Cuaj-Canadian Urological Association Journal最新文献

Introduction: Anesthesia choice during the procedural management of suspected renal colic during pregnancy may vary based on available resources and patient or provider preferences, as there are no specific recommendations. Our objective was to evaluate whether preterm birth (<37 weeks) was associated with anesthesia type, anesthesia timing by trimester, or procedure type.

Methods: We retrospectively identified pregnant patients who required procedural management with ureteral stent, percutaneous nephrostomy (PCN), or ureteroscopy (URS) for suspected renal colic based on laboratory and imaging findings from 2009-2021 at our center. Analyzed data included anesthesia type (local analgesia only, monitored anesthesia care [MAC], spinal anesthesia, or general anesthesia), trimester of procedure, procedure type, and obstetric outcomes, including preterm birth.

Results: The study cohort included 96 patients who underwent 231 total procedures, including primary URS, PCN, and stent, as well as PCN and stent change. The median gestational age was 38.7 weeks (37.1-39.5), and preterm birth rate was 15.8%. The most common anesthetic used across all procedures and trimesters was MAC. PCN was associated with the use of less invasive analgesia or anesthesia, whereas endoscopic procedures were more commonly performed with spinal or general anesthesia. Using multivariable logistic regression, procedure type was associated with preterm birth, but not anesthesia type or timing by trimester.

Conclusions: Anesthesia type and timing were not associated with preterm birth, and selection may be influenced by resources, clinical scenario, or patient and provider preferences.

Introduction: Sexuality is an integral part of well-being. Urologists are a population faced with a significant workload and stress that can affect their sexuality. The purpose of this study was to investigate sexuality in this population and assess factors that may impact it.

Methods: A cross-sectional study was conducted between May and July 2023 among French urology residents and fellows. Data was collected through an anonymous questionnaire sent by the French Association of Trainee Urologists (AFUF) via email.

Results: Out of 445 members of the AFUF, 196 trainee urologists responded. Among them, 130 (66%) respondents were satisfied with their sexual life, and 123 (63%) reported having one or more sexual encounters per week. In univariate analysis, factors significantly impacting the level of sexual satisfaction were gender (p=0.029), level of job satisfaction/well-being (p<0.01), level of professional burnout (p<0.001), and the existence of a romantic relationship.

Conclusions: Young urologists are mostly satisfied with their sexual life. Gender, level of job satisfaction/well-being, and level of professional burnout are significant factors impacting the level of sexual satisfaction.

Introduction: This study aimed to assess the detection rate of prostate cancer recurrence by prostate-specific member antigen-positron emission tomography/computed tomography (PSMA-PET/CT) with ¹⁸F-DCFPyL in patients with residual disease or biochemical recurrence (BCR), and its association with surgical pathology and prostate-specific antigen (PSA) kinetics.

Methods: Men from South Central Ontario enrolled in the PSMA Registry for Recurrent Prostate cancer (PREP) between April 2019 and December 2021 after radical prostatectomy (RP) and who had 1) pathologic stage N1 or persistent elevated PSA; or 2) BCR (PSA ≥0.10 ng/mL) where initial postoperative PSA was undetectable were included.

Results: A total of 169 men (median age 68 years; interquartile range [IQR] 62-71) with complete data met the above criteria. The median PSA was 0.27 ng/mL (IQR 0.16-0.85) prior to PSMA-PET. Overall positivity rate 59%; when PSA was <0.40 ng/mL, overall positivity rate 42% vs. 85% with PSA ≥0.40 ng/mL (p<0.001). Higher pathologic tumor stage increased detection of regional lymph nodes (LNs) (pT2-3a: 32% vs. pT3b: 69%, p<0.001) but not distant metastases (pT2-3a: 12% vs. pT3b: 24%, p=0.15). PSMA-PET detected 18% with prostate bed, 42% with regional LN disease, and 44% with pelvic-only disease. The three most involved LN chains were the internal (21%) and external (20%) iliac, and obturator chains (16%).

Conclusions: This prospective study of patients with residual disease or BCR after RP illustrates patterns of failure that could impact diagnosis and postoperative management. Such patients have significant risk of regional LN positivity on PSMA-PET, highlighting a need to include pelvic LNs within salvage radiotherapy volumes.

Introduction: Radical prostatectomy (RP) for prostate cancer has changed over the years with the advent of minimally invasive (MIRP) approaches, which includes robotic-assisted RP (RARP). The MIRP approaches have been shown to reduce complication rate, but there remain barriers to adoption. The objective of this study was to quantitatively describe the trend in the RP approach in Ontario, and to assess the trend in complication rates.

Methods: We conducted a population-based, retrospective cohort study including all men who underwent RP for prostate cancer in Ontario from 2010-2019. We used administrative data from Ontario's health databases to gather surgical outcome data. Our primary outcomes were the annualized frequency of RP by surgical approach and annualized 30-day composite complication rate.

Results: In total, 22 118 patients were included in the analysis over the study period. There was a trend away from retropubic (RRP) frequency over the study period (80.3% of cases in fiscal year [FY] 2010 to 55.6% in FY 2018) and towards RARP approach (6.8% of cases in FY 2010 and 36.7% in FY 2018). The most common complication was blood transfusion at 6.26%, which saw a downtrend over the study period (7.96% FY 2010, 3.47% FY 2018). The odds ratio for 30-day complication for open RP compared to MIRP was 1.74 (95% confidence interval 1.57-1.92, p<0.001).

Conclusions: In Ontario, there has been a steady shift away from RRP and towards RARP. Minimally invasive approaches portend a significantly lower complication rate, likely driven by a lower blood transfusion rate.

Introduction: Focal therapy is an emerging treatment for localized prostate cancer (PCa). The objectives of this review were to: 1) review how focal therapies are regulated and approved; 2) summarize the scope and quality of the literature regarding safety, efficacy, and side-effects; and 3) outline ongoing clinical trials of focal therapy in Canada.

Methods: Using the PRISMA framework for scoping reviews, we searched PubMed, Embase, and Cochrane from 2021-2024, complementing Hopstaken et al's search up to 2020. We focused on studies reporting functional and oncologic outcomes. Additionally, we examined the FDA database for regulatory details and ongoing trials in Canada via ClinicalTrials.gov.

Results: FDA approval for prostate tissue ablation was granted to high-intensity focused ultrasound (HIFU) in 2015 via the de novo pathway; other therapies followed the 510(k) route, citing equivalence to predicate devices. Most studies are in early stages, primarily single-arm, prospective cohort designs. Oncologic outcomes like cancer detection and survival rates, alongside functional data, such as adverse events and erectile function, were assessed. Recurrence-free survival at 48 months ranged from 58-92%, pad-free rates were greater than 95%, and rates of new-onset erectile dysfunction were variable, ranging from no change to 50%. Rates of serious adverse events were low, ranging from 0-14%. Three Canadian clinical trials are actively enrolling participants, and five private clinics were found offering private HIFU, irreversible electroporation, or transurethral ultrasound ablation.

Conclusions: Focal therapy technologies have gained regulatory approval for prostate tissue ablation, and aside from provincial support for cryoablation in Alberta, are available to Canadians through private payment or clinical trials. Many studies demonstrate promising cancer control and impressive functional outcomes but are limited by their short followup and lack of comparator group. Clinical trial or registry participation should be prioritized to ensure an evidence-based integration into current prostate cancer treatment approaches.

Introduction: Prostate cancer (PCa) impacts patient lives beyond oncologic concerns alone. PCa survivorship entails all impacts of PCa, from time of diagnosis to end of life. This may include decision regret (DR). We aimed to determine survivor experiences from a functional perspective throughout survivorship.

Methods: Our cross-sectional survey was circulated to all members of the Manitoba Prostate Cancer Support Group. Questions explored patient understanding of functional impacts concerning treatment. Survey items included binary and Likert scale questions, and an open-answered question asking how care may be improved. Responses were used to identify predictors of DR.

Results: A total of 514 patients received our survey, with a response rate of 23.7% (n=122). Most survivors were offered radical prostatectomy (RP) or radiation therapy, at 73.0% and 63.9%, respectively; 14.9% reported lacking understanding of treatment impact on erections. Similarly, 11.5% reported lacking understanding of treatment on urinary continence. Predictors of DR included treatment with RP and low pre-treatment understanding of potential erectile dysfunction (ED) and urinary incontinence.

Conclusions: PCa survivors are at high risk of DR, particularly those who undergo treatment with RP and those who identify as having low pre-treatment understanding of potential ED and urinary incontinence. Virtual care did not impact DR. Results highlight the importance of thorough counseling on functional aspects of PCa management prior to treatment.