Cuaj-Canadian Urological Association Journal最新文献

Introduction: Women are under-represented in Canadian urology, particularly within academic leadership. This study aimed to analyze gender differences and trends in Canadian Urological Association (CUA) guideline authorship.

Methods: We searched the Canadian Urological Association Journal from March 2007 to August 2024 for all versions of eligible guidelines, best practice reports, and consensus statements. Two independent reviewers extracted data in duplicate. Authors appearing in multiple guidelines were counted more than once. We analyzed author characteristics by gender using the Chi-squared test and assessed authorship over time using the Cochran-Armitage test for trend.

Results: There were 1172 non-unique authors across 112 guidelines, of whom 750 (64%) were urologists. Women represented 15.5% of all authors and 7.5% of urologist authors. Focusing only on urologists, women were more likely to be first authors and to be included on functional, pediatric, and endourology guidelines than men. The proportion of women urologist authors, first authors, and last authors did not change significantly over time. Men and women urologists had similar rates of repeated authorship (56.7% vs. 51.7%, p=0.61), although men were more likely to appear on ≥5 guideline panels (23.6% vs. 6.9%, p=0.04).

Conclusions: CUA guideline authorship is dominated by men, with limited progress in the participation of women over the past 18 years. CUA guideline panels help establish the standard of urologic care, and guideline authorship represents a significant academic opportunity. Further work to minimize this gender disparity is needed to ensure our guidelines better reflect the diversity of Canadian urologists, urology trainees, and patients.

Introduction: We aimed to evaluate the association between race and postoperative complications in patients undergoing urologic cancer surgeries, comparing 30-day outcomes between black and white-identifying patients using propensity score matching.

Methods: Adult patients undergoing urologic cancer surgeries from 2015-2019 were identified from the National Surgical Quality Improvement Program database. Black-identifying patients were matched 1:1 with white-identifying patients based on surgical procedure, demographics, and medical history. The primary outcome was 30-day mortality. Secondary outcomes included specific complications, such as unplanned readmission, reintubation, and reoperation; myocardial infarction; renal insufficiency; cardiac arrest; surgical site infections (SSIs) and septic shock. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression.

Results: Among 110 028 patients (mean age 46.8 years; 79.1% male; 12.7% black-identifying), a matched cohort of 28 056 was analyzed. No significant difference in 30-day mortality (OR 1.18, 95% CI 0.86-1.63, p=0.296) was observed. Secondary outcomes showed higher odds of unplanned readmission (OR 1.12, 95% CI 1.02-1.24, p=0.018), reintubation (OR 1.36, 95% CI 1.03-1.81, p=0.032), renal insufficiency (OR 1.84, 95% CI 1.37-2.47, p<0.001), and cardiac arrest (OR 1.49, 95% CI 1.01-2.20, p=0.043), but lower odds of myocardial infarction (OR 0.65, 95% CI 0.43-0.99, p=0.048), superficial SSIs (OR 0.65, 95% CI 0.50-0.85 p=0.001), and septic shock (OR 0.67, 95% CI 0.45-0.98, p=0.041) among black-identifying patients.

Conclusions: While no significant difference in 30-day mortality was observed, black-identifying patients were at an increased risk of several postoperative complications compared to white-identifying patients. These observations warrant further investigations into health equity within urology.

Introduction: Radical cystectomy (RC) is the standard treatment for muscle-invasive bladder cancer (MIBC), but it is associated with substantial perioperative blood loss and high transfusion rates. Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated efficacy in reducing surgical blood loss across various specialties; however, due to a paucity of randomized controlled trials in the RC setting, its role remains uncertain. We conducted a systematic review and meta-analyses to synthesize the current evidence and provide a critical assessment of TXA use during RC.

Methods: Studies evaluating TXA during RC were identified through a comprehensive search of multiple databases up to November 2024. Primary outcomes included intraoperative and perioperative blood transfusion rates and estimated blood loss. The secondary outcome assessed was thromboembolic events RESULTS: Five studies comprising 1736 patients were included. TXA did not significantly reduce estimated blood loss (MD: -85.56 mL; 95% confidence interval [CI] -191.13-20.02, p>0.05) or intraoperative transfusion rates (odds ratio [OR] 0.73, 95% CI 0.40-1.33, p>0.05); however, TXA was associated with a lower likelihood of perioperative transfusions (OR 0.56, 95% CI 0.32-0.97, p<0.05). Notably, TXA increased the risk of thromboembolic events (OR 2.05, 95% CI 1.15-4.65, p<0.05). Heterogeneity varied across analyses, with robotic-assisted RC underrepresented in the included studies.

Conclusions: This systematic review and meta-analysis revealed that, in patients undergoing RC, the use of TXA does not significantly reduce estimated blood loss or intraoperative transfusion rates. Moreover, TXA appears to be associated with an increased incidence of thromboembolic events, suggesting a potential pro-thrombotic effect. Based on these findings, its routine use in this context cannot be recommended, particularly when intended to reduce thromboembolic risk.