VA Risk Analysis Index Overestimate Frailty in Patients with Localized Prostate Cancer? VA风险分析指数是否高估了局限性前列腺癌患者的脆弱性?
IF 1.7 Q4 UROLOGY & NEPHROLOGY Pub Date : 2026-01-20 DOI: 10.1097/UPJ.0000000000000973
Pranay Manda, Siddharth Marthi, Ernest Morton, Mihir Patel, Dattatraya Patil, Taylor Goodstein, Akanksha Mehta, Shreyas Joshi, Martin Sanda, Mohammad Hajiha

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.

简介和目标:退伍军人事务(VA)卫生系统最近实施了风险分析指数(RAI)来评估手术前的虚弱程度。升高的RAI评分触发“手术暂停”和老年会诊以减少短期发病率。然而,任何癌症诊断,包括局限性前列腺癌(PCa),都会增加RAI,潜在地夸大了其他健康患者的虚弱。我们假设低或中危PCa与RAI预测的30天发病率和死亡率无关。方法:我们回顾性分析了在同一机构接受根治性前列腺切除术的低或中危前列腺癌患者,时间超过5年。RAI-A(行政)评分计算包括和不包括PCa。使用原始VASQIP研究的数据,将术后30天的并发症和死亡率与raa预测的比率进行比较。结果:在130例患者中(中位年龄61岁),53.4%为有利中危PCa, 41.2%为不利中危PCa, 5.3%为低危PCa。排除PCa的平均RAI-A为8.58;包括PCa,为24.95。相应的vasqip预测并发症发生率为4.6% (IV-V级为2.5%)和11.2% (IV-V级为5.6%)。在我们的队列中,6名患者(4.6%)出现了并发症,没有IV-V级。结论:在raa计算中包括局部PCa高估了虚弱和预测的发病率。排除前列腺癌诊断可以更好地反映低或中危患者的手术风险,防止不必要的治疗延误。
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引用次数: 0
Utility of 18F-Flotufolastat PET/CT Imaging in High-Risk Prostate Cancer in a Real-World Setting. 18f -氟福司他PET/CT成像在真实世界高风险前列腺癌中的应用
IF 1.7 Q4 UROLOGY & NEPHROLOGY Pub Date : 2026-01-12 DOI: 10.1097/UPJ.0000000000000971
Zachariah Taylor, Kayla Meyer, Nachum Stollman, Cheryl Zinar, Laurence Belkoff, Ilia Zeltser

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.

本研究由研究者发起,前瞻性低干预的3期研究评估了18F-flotufolastat(原18F-rhPSMA-7.3)在新诊断为高危前列腺癌且常规影像学阴性的男性中的临床应用。主要终点是临床抢先期率及其对后续治疗的影响。方法:纳入113例treatment-naïve符合NCCN高危标准的男性;110例患者行PSMA PET/CT检查,并应用18f - flofolastat。在影像学检查之前,所有患者的常规分期均为阴性,由骨扫描和CT或MRI确定。注射8mci±20% 18f - flofolastat后50-70分钟成像。结果由经过PSMA成像培训的委员会认证核医学医师进行解释。结果:18F-flotufolastat在110例患者中发现了36例前列腺外病变(32.7%)。其中,36例中有15例(41.7%)有孤立的区域淋巴结(N1)受累,而36例中有21例(58.3%)表现为远处转移性(M1)疾病。在被抢镜的患者中,36例患者中有34例(94.4%)改变了治疗方案。最常见的强化治疗包括添加雄激素受体抑制剂和扩大放疗范围(50.0%)。此外,34.3%的患者接受了化疗、雄激素受体抑制剂和放疗。少数患者(8.6%)将根治性前列腺切除术作为多模式治疗的第一步。结论:PSMA PET/CT加18f - flofolastat导致近三分之一的高危前列腺癌男性患者临床显影,常规影像学阴性,导致大多数患者治疗发生显著变化。这些发现支持将psma靶向成像整合到高危前列腺癌患者的初始分期途径中。
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引用次数: 0
Editorial Commentary. 编辑评论。
IF 1.7 Q4 UROLOGY & NEPHROLOGY Pub Date : 2026-01-12 DOI: 10.1097/UPJ.0000000000000960
Samuel H Eaton
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引用次数: 0
Is Lower Pole Access Safer for Ultrasound-Guided Supine Percutaneous Nephrolithotomy? 超声引导下仰卧经皮肾镜取石更安全吗?
IF 1.7 Q4 UROLOGY & NEPHROLOGY Pub Date : 2026-01-12 DOI: 10.1097/UPJ.0000000000000970
Ziv Savin, Linda Dayan Rahmani, Eve Frangopoulos, Vinay Durbhakula, Asher Mandel, Juan S Serna, Aubrey Dibello, Esther Kim, Adam Daniel Geffner, Kavita Gupta, Blair Gallante, William M Atallah, Mantu Gupta

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.

导读:超声(US)引导下的仰卧经皮肾镜取石术(PCNL)越来越多地被采用。本研究的目的是评估仰卧位us引导PCNL下极与非下极通路的安全性和有效性。方法:本研究对228例于2023年3月至2024年6月接受单通道US-guided仰卧PCNL的患者进行回顾性队列分析,分为下通道(n=162)、极间通道(n=42)和上极通道(n=21)。对两组患者的基线人口统计学、结石特征和术中细节进行分析和比较。安全性结果,包括术后30天的总并发症和主要并发症(基于Clavien-Dindo分类),以及疼痛评分,比较下极通路(LPa)和非LPa通路。结果:两组之间的基线临床和结石特征具有可比性。非LPa更常在右侧第12肋骨以上(p=0.04)进行。结论:在进行us引导仰卧PCNL时,LPa具有更好的安全性,与非LPa相比,LPa的主要并发症和总并发症更少。
{"title":"Is Lower Pole Access Safer for Ultrasound-Guided Supine Percutaneous Nephrolithotomy?","authors":"Ziv Savin, Linda Dayan Rahmani, Eve Frangopoulos, Vinay Durbhakula, Asher Mandel, Juan S Serna, Aubrey Dibello, Esther Kim, Adam Daniel Geffner, Kavita Gupta, Blair Gallante, William M Atallah, Mantu Gupta","doi":"10.1097/UPJ.0000000000000970","DOIUrl":"https://doi.org/10.1097/UPJ.0000000000000970","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>When performing US-guided supine PCNL, LPa has a superior safety profile, resulting in fewer major and total complications compared to non-LPa.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000970"},"PeriodicalIF":1.7,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953199","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}
引用次数: 0
The Who and What of Testosterone Replacement Therapy: Trends in Medicare Part D Testosterone Claims. 睾酮替代疗法的对象和内容:医疗保险D部分睾酮索赔的趋势。
IF 1.7 Q4 UROLOGY & NEPHROLOGY Pub Date : 2026-01-08 DOI: 10.1097/UPJ.0000000000000966
Leane Kuo, Michael Sessine, Lillian Lai, Ava Zamani, Aron Liaw
{"title":"The Who and What of Testosterone Replacement Therapy: Trends in Medicare Part D Testosterone Claims.","authors":"Leane Kuo, Michael Sessine, Lillian Lai, Ava Zamani, Aron Liaw","doi":"10.1097/UPJ.0000000000000966","DOIUrl":"https://doi.org/10.1097/UPJ.0000000000000966","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000966"},"PeriodicalIF":1.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935484","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}
引用次数: 0
Authentic or Algorithm? Assessing the Use of Generative Artificial Intelligence in Urology Residency Personal Statements. 真实还是算法?评估生成人工智能在泌尿外科住院医师个人陈述中的使用。
IF 1.7 Q4 UROLOGY & NEPHROLOGY Pub Date : 2026-01-08 DOI: 10.1097/UPJ.0000000000000969
Jay R Dalvi, Andrew J Zganjar, Anna E Witten, Raymond W Pak, Ram A Pathak, Gregory A Broderick, Timothy D Lyon
{"title":"Authentic or Algorithm? Assessing the Use of Generative Artificial Intelligence in Urology Residency Personal Statements.","authors":"Jay R Dalvi, Andrew J Zganjar, Anna E Witten, Raymond W Pak, Ram A Pathak, Gregory A Broderick, Timothy D Lyon","doi":"10.1097/UPJ.0000000000000969","DOIUrl":"10.1097/UPJ.0000000000000969","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000969"},"PeriodicalIF":1.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935508","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}
引用次数: 0
期刊
Urology Practice
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