Pub Date : 2025-09-09DOI: 10.1097/ju.0000000000004779
Adrian J Waisman Malaret,Paul J Feustel,Fortis Gaba,Hasim Bakbak,Jillian M Egan Kelly,Hugh A G Fisher,Adrien N Bernstein,Ronald P Kaufman,Badar M Mian
PURPOSEPatient-reported outcome measures (PROMs) play a pivotal role when recommending medical interventions. There is a lack of prospective studies directly comparing PROMs following transrectal (TR-Bx) and transperineal prostate biopsy (TP-Bx). We conducted a pre-specified comparative analysis of PROMs from the ProBE-PC randomized trial.MATERIALS AND METHODS840 men randomized to TR-Bx or TP-Bx under local anesthesia (LA). Participant-reported Numerical Rating Scale (NRS) pain scores at various time points were collected, with score ≥ 4 defined as clinically significant pain (csPain). Pre- and post-biopsy IPSS, IPSS-quality of life (QoL), and IIEF-5 were analyzed including minimum clinically important change in IPSS, IPSS-QoL and IIEF-5 scores.RESULTSHigher pain scores were reported by patients undergoing TP-Bx than TR-Bx at 3 time points: LA injection, evening of the procedure, and Day 3 (p< 0.001). Compared to TR-Bx, csPain was reported more frequently with TP-Bx during LA injection (3% vs 38%; odds ratio, 19.39; 95% CI, 6.57-10.28), and on the evening of procedure (11% vs 19%; OR 1.84; CI 1.21-2.79). Increasing experience with TP-Bx between the first and later quartiles of participants did not influence pain scores. Findings were confirmed on adjusted multivariable analysis. Clinically important worsening of IPSS and IPSS-QoL was reported more frequently after TP-Bx than TR-Bx (28% vs 18% p=0.009, and 31% vs 22%, p < 0.01).CONCLUSIONSCompared to TR-Bx, higher rates and increased level of pain, as well as increased urinary dysfunction, were reported following TP-Bx. This information is clinically relevant during patient counseling regarding prostate biopsy procedures.
目的：患者报告的结果测量（PROMs）在推荐医疗干预措施时起着关键作用。目前缺乏直接比较经直肠前列腺活检（TR-Bx）和经会阴前列腺活检（TP-Bx）后PROMs的前瞻性研究。我们对ProBE-PC随机试验中的prom进行了预先指定的比较分析。材料与方法840名男性在局麻（LA）下随机接受TR-Bx或TP-Bx治疗。收集参与者在不同时间点报告的数值评定量表（NRS）疼痛评分，评分≥4定义为临床明显疼痛（csPain）。分析活检前和活检后的IPSS、IPSS生活质量（QoL）和IIEF-5，包括IPSS、IPSS-QoL和IIEF-5评分的最小临床重要变化。结果TP-Bx患者在注射LA、手术当晚和第3天3个时间点的疼痛评分均高于TR-Bx （p< 0.001）。与TR-Bx相比，TP-Bx在注射LA期间（3% vs 38%；优势比，19.39;95% CI, 6.57-10.28）和手术当晚（11% vs 19%; OR 1.84; CI 1.21-2.79）更频繁地报道c西班牙。在第一和后四分位数的参与者之间增加TP-Bx的经验对疼痛评分没有影响。通过调整后的多变量分析证实了研究结果。TP-Bx术后IPSS和IPSS- qol的临床重要恶化发生率高于TR-Bx （28% vs 18% p=0.009, 31% vs 22%, p < 0.01）。结论与TR-Bx相比，TP-Bx的发生率更高，疼痛程度加重，泌尿功能障碍加重。这些信息在前列腺活检过程的患者咨询中具有临床相关性。
{"title":"Participant-Reported Outcome Measures Following Transrectal and Transperineal Prostate Biopsy in a Randomized Clinical Trial.","authors":"Adrian J Waisman Malaret,Paul J Feustel,Fortis Gaba,Hasim Bakbak,Jillian M Egan Kelly,Hugh A G Fisher,Adrien N Bernstein,Ronald P Kaufman,Badar M Mian","doi":"10.1097/ju.0000000000004779","DOIUrl":"https://doi.org/10.1097/ju.0000000000004779","url":null,"abstract":"PURPOSEPatient-reported outcome measures (PROMs) play a pivotal role when recommending medical interventions. There is a lack of prospective studies directly comparing PROMs following transrectal (TR-Bx) and transperineal prostate biopsy (TP-Bx). We conducted a pre-specified comparative analysis of PROMs from the ProBE-PC randomized trial.MATERIALS AND METHODS840 men randomized to TR-Bx or TP-Bx under local anesthesia (LA). Participant-reported Numerical Rating Scale (NRS) pain scores at various time points were collected, with score ≥ 4 defined as clinically significant pain (csPain). Pre- and post-biopsy IPSS, IPSS-quality of life (QoL), and IIEF-5 were analyzed including minimum clinically important change in IPSS, IPSS-QoL and IIEF-5 scores.RESULTSHigher pain scores were reported by patients undergoing TP-Bx than TR-Bx at 3 time points: LA injection, evening of the procedure, and Day 3 (p< 0.001). Compared to TR-Bx, csPain was reported more frequently with TP-Bx during LA injection (3% vs 38%; odds ratio, 19.39; 95% CI, 6.57-10.28), and on the evening of procedure (11% vs 19%; OR 1.84; CI 1.21-2.79). Increasing experience with TP-Bx between the first and later quartiles of participants did not influence pain scores. Findings were confirmed on adjusted multivariable analysis. Clinically important worsening of IPSS and IPSS-QoL was reported more frequently after TP-Bx than TR-Bx (28% vs 18% p=0.009, and 31% vs 22%, p < 0.01).CONCLUSIONSCompared to TR-Bx, higher rates and increased level of pain, as well as increased urinary dysfunction, were reported following TP-Bx. This information is clinically relevant during patient counseling regarding prostate biopsy procedures.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"81 1","pages":"101097JU0000000000004779"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025541","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}
Pub Date : 2025-09-08DOI: 10.1097/ju.0000000000004691
Giulia M Ippolito,Irene Crescenze,Hannah Sitto,Rita R Palanjian,Daniel Raza,Paholo Barboglio-Romo,Sheila A Wallace,Giovany Orozco Leal,J Quentin Clemens,Philipp Dahm,Priyanka Gupta
PURPOSEWe assessed the effects of vaginal lasers for treating stress urinary incontinence (SUI) in women.MATERIALS AND METHODSThis systematic review and meta-analysis included randomized trials of women with SUI and assessed therapy with vaginal laser vs sham, control, or topical treatments.RESULTSNine studies of 689 women with SUI were included. Overall, the data regarding vaginal laser vs sham treatments were uncertain, and few studies assessed outcome beyond 1 year. In the short term, there may be no difference between the number of continent women between women who underwent vaginal laser compared with sham (risk ratio, 1.50; 95% CI, 0.72-3.10; I2 = 81%; n = 196; very low-certainty evidence). Although vaginal lasers may improve patient-reported incontinence measures compared with sham, the point estimate for improvement does not meet the prespecified minimally clinical importance differences (mean difference, -1.42 points; 95% CI, -2.41 to -0.43; I2 = 54%; n = 632; very low-certainty evidence). Only 1 study provided evidence comparing vaginal laser with topical estrogen. There were no major adverse events in any treatment group at any time point.CONCLUSIONSVaginal lasers may have little to no effect on SUI as measured by both clinical assessment in the short term compared with sham, control, or topical treatments, but the evidence is uncertain. Vaginal lasers may improve patient-reported measures of SUI, but the evidence is uncertain, and the change may not be noticeable to patients. No major adverse events were reported.
目的评价阴道激光治疗女性压力性尿失禁（SUI）的效果。材料和方法本系统综述和荟萃分析纳入了SUI女性的随机试验，并评估了阴道激光治疗与假手术、对照或局部治疗的疗效。结果纳入689例SUI女性患者的9项研究。总的来说，关于阴道激光与假治疗的数据是不确定的，很少有研究评估超过1年的结果。在短期内，接受阴道激光治疗的女性与不接受阴道激光治疗的女性之间大陆女性的数量可能没有差异（风险比，1.50;95% CI, 0.72-3.10; I2 = 81%; n = 196；极低确定性证据）。尽管与假手术相比，阴道激光可以改善患者报告的失禁措施，但改善的点估计不符合预先规定的最小临床重要性差异（平均差为-1.42点；95% CI为-2.41至-0.43;I2 = 54%; n = 632；非常低确定性证据）。只有1项研究提供了阴道激光与局部雌激素比较的证据。各治疗组在任何时间点均无重大不良事件发生。结论与假手术、对照或局部治疗相比，阴道激光在短期内对SUI的影响可能很小或没有影响，但证据不确定。阴道激光可能会改善患者报告的SUI测量，但证据不确定，并且患者可能不会注意到这种变化。无重大不良事件报告。
{"title":"Vaginal Lasers for Treating Stress Urinary Incontinence in Women: An Abridged Cochrane Systematic Review and Meta-Analysis.","authors":"Giulia M Ippolito,Irene Crescenze,Hannah Sitto,Rita R Palanjian,Daniel Raza,Paholo Barboglio-Romo,Sheila A Wallace,Giovany Orozco Leal,J Quentin Clemens,Philipp Dahm,Priyanka Gupta","doi":"10.1097/ju.0000000000004691","DOIUrl":"https://doi.org/10.1097/ju.0000000000004691","url":null,"abstract":"PURPOSEWe assessed the effects of vaginal lasers for treating stress urinary incontinence (SUI) in women.MATERIALS AND METHODSThis systematic review and meta-analysis included randomized trials of women with SUI and assessed therapy with vaginal laser vs sham, control, or topical treatments.RESULTSNine studies of 689 women with SUI were included. Overall, the data regarding vaginal laser vs sham treatments were uncertain, and few studies assessed outcome beyond 1 year. In the short term, there may be no difference between the number of continent women between women who underwent vaginal laser compared with sham (risk ratio, 1.50; 95% CI, 0.72-3.10; I2 = 81%; n = 196; very low-certainty evidence). Although vaginal lasers may improve patient-reported incontinence measures compared with sham, the point estimate for improvement does not meet the prespecified minimally clinical importance differences (mean difference, -1.42 points; 95% CI, -2.41 to -0.43; I2 = 54%; n = 632; very low-certainty evidence). Only 1 study provided evidence comparing vaginal laser with topical estrogen. There were no major adverse events in any treatment group at any time point.CONCLUSIONSVaginal lasers may have little to no effect on SUI as measured by both clinical assessment in the short term compared with sham, control, or topical treatments, but the evidence is uncertain. Vaginal lasers may improve patient-reported measures of SUI, but the evidence is uncertain, and the change may not be noticeable to patients. No major adverse events were reported.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"72 1","pages":"101097JU0000000000004691"},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018208","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}
Pub Date : 2025-09-05DOI: 10.1097/ju.0000000000004734
David C Chen,Zein Alhamdani,Nathan Papa,Edward Shen,Natalia Kovaleva,Maggie Gao,Louise Emmett,Michael S Hofman,Andrew Ryan,Andrew M Scott,Sze Ting Lee,Nathan Lawrentschuk,Marlon L Perera,Damien M Bolton
PURPOSEProstate-specific membrane antigen positron emission tomography (PSMA PET) is increasingly used to diagnose and stage prostate cancer. A PRIMARY score uses anatomical localization and uptake patterns to improve diagnostic accuracy. We evaluated the histopathology of patients with no uptake pattern (PRIMARY score 1) and the prevalence of intraductal carcinoma of the prostate (IDC-P) in this subset compared with those with an uptake pattern (PRIMARY score ≥ 2).MATERIALS AND METHODSA 2-center, retrospective cohort study was conducted including consecutive patients imaged with intraprostatic [68Ga]Ga-PSMA-11 or [18F]DCFPyL PSMA PET before radical prostatectomy. All PSMA PET scans were centrally reviewed by nuclear medicine physicians, with PRIMARY scores and quantitative imaging parameters recorded. Perioperative characteristics, Prostate Imaging Reporting and Data System (PI-RADS), and histopathology were collected. The distribution of grade group and other histopathological findings, including IDC-P, were examined according to PSMA uptake patterns.RESULTSA total of 178 patients were analyzed. A PRIMARY score 1 finding on intraprostatic PSMA PET was seen in 30 (17%) patients. IDC-P in prostatectomy specimens was more frequent in these patients compared with PRIMARY score ≥ 2 patients (12/30, 40% vs 31/148, 21%; P = .026). In the PRIMARY score 1 subset, patients with IDC-P had considerably more pathological grade group ≥ 3 disease than those without IDC-P (100% vs 33%). Eighty-one percent of all patients had PI-RADS scores 4 or 5 on prebiopsy MRI. This study is potentially limited by the selection of patients with PRIMARY score 1 disease who subsequently proceeded to surgery.CONCLUSIONSIn patients who are being considered for radical prostatectomy because of adverse clinical, PI-RADS or biopsy features, a PSMA PET demonstrating no intraprostatic uptake pattern should not be considered inherently a marker or small volume or lesser grade disease. Some high-grade cancers, particularly those associated with IDC-P, may not be well visualized on PSMA PET.
目的前列腺特异性膜抗原正电子发射断层扫描（PSMA PET）越来越多地用于前列腺癌的诊断和分期。PRIMARY评分使用解剖定位和摄取模式来提高诊断的准确性。我们评估了无摄取模式（PRIMARY评分为1）患者的组织病理学，以及与有摄取模式（PRIMARY评分≥2）患者相比，该亚群中导管内前列腺癌（IDC-P）的患病率。材料与方法采用2中心回顾性队列研究，纳入根治性前列腺切除术前连续行前列腺内[68Ga]Ga-PSMA-11或[18F]DCFPyL PSMA PET显像的患者。所有PSMA PET扫描由核医学医师集中审查，记录PRIMARY评分和定量成像参数。收集围手术期特征、前列腺影像学报告和数据系统（PI-RADS）及组织病理学。根据PSMA摄取模式检查分级组的分布和其他组织病理学结果，包括IDC-P。结果共分析178例患者。30例（17%）患者前列腺内PSMA PET的PRIMARY评分为1分。与PRIMARY评分≥2的患者相比，前列腺切除术标本中IDC-P的发生率更高（12/ 30,40% vs 31/ 148,21%; P = 0.026）。在PRIMARY评分1的亚组中，患有IDC-P的患者比没有IDC-P的患者有更多的病理分级≥3组疾病（100% vs 33%）。81%的患者活检前MRI PI-RADS评分为4或5分。该研究可能受到PRIMARY评分为1的患者随后进行手术的选择的限制。结论：对于由于不良的临床、PI-RADS或活检特征而考虑根治性前列腺切除术的患者，PSMA PET未显示前列腺内摄取模式不应被视为固有的标志物或小体积或较小级别的疾病。一些高级别癌症，特别是与IDC-P相关的癌症，在PSMA PET上可能无法很好地显示。
{"title":"The Blind Spot of PSMA-PET Staging? Intraductal Carcinoma of the Prostate Is Overrepresented in Patients With No Uptake Pattern on Prostate-Specific Membrane Antigen Positron Emission Tomography and High-Grade Prostate Cancer.","authors":"David C Chen,Zein Alhamdani,Nathan Papa,Edward Shen,Natalia Kovaleva,Maggie Gao,Louise Emmett,Michael S Hofman,Andrew Ryan,Andrew M Scott,Sze Ting Lee,Nathan Lawrentschuk,Marlon L Perera,Damien M Bolton","doi":"10.1097/ju.0000000000004734","DOIUrl":"https://doi.org/10.1097/ju.0000000000004734","url":null,"abstract":"PURPOSEProstate-specific membrane antigen positron emission tomography (PSMA PET) is increasingly used to diagnose and stage prostate cancer. A PRIMARY score uses anatomical localization and uptake patterns to improve diagnostic accuracy. We evaluated the histopathology of patients with no uptake pattern (PRIMARY score 1) and the prevalence of intraductal carcinoma of the prostate (IDC-P) in this subset compared with those with an uptake pattern (PRIMARY score ≥ 2).MATERIALS AND METHODSA 2-center, retrospective cohort study was conducted including consecutive patients imaged with intraprostatic [68Ga]Ga-PSMA-11 or [18F]DCFPyL PSMA PET before radical prostatectomy. All PSMA PET scans were centrally reviewed by nuclear medicine physicians, with PRIMARY scores and quantitative imaging parameters recorded. Perioperative characteristics, Prostate Imaging Reporting and Data System (PI-RADS), and histopathology were collected. The distribution of grade group and other histopathological findings, including IDC-P, were examined according to PSMA uptake patterns.RESULTSA total of 178 patients were analyzed. A PRIMARY score 1 finding on intraprostatic PSMA PET was seen in 30 (17%) patients. IDC-P in prostatectomy specimens was more frequent in these patients compared with PRIMARY score ≥ 2 patients (12/30, 40% vs 31/148, 21%; P = .026). In the PRIMARY score 1 subset, patients with IDC-P had considerably more pathological grade group ≥ 3 disease than those without IDC-P (100% vs 33%). Eighty-one percent of all patients had PI-RADS scores 4 or 5 on prebiopsy MRI. This study is potentially limited by the selection of patients with PRIMARY score 1 disease who subsequently proceeded to surgery.CONCLUSIONSIn patients who are being considered for radical prostatectomy because of adverse clinical, PI-RADS or biopsy features, a PSMA PET demonstrating no intraprostatic uptake pattern should not be considered inherently a marker or small volume or lesser grade disease. Some high-grade cancers, particularly those associated with IDC-P, may not be well visualized on PSMA PET.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"24 1","pages":"101097JU0000000000004734"},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995713","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}
Pub Date : 2025-08-22DOI: 10.1097/ju.0000000000004746
Luke T Lavallée,Antonio Finelli,Simon Tanguay,Bimal Bhindi,Lori A Wood,Ricardo Rendon,Rahul Bansal,Aly-Khan A Lalani,Daniel Y C Heng,Naveen Basappa,Jasmir G Nayak,Georg Bjarnason,Frederic Pouliot,Ryan McLarty,Ammar Alam,Ranjeeta Mallick,Rodney H Breau
PURPOSEThe objective of this study was to determine the incidence of local treatment and incidence of metastasis for patients with a solitary small renal mass (SRM) (≤4cm) initiating active surveillance (AS).MATERIALS AND METHODSPatients enrolled in the Canadian Kidney Cancer information system (CKCis) between January 2011 and January 2023 with a solitary renal mass ≤4cm opting for AS were included. The primary outcome was local treatment progression, achieved if the patient received definitive local treatment after initiating AS. The secondary outcomes were growth rate progression (>0.5cm/year), size progression (>4cm), composite progression (either size or growth rate progression) and development of metastases.RESULTSCKCis included 1,393 patients who initiated AS for a SRM ≤4cm during the study period. At a median follow up of 4.0 years (95%CI 2.1-6.4), 238 patients received local treatment and of these, 195 were nephron-sparing. Two- and five-year cumulative incidence of treatment were 8.4% (95% confidence interval (CI) 6.9-10) and 21% (95%CI 19-24%) respectively. Twenty-nine patients developed metastasis. Two- and five-year cumulative incidence of metastasis were 0.67% (95%CI 0.32-1.3%) and 2.3% (95%CI 1.5-3.5%) respectively. Of the 29 patients who developed metastases, 23 had progressed using size or growth rate cutoffs, and 7 had received local treatment with curative intent, prior to the identification of metastases.CONCLUSIONSPatients choosing surveillance for a SRM have low cumulative incidence of local treatment and metastasis at 5 years, demonstrating AS is a safe initial management approach.
{"title":"Incidence of local treatment and metastasis during active surveillance for patients with a small renal mass in a national multicenter prospective cohort.","authors":"Luke T Lavallée,Antonio Finelli,Simon Tanguay,Bimal Bhindi,Lori A Wood,Ricardo Rendon,Rahul Bansal,Aly-Khan A Lalani,Daniel Y C Heng,Naveen Basappa,Jasmir G Nayak,Georg Bjarnason,Frederic Pouliot,Ryan McLarty,Ammar Alam,Ranjeeta Mallick,Rodney H Breau","doi":"10.1097/ju.0000000000004746","DOIUrl":"https://doi.org/10.1097/ju.0000000000004746","url":null,"abstract":"PURPOSEThe objective of this study was to determine the incidence of local treatment and incidence of metastasis for patients with a solitary small renal mass (SRM) (≤4cm) initiating active surveillance (AS).MATERIALS AND METHODSPatients enrolled in the Canadian Kidney Cancer information system (CKCis) between January 2011 and January 2023 with a solitary renal mass ≤4cm opting for AS were included. The primary outcome was local treatment progression, achieved if the patient received definitive local treatment after initiating AS. The secondary outcomes were growth rate progression (>0.5cm/year), size progression (>4cm), composite progression (either size or growth rate progression) and development of metastases.RESULTSCKCis included 1,393 patients who initiated AS for a SRM ≤4cm during the study period. At a median follow up of 4.0 years (95%CI 2.1-6.4), 238 patients received local treatment and of these, 195 were nephron-sparing. Two- and five-year cumulative incidence of treatment were 8.4% (95% confidence interval (CI) 6.9-10) and 21% (95%CI 19-24%) respectively. Twenty-nine patients developed metastasis. Two- and five-year cumulative incidence of metastasis were 0.67% (95%CI 0.32-1.3%) and 2.3% (95%CI 1.5-3.5%) respectively. Of the 29 patients who developed metastases, 23 had progressed using size or growth rate cutoffs, and 7 had received local treatment with curative intent, prior to the identification of metastases.CONCLUSIONSPatients choosing surveillance for a SRM have low cumulative incidence of local treatment and metastasis at 5 years, demonstrating AS is a safe initial management approach.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"52 1","pages":"101097JU0000000000004746"},"PeriodicalIF":0.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930182","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}
Pub Date : 2025-08-14DOI: 10.1097/ju.0000000000004698
Daniel D Joyce,D Robert Siemens
{"title":"Shared Decision-Making in Prostate Cancer Management: Easy to Say, Hard to Measure.","authors":"Daniel D Joyce,D Robert Siemens","doi":"10.1097/ju.0000000000004698","DOIUrl":"https://doi.org/10.1097/ju.0000000000004698","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"14 1","pages":"101097JU0000000000004698"},"PeriodicalIF":0.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850932","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}
Pub Date : 2025-08-14DOI: 10.1097/ju.0000000000004728
Kerri A McKie,Anoosha Moturu,Dionne A Graham,Melvin Coleman,Reiping Huang,Catherine Grant,Jacqueline M Saito,Bruce L Hall,Julia B Finkelstein,Claudia Berrondo,Jason G Newland,Clifford Ko,Jonathan S Ellison,Shawn J Rangel
PURPOSETo compare clinically relevant outcomes in children undergoing laparoscopic orchiopexy who did and did not receive antimicrobial prophylaxis.MATERIALS AND METHODSThis was a multicenter cohort study using data from 144 National Surgical Quality Improvement Program-Pediatric hospitals. Patients < 18 years who underwent laparoscopic orchiopexy from 1/1/2021 to 12/31/2023 were included. Complementary hospital and patient-level analyses were performed to explore the relationship between prophylaxis and 30-day postoperative surgical site infection rates. In the patient-level analysis, propensity score matching was used to balance groups on patient and procedural characteristics. The hospital-level analysis explored the correlation between prophylaxis and observed to expected surgical site infection rate ratios after adjusting for patient and procedural characteristics.RESULTSA total of 2739 children met inclusion criteria, of which 57% received prophylaxis. Outcomes were similar for surgical site infections in the patient-level analysis, including 2066 patients (prophylaxis: 13/1033 [1.3%] vs no prophylaxis: 13/1033 [1.3%]; adjusted odds ratio, 0.79; 95% CI, 0.30-2.11), and no correlation was found between rates of prophylaxis and surgical site infections in the hospital-level analysis (Spearman ρ = -0.081; P = 0.3). Outcomes were similar between groups in the patient-level analysis for reoperation (prophylaxis: 5/1033 [0.48%] vs no prophylaxis: 7/1033 [0.68%]; adjusted odds ratio, 0.86; 95% CI, 0.22-3.45) and readmission (prophylaxis: 6/1033 [0.58%] vs no prophylaxis: 10/1033 [1.0%]; adjusted odds ratio, 0.72; 95% CI, 0.23-2.32).CONCLUSIONSThis study does not find significant evidence to support the association between the routine use of antimicrobial prophylaxis and improved outcomes in children undergoing laparoscopic orchiopexy.
{"title":"Antibiotic prophylaxis use and outcomes in children undergoing laparoscopic orchiopexy.","authors":"Kerri A McKie,Anoosha Moturu,Dionne A Graham,Melvin Coleman,Reiping Huang,Catherine Grant,Jacqueline M Saito,Bruce L Hall,Julia B Finkelstein,Claudia Berrondo,Jason G Newland,Clifford Ko,Jonathan S Ellison,Shawn J Rangel","doi":"10.1097/ju.0000000000004728","DOIUrl":"https://doi.org/10.1097/ju.0000000000004728","url":null,"abstract":"PURPOSETo compare clinically relevant outcomes in children undergoing laparoscopic orchiopexy who did and did not receive antimicrobial prophylaxis.MATERIALS AND METHODSThis was a multicenter cohort study using data from 144 National Surgical Quality Improvement Program-Pediatric hospitals. Patients < 18 years who underwent laparoscopic orchiopexy from 1/1/2021 to 12/31/2023 were included. Complementary hospital and patient-level analyses were performed to explore the relationship between prophylaxis and 30-day postoperative surgical site infection rates. In the patient-level analysis, propensity score matching was used to balance groups on patient and procedural characteristics. The hospital-level analysis explored the correlation between prophylaxis and observed to expected surgical site infection rate ratios after adjusting for patient and procedural characteristics.RESULTSA total of 2739 children met inclusion criteria, of which 57% received prophylaxis. Outcomes were similar for surgical site infections in the patient-level analysis, including 2066 patients (prophylaxis: 13/1033 [1.3%] vs no prophylaxis: 13/1033 [1.3%]; adjusted odds ratio, 0.79; 95% CI, 0.30-2.11), and no correlation was found between rates of prophylaxis and surgical site infections in the hospital-level analysis (Spearman ρ = -0.081; P = 0.3). Outcomes were similar between groups in the patient-level analysis for reoperation (prophylaxis: 5/1033 [0.48%] vs no prophylaxis: 7/1033 [0.68%]; adjusted odds ratio, 0.86; 95% CI, 0.22-3.45) and readmission (prophylaxis: 6/1033 [0.58%] vs no prophylaxis: 10/1033 [1.0%]; adjusted odds ratio, 0.72; 95% CI, 0.23-2.32).CONCLUSIONSThis study does not find significant evidence to support the association between the routine use of antimicrobial prophylaxis and improved outcomes in children undergoing laparoscopic orchiopexy.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"86 1","pages":"101097JU0000000000004728"},"PeriodicalIF":0.0,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850930","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}
Pub Date : 2025-08-12DOI: 10.1097/ju.0000000000004696
Andrew Vickers,Karim Touijer
{"title":"Letter: Pelvic Lymph Node Dissection in Prostate Cancer: Is It Really Necessary? A Multicentric Longitudinal Study Assessing Oncological Outcomes in Prostate Cancer Patients Undergoing Pelvic Lymph Node Dissection vs Radical Prostatectomy Only.","authors":"Andrew Vickers,Karim Touijer","doi":"10.1097/ju.0000000000004696","DOIUrl":"https://doi.org/10.1097/ju.0000000000004696","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"31 1","pages":"101097JU0000000000004696"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819809","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}
Pub Date : 2025-08-12DOI: 10.1097/ju.0000000000004715
Sergey Vavilov,Erin Nolan,Peter Pockney,Grahame Hh Smith,Malcolm R Starkey,Jonathan C Craig,Aniruddh V Deshpande
PURPOSETo assess the long-term risk of reoperation following hypospadias repair in childhood and identify the risk factors associated with reoperation. We hypothesised that the technique used to repair hypospadias would influence the re-operation rate.MATERIALS AND METHODSConsecutive children who underwent hypospadias repair in New South Wales, Australia between 1991 and 2006 were included. The reoperations were identified using data linkages. The reoperation rate was calculated, and potential risk factors identified (hypospadias severity, type of repair, urethral plate division, and persistent chordee after degloving). Time-to-first event analyses were conducted using the Kaplan-Meier method.RESULTS1105 children (median follow-up 15.2 years, interquartile range 3.3 to 17.1) with a cumulative follow-up of 16,790 patient-years were included. The rates of penile reoperations was 7.3 per 100-patient years in the first, 1.7 in the second, and 0.6 in the third decade of life (p<0.001). The highest rates of penile reoperations occurred after multi-stage hypospadias repair (9.94), single-stage proximal hypospadias repair (5.7), and tubularized incised urethroplasty (TIP) (3.64). The overall probability of reoperation-free survival was 62%.CONCLUSIONSApproximately 40% of children who require hypospadias repair require an additional corrective procedure, usually before their fifth birthday, with a low risk of penile reoperation in the second and third decades of life. The risk is higher after TIP repair among repairs for distal hypospadias, multistage repair, and single-stage proximal repair.
{"title":"Long-term risk of reoperation following hypospadias surgery in childhood: a data-linkage study.","authors":"Sergey Vavilov,Erin Nolan,Peter Pockney,Grahame Hh Smith,Malcolm R Starkey,Jonathan C Craig,Aniruddh V Deshpande","doi":"10.1097/ju.0000000000004715","DOIUrl":"https://doi.org/10.1097/ju.0000000000004715","url":null,"abstract":"PURPOSETo assess the long-term risk of reoperation following hypospadias repair in childhood and identify the risk factors associated with reoperation. We hypothesised that the technique used to repair hypospadias would influence the re-operation rate.MATERIALS AND METHODSConsecutive children who underwent hypospadias repair in New South Wales, Australia between 1991 and 2006 were included. The reoperations were identified using data linkages. The reoperation rate was calculated, and potential risk factors identified (hypospadias severity, type of repair, urethral plate division, and persistent chordee after degloving). Time-to-first event analyses were conducted using the Kaplan-Meier method.RESULTS1105 children (median follow-up 15.2 years, interquartile range 3.3 to 17.1) with a cumulative follow-up of 16,790 patient-years were included. The rates of penile reoperations was 7.3 per 100-patient years in the first, 1.7 in the second, and 0.6 in the third decade of life (p<0.001). The highest rates of penile reoperations occurred after multi-stage hypospadias repair (9.94), single-stage proximal hypospadias repair (5.7), and tubularized incised urethroplasty (TIP) (3.64). The overall probability of reoperation-free survival was 62%.CONCLUSIONSApproximately 40% of children who require hypospadias repair require an additional corrective procedure, usually before their fifth birthday, with a low risk of penile reoperation in the second and third decades of life. The risk is higher after TIP repair among repairs for distal hypospadias, multistage repair, and single-stage proximal repair.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"21 1","pages":"101097JU0000000000004715"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144825473","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}
Pub Date : 2025-08-11DOI: 10.1097/ju.0000000000004720
Andrew J Vickers,Melissa Assel,Rodney L Dunn,Graeme MacLennan,Betsy Jane Becker,Richard D Riley
{"title":"Guidelines for meta-analyses and systematic reviews in urology.","authors":"Andrew J Vickers,Melissa Assel,Rodney L Dunn,Graeme MacLennan,Betsy Jane Becker,Richard D Riley","doi":"10.1097/ju.0000000000004720","DOIUrl":"https://doi.org/10.1097/ju.0000000000004720","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"17 1","pages":"101097JU0000000000004720"},"PeriodicalIF":0.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819810","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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