Cuaj-Canadian Urological Association Journal最新文献

Introduction: The use of alternative therapies for men's health continues to grow in popularity, as claims of their urologic and overall health benefits become more widespread. This study aimed to evaluate commonly purported therapies (intravenous [IV] nutrient infusions, saunas, ice baths, light therapy, and condensed nutritional supplements) in the treatment or improvement of men's urologic health.

Methods: A scoping review was conducted using the databases PubMED and SCOPUS to identify literature discussing each intervention. Outcomes of interest were urologic parameters in men aged 18 and above.

Results: Overall, the results were often conflicting or inconclusive. IV therapy lacked any supportive evidence for the claims regarding its benefits in erectile dysfunction, sperm quality, or testosterone enhancement. Sauna had mixed outcomes, with some temporary increases in testosterone and reversible adverse effects on sperm parameters. Similarly, cold water immersion showed inconsistent benefits for testosterone, with improvements in fatigue and soreness. Light therapy showed non-significant changes in hormone levels, while improvements in sexual satisfaction and hair regrowth were noted. While some herbal products showed benefits for sexual function, testosterone levels, and sperm quality, others had negligible or inconsistent outcomes.

Conclusions: There is a discordance between media claims and scientific literature regarding the impact of alternative therapies for men's health. This data is significantly limited by small sample sizes and a lack of long-term followup. There is a need for larger-scale trials to better inform patient counseling.

Introduction: With rising surgical wait times for benign prostatic hyperplasia (BPH)-related urinary retention (UR), we aimed to assess the healthcare costs of prolonged UR management in patients awaiting holmium laser enucleation of the prostate (HoLEP) and evaluate the impact of wait times on resource utilization and complications.

Methods: We retrospectively analyzed 91 patients with BPH-related UR on the HoLEP waitlist (September 2021-2024). Wait times, urologic and emergency department (ED) visits, interventions, and costs were recorded. Total costs included institutional and physician-billed fees from our cost center. Continuous variables were reported as mean ± standard deviation or median (interquartile range).

Results: Mean patient age was 71±8 years, with a mean prostate size of 123±54 g. Median wait time from retention to surgery was 220 days (149-300), with median total cost of $5315.95 (4343.85-7385.94). Longer wait times correlated with higher total costs (r=0.374, p<0.001), but inversely with cost per month (r=-0.680, p<0.001), suggesting cumulative burden over time. There were 685 urology clinic visits and 55 ED visits, nine (16%) resulting in hospital admissions. Complications occurred in 51 patients, including infections (63%), hematuria (47%), catheter issues (18%), and urosepsis (16%). Admissions were due to acute kidney injury (AKI) (n=3), urosepsis (n=2), pyelonephritis (n=2), and hematuria (n=2), with pyelonephritis, AKI, and urosepsis contributing the highest costs. Patients with complications required more visits and incurred higher costs (all p<0.05).

Conclusions: Prolonged UR management significantly increases healthcare costs. Prioritizing earlier surgical intervention may reduce complications, lessen economic strain, and improve patient outcomes.

Introduction: This study evaluated the long-term efficacy and safety of Rezūm water vapor thermal therapy (WVTT) for treating lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). The objective was to assess the durability of symptom relief and sustained LUTS improvement over a three-year followup in a real-world, multicenter cohort.

Methods: A prospective registry was maintained at two high-volume international centers for men undergoing Rezūm therapy between April 2019 and October 2024. All participants had baseline clinical data recorded, including BPH history, uroflowmetry parameters (peak flow rate [Qmax] and postvoid residual [PVR]), and validated questionnaires (International Prostate Symptom Score [IPSS], IPSS quality of life [QoL], BPH Impact Index [BPHII], International Index of Erectile Function [IIEF-15], and Male Sexual Health Questionnaire for Ejaculatory Dysfunction [MSHQ-EjD]).

Results: A total of 712 men with at least one year of followup were analyzed. The mean age was 67.2 years (stanadrad deviation [SD] 8.9), and the average baseline prostate volume was 74.1 cc (SD 34.4). Mean IPSS scores improved from 22 at baseline to 9.8 at 36 months. IPSS QoL scores improved from 4.5 to 1.9. Qmax increased from 8.6 ml/s at baseline to 15 ml/s at 24 months and 12.1 ml/s at 36 months. PVR decreased from 134.9 ml to 38.5 ml. There were no significant changes in IIEF or MSHQ-EjD domains.

Conclusions: Rezūm WVTT provides significant, durable symptom relief and improved urinary function over three years, with preserved sexual function.

Introduction: Accurate pre-intervention staging of upper tract urothelial carcinoma (UTUC) remains a significant clinical challenge, particularly in identifying muscle-invasive disease (≥pT2), where kidney-sparing surgery may not be appropriate. Current imaging and biopsy approaches are often inadequate. Radiomics, which extracts high-dimensional features from medical imaging, may improve non-invasive staging. This study assessed whether computed tomography (CT)-based radiomic features, alone or combined with clinical data, could predict ≥pT2 UTUC in a multicenter Canadian cohort.

Methods: We retrospectively analyzed clinical, pathologic, and radiographic features of patients with UTUC who underwent extirpative surgery at five academic centers from January 2, 2001, to May 1, 2023. Radiomic features were extracted from machine-learning segmentations of the affected kidney using the excretory phase of CT. Predictive models were developed using clinical only, radiomic only, and combined data to predict stage ≥pT2. Feature selection included univariable logistic regression, correlation filtering, and LASSO. Model performance was assessed via five-fold cross-validation repeated 10 times, with area under the curve (AUC) as the primary metric.

Results: Of 441 patients, 208 (47.2%) were included. Of the 208 patients, 97 (46.6%) had ≥pT2 disease. The clinical model (AUC 0.602) included age, hydronephrosis, and high-grade cytology. The radiomics model, based on two texture features, achieved an AUC of 0.653. The combined model achieved an AUC of 0.647. Radiomics and combined models significantly outperformed the clinical model (p<0.01), but did not differ from each other. For 117 patients with renal pelvis cancers, the combined model's discrimination performance was statistically better than the clinical model (AUC 0.708 vs. AUC 0.607, p<0.001). Likewise, the radiomics' AUC discrimination performance was statistically better than the clinical model (AUC 0.694 vs. AUC 0.607, p=0.004). In contrast, we found no significant difference in model performance in the non-renal pelvis subgroup (n=91).

Conclusions: Conventional radiomics improved the prediction of muscle-invasive UTUC compared to clinical models alone, but overall accuracy remained suboptimal for clinical use. Heterogeneity in CT protocols and challenges with tumor segmentation were the main limitations. Future work should develop more adaptable AI models trained on larger, more diverse datasets to better reflect real-world imaging conditions.

Introduction: We aimed to evaluate intraoperative point-of-care urinalysis (UA) for predicting positive urine cultures and postoperative urinary tract infections (UTIs) in children undergoing cystoscopy, and to assess its potential to reduce unnecessary cultures and antibiotics.

Methods: In this retrospective cohort at a tertiary pediatric urology center (August 2023 to April 2024), 62 cystoscopy cases with paired dipstick UA and quantitative culture were analyzed after excluding recent antibiotic use or incomplete data. Dipstick markers -leukocyte esterase and nitrite - were evaluated alone and combined ("either-positive" vs. "both-positive"). Positive culture was defined as ≥10⁵ CFU/mL; postoperative UTI required fever, clinical signs, and a positive culture within seven days. Diagnostic accuracy was assessed by ROC curves and χ² tests. A multivariable logistic regression adjusted for age, sex, procedure, laterality, and clinical condition. A retrospective quality improvement (QI) model estimated reductions in culture orders and empiric antibiotics.

Results: Thirty-nine patients (62.9%) were dipstick-negative by the "either-positive" rule; one had a positive culture (negative predictive value [NPV] 97.4%; 95% confidence interval [CI] 86.5-99.9). Of 23 dipstick-positive patients, 13 (56.5%) had positive cultures. In multivariable analysis, "either-positive" dipstick was the sole predictor of culture positivity (odds ratio [OR] 330.2, 95% CI 30.5-3 574.1, p=0.003). QI modeling indicated that restricting cultures to the 23 dipstick-positive specimens would have averted 39 of 62 cultures (62.9%), at the expense of missing one infection (2.6% of uncultured cases).

Conclusions: Intraoperative dipstick UA reliably identifies pediatric cystoscopy patients at low risk for postoperative UTI, offering a rapid, cost-effective tool to enhance antimicrobial stewardship and reduce laboratory utilization. This single-center, retrospective study with a modest sample and low event rate may limit generalizability; prospective, multicenter validation is warranted.

Introduction: Infertility represents a devastating side effect of antineoplastic agents, particularly in adolescents and young adults (AYA). A paucity of practitioner-initiated fertility preservation (FP) counseling has resulted in low uptake of assisted reproductive technologies. There is no dedicated FP program in British Columbia (BC) and few across Canada, leaving patients without adequate support. This study aimed to identify, analyze, and prioritize the FP needs of BC oncology patients, predominantly AYAs, according to healthcare providers.

Methods: An online survey developed by a multidisciplinary team was distributed to practitioners across the British Columbia Cancer Network from March to September 2023. Survey data were analyzed descriptively.

Results: Overall, our survey response rate was 74.2%. Of 120 responses recorded in total, 89 - from 27 oncologists, 58 nurses/nurse practitioners, two family physicians, one fertility specialist, and one care aide - were included in the analysis. While 43.6% of respondents indicated that their patients were likely to be impacted by treatment-related infertility, only 26.8% reported that their patients are usually referred to FP services, and 45.7% reported that their patients receive fertility counseling. Barriers to FP counseling included competing priorities, appointment length, lack of clinical knowledge, urgency to start treatment, perceived futility of FP, and perceived lack of financial resources. Facilitators of FP discussions were awareness, education, financial assistance, provider-initiated discussions, knowledgeable providers, and locally dedicated FP programs.

Conclusions: This study represents the first characterization of interdisciplinary provider practices and beliefs surrounding FP among oncology patients in BC, highlighting the need for an FP program to improve patient care and quality of life. This data can be leveraged nationwide to inform the development and evolution of FP programs for this critically underserved patient population.

Introduction: Urolithiasis is a common complication of primary hyperparathyroidism (PHPT). Parathyroidectomy has been shown to decrease the rate of stone formation. The purpose of this study was to evaluate healthcare resource utilization before and after parathyroidectomy and identify predictors of increased healthcare utilization.

Methods: A retrospective analysis of patients who had a parathyroidectomy for PHPT in Nova Scotia from 2013-2018 was performed. Data from five years before parathyroidectomy to three years after were included. Outcomes included emergency department (ED) visits and the number of urologic interventions. Random-effects Poisson regression models were used to calculate the primary outcomes, ED visits, and the number of urologic interventions while adjusting for prespecified characteristics.

Results: Fifty patients (62% female) with a mean age of 60±11 years were identified. ED visits were 0.42 per year before parathyroidectomy and 0.20 per year after in a multivariate analysis (incidence rate ratio [IRR] 0.48, confidence interval [CI] 0.25-0.91, p=0.024). There was no statistical difference between male and female ED visits (p=0.6719). There was no difference in the rate of ED visits for non-urologic reasons after parathyroidectomy (p=0.0749). The incidence of urologic intervention for stones was 1.24 per year before parathyroidectomy and 0.53 per year after (IRR 0.42, CI 0.26-0.68, p=0.0005).

Conclusions: Healthcare resource utilization, in terms of ED visits and urologic intervention, significantly decreased after parathyroidectomy. Sex showed no statistical difference in predicting healthcare utilization, while non-urologic ED visits remained the same after surgery. Expedited parathyroidectomy for PHPT patients may decrease urologic interventions and ED visits, resulting in less healthcare utilization.

Introduction: Approximately 25% of patients diagnosed with bladder cancer have muscle-invasive disease (MIBC). While real-world data have highlighted opportunities to improve curative-intent treatment rates, comprehensive population-level data in Canada are limited. This study aimed to assess patterns of care and outcomes in a real-world cohort of MIBC in Canada.

Methods: This retrospective, observational study describes baseline characteristics, treatment patterns, and overall survival (OS) of individuals with de novo MIBC diagnosed between 2010 and 2020 in Alberta, Canada. Data from adult patients with MIBC (T2-T4, N0/1, M0) were obtained from administrative databases and analyzed using basic statistics, multivariate regression analyses, and the Kaplan-Meier method.

Results: We identified 1292 patients with de novo MIBC. Of these, 76% were male with a median age of 73 years, 68% had cT2, and 76% had cN0 disease; approximately half had a Charlson comorbidity index (CCI) ≥1. Overall, 25% did not receive active treatment, while 58% received curative-intent treatment (49% underwent radical cystectomy [RC] and 9% received chemoradiotherapy), and 17% received some form of non-curative-intent treatment. Of those who underwent RC, 45% received neoadjuvant chemotherapy (NAC). Median overall survival (mOS) in the entire cohort was 2.1 years (95% confidence interval 1.9-2.4). Key predictors of inferior survival were age ≥76 years, CCI score of ≥1, T4 tumor stage, or not receiving NAC.

Conclusions: This real-world analysis highlights opportunities to improve outcomes for patients with MIBC. Increasing access to curativeintent treatments, particularly in the elderly and those with comorbidities, is likely to enhance patient care and outcomes.