Pub Date : 2025-08-08DOI: 10.1097/ju.0000000000004716
Elia Abou Chawareb,Muhammed A M Hammad,Babak Azad,Martin S Gross,Brayden Payne,Daniel Swerdloff,Jake A Miller,Robert Andrianne,Arthur L Burnett,Kelli Gross,Georgios Hatzichristodoulou,James M Hotaling,Tung-Chin Hsieh,James M Jones,Aaron Lentz,Vaibhav Modgil,Daniar Osmonov,Sung Hun Park,Ian Pearce,Paul Perito,Hossein Sadeghi-Nejad,Maxime Sempels,Alfredo Suarez-Sarmiento,Jay Simhan,Koenraad van Renterghem,J Nicholas Warner,Matthew Ziegelmann,Faysal A Yafi,David W Barham
PURPOSEThis study aims to evaluate the association between antimicrobial practices, including oral antibiotics, intravenous antibiotics, antifungal prophylaxis, and infection outcomes in patients undergoing primary or revision inflatable penile prosthesis surgery.MATERIALS AND METHODSWe conducted a multicenter, retrospective cohort study of 5,261 patients who underwent primary or revision inflatable penile prosthesis surgery at 16 specialized centers across the United States, Europe, and Korea from July 2016 to July 2021. Patient data included demographic and clinical characteristics, antibiotic and antifungal administration, and infection outcomes. The primary outcome was infection following inflatable penile prosthesis placement. Univariable and multivariable regression analyses were performed to identify predictors of infection.RESULTSThe overall infection rate was 1.9% (n=102), with higher rates among diabetic patients (p=0.023), those with prior inflatable penile prosthesis infection (p<0.001), or undergoing revision surgery (p<0.001). Multivariable analysis identified diabetes (OR=1.68, p=0.022) and previous inflatable penile prosthesis infection (OR=4.67, p<0.001) as independent risk factors for infection. Perioperative intravenous antifungal use was significantly associated with a lower infection risk (OR=0.22, p<0.001), while postoperative oral antibiotics (p=0.5) and prolonged intravenous antibiotic prophylaxis (>24 hours) (p=0.2) did not demonstrate protective effects. Pre- and postoperative oral antibiotics were not associated with a statistically significant reduction in infection after adjustment for confounding variables.CONCLUSIONSThis large multicenter study highlights a significant association between perioperative antifungal prophylaxis and lower infection risk in inflatable penile prosthesis surgery while demonstrating the limited utility of preoperative and postoperative oral antibiotics and prolonged intravenous prophylaxis. These findings support evidence-based antimicrobial stewardship to optimize outcomes and minimize complications, including antibiotic resistance.
{"title":"Perioperative Antimicrobial Strategies in IPP Surgery: Associations Between Antifungals, Oral Antibiotics, and IV Antibiotic Duration, and Infection Outcomes.","authors":"Elia Abou Chawareb,Muhammed A M Hammad,Babak Azad,Martin S Gross,Brayden Payne,Daniel Swerdloff,Jake A Miller,Robert Andrianne,Arthur L Burnett,Kelli Gross,Georgios Hatzichristodoulou,James M Hotaling,Tung-Chin Hsieh,James M Jones,Aaron Lentz,Vaibhav Modgil,Daniar Osmonov,Sung Hun Park,Ian Pearce,Paul Perito,Hossein Sadeghi-Nejad,Maxime Sempels,Alfredo Suarez-Sarmiento,Jay Simhan,Koenraad van Renterghem,J Nicholas Warner,Matthew Ziegelmann,Faysal A Yafi,David W Barham","doi":"10.1097/ju.0000000000004716","DOIUrl":"https://doi.org/10.1097/ju.0000000000004716","url":null,"abstract":"PURPOSEThis study aims to evaluate the association between antimicrobial practices, including oral antibiotics, intravenous antibiotics, antifungal prophylaxis, and infection outcomes in patients undergoing primary or revision inflatable penile prosthesis surgery.MATERIALS AND METHODSWe conducted a multicenter, retrospective cohort study of 5,261 patients who underwent primary or revision inflatable penile prosthesis surgery at 16 specialized centers across the United States, Europe, and Korea from July 2016 to July 2021. Patient data included demographic and clinical characteristics, antibiotic and antifungal administration, and infection outcomes. The primary outcome was infection following inflatable penile prosthesis placement. Univariable and multivariable regression analyses were performed to identify predictors of infection.RESULTSThe overall infection rate was 1.9% (n=102), with higher rates among diabetic patients (p=0.023), those with prior inflatable penile prosthesis infection (p<0.001), or undergoing revision surgery (p<0.001). Multivariable analysis identified diabetes (OR=1.68, p=0.022) and previous inflatable penile prosthesis infection (OR=4.67, p<0.001) as independent risk factors for infection. Perioperative intravenous antifungal use was significantly associated with a lower infection risk (OR=0.22, p<0.001), while postoperative oral antibiotics (p=0.5) and prolonged intravenous antibiotic prophylaxis (>24 hours) (p=0.2) did not demonstrate protective effects. Pre- and postoperative oral antibiotics were not associated with a statistically significant reduction in infection after adjustment for confounding variables.CONCLUSIONSThis large multicenter study highlights a significant association between perioperative antifungal prophylaxis and lower infection risk in inflatable penile prosthesis surgery while demonstrating the limited utility of preoperative and postoperative oral antibiotics and prolonged intravenous prophylaxis. These findings support evidence-based antimicrobial stewardship to optimize outcomes and minimize complications, including antibiotic resistance.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"702 1","pages":"101097JU0000000000004716"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802611","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 : 2025-08-08DOI: 10.1097/ju.0000000000004703
Timothy F Donahue,Melissa Assel,Eugene K Cha,Alvin Goh,Eugene Pietzak,Guido Dalbagni,Andrew Vickers,Hebert Alberto Vargas,Stephen Fleming,Bernard H Bochner
PURPOSEStomal complications following ileal conduit (IC) urinary diversion are challenging and can negatively impact quality of life after radical cystectomy. Parastomal hernias (PH) develop in up to half of patients; 30%-75% are symptomatic, and up to 1/3 require surgical repair. Recurrence rates after local tissue repair are high, and relocation of the stoma requires closure of the original defect, placing both sites at risk for hernias.MATERIALS AND METHODSPrimary aim of this randomized phase 3 trial was to test whether prophylactic placement of a parastomal mesh at IC formation reduced radiographic PH (rPH) rate compared with standard techniques without mesh; final rPH assessment was at 24 months. Ultrapro semi-absorbable mesh was placed in a sublay position dorsal to rectus muscle and anterior to posterior rectus sheath.RESULTSOf 178 patients randomized, 137 were eligible for analysis. Thirty-two of the 68 (47%) evaluable patients in the mesh arm had rPH versus 23/69 (33%) patients in the non-mesh arm (risk difference 14%; 95% CI -4.0%, 31%; p=0.14). The overall odds ratio (OR) comparing those randomized to mesh versus no mesh was 1.78 (95% CI 0.89, 3.55). Results were not meaningfully impacted when stratified by BMI or surgeon, separately (by BMI: OR 1.74; 95% CI 0.86, 3.51; p=0.2; by surgeon: OR 1.69; 95% CI 0.83, 3.41; p=0.2).CONCLUSIONSWe were unable to identify a clinical benefit to prophylactic parastomal mesh placement. Based on these findings, mesh at the time of conduit creation should not be used to avoid PH formation.
目的回肠导管（IC）尿改道术后的造口并发症具有挑战性，并可能对根治性膀胱切除术后的生活质量产生负面影响。造口旁疝（PH）在多达一半的患者中发展；30%-75%有症状，高达1/3需要手术修复。局部组织修复后的复发率很高，并且重新定位造口需要关闭原始缺陷，这使得两个部位都有发生疝气的风险。材料和方法这项随机3期试验的主要目的是测试在IC形成时预防性放置造口旁补片是否比不使用补片的标准技术降低了x线摄影PH （rPH）率；最终rPH评估在24个月时进行。超超半可吸收网状物放置在腹直肌背侧和腹直肌鞘前后的下位。结果178例患者中，137例符合分析条件。补片组68例可评估患者中有32例（47%）有rPH，而非补片组23/69例（33%）有rPH(风险差14%；95% ci -4.0%, 31%；p = 0.14)。将随机分组的补片组与未补片组进行比较的总优势比（OR）为1.78 （95% CI 0.89, 3.55）。当以BMI或外科医生分别分层时，结果没有显著影响(BMI: or 1.74；95% ci 0.86, 3.51；p = 0.2;外科医生：OR 1.69；95% ci 0.83, 3.41；p = 0.2)。结论：我们无法确定预防性造口旁补片放置的临床益处。基于这些发现，在导管形成时不应该使用网状物来避免PH的形成。
{"title":"Evaluating Benefits of Peristomal Mesh Placement at the Time of Radical Cystectomy and Ileal Conduit Formation: A Phase 3, Randomized Controlled Trial.","authors":"Timothy F Donahue,Melissa Assel,Eugene K Cha,Alvin Goh,Eugene Pietzak,Guido Dalbagni,Andrew Vickers,Hebert Alberto Vargas,Stephen Fleming,Bernard H Bochner","doi":"10.1097/ju.0000000000004703","DOIUrl":"https://doi.org/10.1097/ju.0000000000004703","url":null,"abstract":"PURPOSEStomal complications following ileal conduit (IC) urinary diversion are challenging and can negatively impact quality of life after radical cystectomy. Parastomal hernias (PH) develop in up to half of patients; 30%-75% are symptomatic, and up to 1/3 require surgical repair. Recurrence rates after local tissue repair are high, and relocation of the stoma requires closure of the original defect, placing both sites at risk for hernias.MATERIALS AND METHODSPrimary aim of this randomized phase 3 trial was to test whether prophylactic placement of a parastomal mesh at IC formation reduced radiographic PH (rPH) rate compared with standard techniques without mesh; final rPH assessment was at 24 months. Ultrapro semi-absorbable mesh was placed in a sublay position dorsal to rectus muscle and anterior to posterior rectus sheath.RESULTSOf 178 patients randomized, 137 were eligible for analysis. Thirty-two of the 68 (47%) evaluable patients in the mesh arm had rPH versus 23/69 (33%) patients in the non-mesh arm (risk difference 14%; 95% CI -4.0%, 31%; p=0.14). The overall odds ratio (OR) comparing those randomized to mesh versus no mesh was 1.78 (95% CI 0.89, 3.55). Results were not meaningfully impacted when stratified by BMI or surgeon, separately (by BMI: OR 1.74; 95% CI 0.86, 3.51; p=0.2; by surgeon: OR 1.69; 95% CI 0.83, 3.41; p=0.2).CONCLUSIONSWe were unable to identify a clinical benefit to prophylactic parastomal mesh placement. Based on these findings, mesh at the time of conduit creation should not be used to avoid PH formation.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"33 1","pages":"101097JU0000000000004703"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802637","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}
INTRODUCTIONOncocytic neoplasms account for up to 15% of small renal masses. Active surveillance (AS) is increasingly adopted for these lesions; however, knowledge gaps remain regarding their growth kinetics, concordance with renal tumor biopsy, and impact on renal function. This study reviews these factors in the largest cohort of biopsy-confirmed oncocytic neoplasms managed with AS.METHODSThis single-center, retrospective study included patients with biopsy-confirmed oncocytoma or chromophobe renal cell carcinoma (chRCC) on AS (2003-2021). Tumor growth rates and change in renal function (eGFR) were analyzed using linear mixed models, while development of chronic kidney disease was assessed using Cox proportional hazards model. Biopsy-to-surgical pathology concordance and triggers for intervention were examined.RESULTSAmong 229 patients (245 lesions; 222 oncocytomas, 23 chRCC), the median time between first and last imaging was 4.7 and 2.5 years, respectively. Predicted growth rates were 0.21 cm/year (oncocytoma) and 0.31 cm/year (chRCC). Larger baseline tumor size correlated with faster growth (p=0.04), while age inversely correlated with growth rate (p<0.01). Intervention was more common in the chRCC cohort (35% vs. 13%). Biopsy-to-surgical pathology concordance rates were 80% for oncocytoma and 86% for chRCC. No significant association was found between tumor size and renal function decline (p=0.3) or level (p=0.6). There were no events of metastases or kidney cancer-related deaths over median follow-up of 5.7 years (IQR 3.0, 8.7).DISCUSSIONOncocytic lesions on AS demonstrate slow growth, low intervention rate, preservation of renal function and excellent disease-specific survival. While biopsy limitations exist, histology-guided AS provides effective management.
{"title":"Active Surveillance of Biopsy-Confirmed Oncocytic Renal Tumors: Growth Dynamics and Impact on Renal Function.","authors":"Lucshman Raveendran,Lisa J Martin,Douglas C Cheung,Joyce Tsang,Maria Komisarenko,Susan Prendeville,Satheesh Krishna,Antonio Finelli","doi":"10.1097/ju.0000000000004717","DOIUrl":"https://doi.org/10.1097/ju.0000000000004717","url":null,"abstract":"INTRODUCTIONOncocytic neoplasms account for up to 15% of small renal masses. Active surveillance (AS) is increasingly adopted for these lesions; however, knowledge gaps remain regarding their growth kinetics, concordance with renal tumor biopsy, and impact on renal function. This study reviews these factors in the largest cohort of biopsy-confirmed oncocytic neoplasms managed with AS.METHODSThis single-center, retrospective study included patients with biopsy-confirmed oncocytoma or chromophobe renal cell carcinoma (chRCC) on AS (2003-2021). Tumor growth rates and change in renal function (eGFR) were analyzed using linear mixed models, while development of chronic kidney disease was assessed using Cox proportional hazards model. Biopsy-to-surgical pathology concordance and triggers for intervention were examined.RESULTSAmong 229 patients (245 lesions; 222 oncocytomas, 23 chRCC), the median time between first and last imaging was 4.7 and 2.5 years, respectively. Predicted growth rates were 0.21 cm/year (oncocytoma) and 0.31 cm/year (chRCC). Larger baseline tumor size correlated with faster growth (p=0.04), while age inversely correlated with growth rate (p<0.01). Intervention was more common in the chRCC cohort (35% vs. 13%). Biopsy-to-surgical pathology concordance rates were 80% for oncocytoma and 86% for chRCC. No significant association was found between tumor size and renal function decline (p=0.3) or level (p=0.6). There were no events of metastases or kidney cancer-related deaths over median follow-up of 5.7 years (IQR 3.0, 8.7).DISCUSSIONOncocytic lesions on AS demonstrate slow growth, low intervention rate, preservation of renal function and excellent disease-specific survival. While biopsy limitations exist, histology-guided AS provides effective management.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"17 1","pages":"101097JU0000000000004717"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802599","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 : 2025-08-06DOI: 10.1097/ju.0000000000004704
Sherri M Donat,Amy L Tin,Andrew J Vickers,Harry Herr
PURPOSEBladder preservation is a desired goal for most patients with muscle invasive bladder cancer (MIBC), although select few are ideal candidates based on established criteria. Heterogenous cohorts with short follow-up hinder assessment of true risks/benefits for ideal candidates. We describe long-term outcomes in patients with MIBC, meeting established ideal criteria for bladder preservation, treated initially with systemic therapy and transurethral resection (TUR).MATERIALS AND METHODSInstitutional retrospective review of 101 prospectively monitored patients meeting "ideal" criteria for bladder preservation achieving a clinical complete response to Cisplatin-based chemotherapy and TUR from 1994-2015, with >10 years follow-up. Primary endpoints were bladder-intact survival, local recurrence free survival, and cancer specific survival.RESULTSFifteen-year risk of death from bladder cancer was 11% (95% CI 5.8%, 18%), with the competing risk of death from other causes 44% (95% CI 33%, 54%), and cystectomy risk of 11% (95% CI 5.9%, 18%). Bladder preservation outcomes were near 40:40:10:10 for death from another cause, alive with an intact bladder; cystectomy; death from bladder cancer. Of 41 patients alive with their bladder intact, median (IQR) follow-up time was 14 (11, 20) years. One-third relapsed locally, with the probability persisting beyond 10 years, necessitating lifetime surveillance. Our findings may not be generalizable to other settings or to patients not meeting "ideal" criteria.CONCLUSIONSBladder preservation with neoadjuvant-chemotherapy with TUR is a viable option for select patients meeting established selection criteria. Patients and physicians must consider the probabilities of long-term bladder preservation versus excess mortality when electing bladder-sparing.
目的：膀胱保存是大多数肌浸润性膀胱癌（MIBC）患者的理想目标，尽管根据既定标准，只有少数患者是理想的候选者。短随访的异质队列妨碍了对理想候选人的真实风险/收益的评估。我们描述了MIBC患者的长期预后，符合既定的膀胱保存理想标准，最初接受全身治疗和经尿道切除（TUR）治疗。材料和方法：1994-2015年，101例前瞻性监测患者符合膀胱保存“理想”标准，对基于顺铂的化疗和TUR有临床完全缓解，随访10年。主要终点是膀胱完整生存期、局部无复发生存期和癌症特异性生存期。结果膀胱癌15年死亡风险为11% (95% CI 5.8%, 18%)，其他原因死亡竞争风险为44% (95% CI 33%, 54%)，膀胱切除术风险为11% （95% CI 5.9%, 18%）。其他原因死亡、膀胱完整存活者的膀胱保存率接近40:40:10:10；胆囊切除术;死于膀胱癌在41例膀胱完整存活的患者中，中位（IQR）随访时间为14（11,20）年。三分之一局部复发，有可能持续超过10年，需要终生监测。我们的发现可能不能推广到其他情况或不符合“理想”标准的患者。结论对于符合既定选择标准的患者，膀胱保留联合新辅助化疗联合TUR是一种可行的选择。当选择膀胱保留时，患者和医生必须考虑长期膀胱保留和超额死亡率的可能性。
{"title":"\"Neoadjuvant Chemotherapy with Transurethral Resection for Bladder Preservation: 15-year follow-up of the retained bladder\".","authors":"Sherri M Donat,Amy L Tin,Andrew J Vickers,Harry Herr","doi":"10.1097/ju.0000000000004704","DOIUrl":"https://doi.org/10.1097/ju.0000000000004704","url":null,"abstract":"PURPOSEBladder preservation is a desired goal for most patients with muscle invasive bladder cancer (MIBC), although select few are ideal candidates based on established criteria. Heterogenous cohorts with short follow-up hinder assessment of true risks/benefits for ideal candidates. We describe long-term outcomes in patients with MIBC, meeting established ideal criteria for bladder preservation, treated initially with systemic therapy and transurethral resection (TUR).MATERIALS AND METHODSInstitutional retrospective review of 101 prospectively monitored patients meeting \"ideal\" criteria for bladder preservation achieving a clinical complete response to Cisplatin-based chemotherapy and TUR from 1994-2015, with >10 years follow-up. Primary endpoints were bladder-intact survival, local recurrence free survival, and cancer specific survival.RESULTSFifteen-year risk of death from bladder cancer was 11% (95% CI 5.8%, 18%), with the competing risk of death from other causes 44% (95% CI 33%, 54%), and cystectomy risk of 11% (95% CI 5.9%, 18%). Bladder preservation outcomes were near 40:40:10:10 for death from another cause, alive with an intact bladder; cystectomy; death from bladder cancer. Of 41 patients alive with their bladder intact, median (IQR) follow-up time was 14 (11, 20) years. One-third relapsed locally, with the probability persisting beyond 10 years, necessitating lifetime surveillance. Our findings may not be generalizable to other settings or to patients not meeting \"ideal\" criteria.CONCLUSIONSBladder preservation with neoadjuvant-chemotherapy with TUR is a viable option for select patients meeting established selection criteria. Patients and physicians must consider the probabilities of long-term bladder preservation versus excess mortality when electing bladder-sparing.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"27 1","pages":"101097JU0000000000004704"},"PeriodicalIF":0.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144792073","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 : 2025-08-05DOI: 10.1097/ju.0000000000004705
Ali Ghasemzadeh,E Jason Abel,Jose A Karam,Philippe E Spiess,Charles C Peyton,Brandon J Manley,Richard Barry Sirard,Nicholas Robertson,Elizabeth E Ellis,Brittney H Cotta,Kartik R Patel,Edouard Nicaise,Amber Jani,Wade J Sexton,Dattatraya Patil,Glenn O Allen,Surena F Matin,Viraj A Master,Daniel D Shapiro
PURPOSEPatients with metastatic renal cell carcinoma (mRCC) with oligometastatic disease can achieve radiographic disease-free (M1 NED) status following cytoreductive nephrectomy and concurrent complete metastasectomy (CNCM). This study aimed to evaluate outcomes and identify risk factors associated with metastatic recurrence and overall survival in mRCC M1 NED patients.MATERIALS AND METHODSPatients with synchronous mRCC who were M1 NED following CNCM from four institutions (2010-2020) were identified. Survival outcomes were analyzed by Kaplan Meier method. Patients were grouped by early (first year following surgery) recurrence or delayed/no known metastatic recurrence. Logistic regression modeling identified risk factors for first-year recurrence and decision curve analysis evaluated the utility of a model incorporating identified risk factors.RESULTS109 M1 NED patients were identified including 36 patients who had recurrence in the first year following surgery and 73 patients with delayed or no recurrence. First-year recurrence resulted in significantly shorter overall survival (OS) compared to those with delayed/no recurrence after 1 year (median 15 vs. 97 months respectively, P<0.0001). First-year recurrence predictors included liver metastases, increasing primary tumor size, and elevated preoperative C-reactive protein (CRP). A prognostic model incorporating these factors demonstrated discriminatory capacity and improved clinical decision-making compared to a universal immediate post-operative systemic therapy or active surveillance strategy.CONCLUSIONSLiver metastasis, increasing primary tumor size, and elevated preoperative CRP are associated with increased risk for first-year progression following cytoreductive nephrectomy and complete metastasectomy. Despite radiographic NED status, high risk patients should be considered for immediate systemic therapy following surgery given poor outcomes.
{"title":"Risk Factors for First-Year Recurrence in Patients with Synchronous Metastatic Renal Cell Carcinoma Undergoing Cytoreductive Nephrectomy and Complete Metastasectomy.","authors":"Ali Ghasemzadeh,E Jason Abel,Jose A Karam,Philippe E Spiess,Charles C Peyton,Brandon J Manley,Richard Barry Sirard,Nicholas Robertson,Elizabeth E Ellis,Brittney H Cotta,Kartik R Patel,Edouard Nicaise,Amber Jani,Wade J Sexton,Dattatraya Patil,Glenn O Allen,Surena F Matin,Viraj A Master,Daniel D Shapiro","doi":"10.1097/ju.0000000000004705","DOIUrl":"https://doi.org/10.1097/ju.0000000000004705","url":null,"abstract":"PURPOSEPatients with metastatic renal cell carcinoma (mRCC) with oligometastatic disease can achieve radiographic disease-free (M1 NED) status following cytoreductive nephrectomy and concurrent complete metastasectomy (CNCM). This study aimed to evaluate outcomes and identify risk factors associated with metastatic recurrence and overall survival in mRCC M1 NED patients.MATERIALS AND METHODSPatients with synchronous mRCC who were M1 NED following CNCM from four institutions (2010-2020) were identified. Survival outcomes were analyzed by Kaplan Meier method. Patients were grouped by early (first year following surgery) recurrence or delayed/no known metastatic recurrence. Logistic regression modeling identified risk factors for first-year recurrence and decision curve analysis evaluated the utility of a model incorporating identified risk factors.RESULTS109 M1 NED patients were identified including 36 patients who had recurrence in the first year following surgery and 73 patients with delayed or no recurrence. First-year recurrence resulted in significantly shorter overall survival (OS) compared to those with delayed/no recurrence after 1 year (median 15 vs. 97 months respectively, P<0.0001). First-year recurrence predictors included liver metastases, increasing primary tumor size, and elevated preoperative C-reactive protein (CRP). A prognostic model incorporating these factors demonstrated discriminatory capacity and improved clinical decision-making compared to a universal immediate post-operative systemic therapy or active surveillance strategy.CONCLUSIONSLiver metastasis, increasing primary tumor size, and elevated preoperative CRP are associated with increased risk for first-year progression following cytoreductive nephrectomy and complete metastasectomy. Despite radiographic NED status, high risk patients should be considered for immediate systemic therapy following surgery given poor outcomes.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"40 1","pages":"101097JU0000000000004705"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787151","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 : 2025-07-31DOI: 10.1097/ju.0000000000004682
Amy R Deipolyi,Samuel Deem,Ronald Arellano
{"title":"Stereotactic Body Radiotherapy for Renal Cell Carcinoma: Not yet Comparable to Curative Standards.","authors":"Amy R Deipolyi,Samuel Deem,Ronald Arellano","doi":"10.1097/ju.0000000000004682","DOIUrl":"https://doi.org/10.1097/ju.0000000000004682","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"716 1","pages":"101097JU0000000000004682"},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144747709","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 : 2025-07-30DOI: 10.1097/ju.0000000000004683
Chen Shenhar,Howard B Goldman,Emily Slopnick,Marieke K Jones,Bradley Gill,Jacqueline Zillioux
PURPOSETo evaluate the impact of cognitive impairment (CI) on sacral neuromodulation (SNM) outcomes in older patients, including progression to full implant, patient-reported outcome measures, and device utilization.MATERIALS AND METHODSThis prospective trial recruited patients age ≥ 60 years scheduled for test-phase SNM for refractory overactive bladder (OAB). Screening for CI was completed and defined as Montreal Cognitive Assessment scores < 26/30.Patients underwent initial and follow-up assessments using validated questionnaires (OAB-q SF, IIQ7, UDI-6, PGI-I). Baseline functional status and technology comfort/use were assessed by novel questionnaire. The primary outcome of test-phase success (>50% improvement in baseline symptoms) was compared based on the presence of CI. Secondary outcomes included urinary questionnaire scores and device utilization.RESULTSOf 92 patients recruited, 88 underwent test-phase SNM (mean age 73 ± 8 years, 89% female), and 63% had CI (Montreal Cognitive Assessment < 26). Baseline patient-reported measures of OAB symptom severity and impact were not statistically different between groups. Patients with CI had lower baseline technology use and confidence. Overall test-phase success was 89% and did not differ based on CI (91% vs 87%, P = .7). At 1-month follow-up, patients with CI demonstrated lower rates of appropriate SNM controller use; however, patient-reported outcomes did not differ.CONCLUSIONSOlder patients with OAB presenting for SNM have a high incidence of CI, which is associated with reduced comfort using technology. However, there was no evidence that CI affected SNM test-phase success or short-term patient-reported outcomes.
目的评估认知障碍（CI）对老年患者骶神经调节（SNM）结果的影响，包括植入物进展、患者报告的结果测量和器械使用情况。材料和方法本前瞻性试验招募年龄≥60岁的难治性膀胱过动症（OAB）患者，计划进行测试期SNM。完成CI筛查，定义为蒙特利尔认知评估评分< 26/30。采用有效问卷（OAB-q SF、iiiq7、UDI-6、pgi - 1）对患者进行初步和随访评估。采用新颖的调查问卷对基线功能状态和技术舒适度/使用情况进行评估。测试阶段成功的主要结局（基线症状改善50%）基于CI的存在进行比较。次要结局包括泌尿问卷得分和器械使用情况。结果在招募的92例患者中，88例接受了测试阶段的SNM（平均年龄73±8岁，89%为女性），63%的CI（蒙特利尔认知评估< 26）。患者报告的OAB症状严重程度和影响的基线测量在组间无统计学差异。CI患者有较低的基线技术使用和信心。总体测试阶段的成功率为89%，且CI无差异（91% vs 87%, P = .7）。在1个月的随访中，CI患者表现出较低的适当SNM控制器使用率；然而，患者报告的结果没有差异。结论以SNM为临床表现的OAB患者CI发生率高，这与使用技术的舒适度降低有关。然而，没有证据表明CI影响SNM试验阶段的成功或短期患者报告的结果。
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Pub Date : 2025-07-24DOI: 10.1097/ju.0000000000004692
Yu-Hsiang Lin,Jau-Yuan Chen,Chun-Te Wu
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