Cuaj-Canadian Urological Association Journal最新文献

Introduction: Urinary retention secondary to benign prostatic hyperplasia (BPH) requiring catheterization is a prevalent and morbid condition. The objective of this study was to evaluate the real-world efficacy and safety of Rezūm as the primary treatment of catheter-dependent urinary retention.

Methods: A single-center, retrospective study analyzed patients with catheter-dependent urinary retention secondary to BPH who were treated with Rezūm between April 2022 and April 2024. Standardized postoperative followup was required for inclusion. Patient demographics, medication use, volume drained at time of urinary retention, catheter-free status, complications, and postoperative International Prostate Symptom Score (IPSS) was collected.

Results: A total of 53 patients were included. Mean age was 73.4 years (standard deviation 9.4), and the mean Charlson comorbidity index score was 3.7. The baseline mean prostate volume was 81.7 (range 33-179) mL. Patients were catheter-dependent for an average of 225 (range 30- 1821) days prior to surgical intervention. Average followup time was 10.2 months. Of the 53 patients treated, 42 (79%) patients were able to become catheter-free after treatment. Twenty-six (49%) patients failed their initial trial of void at 14 days postoperatively; 11% (n=6) of patients experienced hematuria with one admitted to hospital due to hematuria/clot retention. There were no Clavien Dindo ≥3 complications. Only retention volume ≥1 L was a significant independent predictor of treatment failure on univariate and multivariate logistic regression analysis.

Conclusions: Rezūm effectively treated catheter-dependent urinary retention. Given the simplicity of treatment, accessibility, and minimal anesthetic requirements, providers should consider Rezūm to minimize indwelling catheter-related morbidity for catheter-dependant patients.

Introduction: We sought to assess the performance of the proudP AI algorithm, integrated into a mobile application, in estimating uroflow curves and parameters using recorded urination sounds.

Methods: A direct comparison was made between the peak flow rate (Qmax), voided volume, and uroflow curves predicted by the proudP algorithm and those obtained through established validation methods. A hardware uroflow simulator replicated uroflow profiles by precisely controlling water flow rates and extracting corresponding sound data. Ten uroflow profiles, representing typical patterns observed in male subjects, were selected. Simulation experiments with proudP were conducted using a standard toilet setup. The uroflow simulator was calibrated to reproduce uroflow profiles, and validation was performed against a Flowmaster uroflowmetry device. Statistical analysis included descriptive summaries, Bland-Altman analysis, and Concordance Correlation Coefficient (CCC) analysis.

Results: The proudP accurately captured various uroflow patterns generated by the simulator, with low standard deviations in Qmax predictions and biases near zero. The SDs of voided volume were slightly larger, primarily due to uroflow patterns with extended voiding times. The study validated the accuracy of proudP against in-office uroflowmetry, demonstrating robustness across different smartphone models.

Conclusions: proudP proved to be as accurate as in-office uroflowmetry in estimating uroflow rate across various patterns. Its convenience in home monitoring offers patients a means to observe their urination patterns accurately, while enabling healthcare professionals to gain detailed insights remotely. proudP emerges as an essential solution for clinical practice and urological research.

Introduction: Treatment intensification beyond androgen deprivation therapy (ADT) has shown survival benefit in patients with metastatic castration-sensitive prostate cancer (mCSPC). There is a need to better understand how these novel treatments fit in real-world practice.

Methods: Using electronic medical records and administrative data, a population-based, retrospective cohort study of patients newly diagnosed with de novo mCSPC between 2010 and 2020 in Alberta, Canada, and initiated ADT was conducted. Treatment intensification was defined as the receipt of apalutamide, abiraterone acetate, enzalutamide, or chemotherapy (e.g., docetaxel) within 180 days of ADT initiation.

Results: A total of 2515 de novo mCSPC were identified, with 2098 (83%) patients initiating ADT post-diagnosis. Of those, 525 (25%) received intensification beyond ADT. The percentage of patients who were intensified was 3% in 2010-2013 and gradually increased to 67% in 2020. From 2014-2017, docetaxel was the most commonly used approach, although it was supplanted by abiraterone acetate, apalutamide and enzalutamide from 2018 onwards. In multivariable logistic regression analyses of patients diagnosed from 2014-2020, significant predictors of intensification were younger age at diagnosis, lower Charlson comorbidity index, greater number of metastatic sites, shorter time to ADT initiation, referral to a medical oncologist, transurethral resection of the prostate or radiation prior to ADT, and more recent year of diagnosis (all p<0.05). Intensification increased for patients living in rural areas and with higher disease burden in 2018+ compared to 2014-2017.

Conclusions: There has been a considerable increase in the use of ADT intensification therapies that correspond with the timing of clinical trial data and approvals of novel agents.

Introduction: We aimed to assess the relationship between the distance traveled to receive treatment for urolithiasis and early outcomes.

Methods: This is a population-based study of patients who received interventions for urolithiasis in Ontario between 2003 and 2019 using administrative data. Patients were stratified into three groups according to the distance travelled. Descriptive statistics and the Chi-squared test were used to examine differences between these groups based on the urolithiasis treatment of choice. The primary outcomes were reoperation rates and readmission rates. To identify the factors associated with the co-primary outcomes, both univariate and multivariable logistic regression models were employed.

Results: A total of 127 195 patients were included in the final analysis, with the majority of patients (n=100 124, 78.7%) having their stone procedure within 30 km from their residence, whereas 9586 patients (7.5%) travelled a distance greater than 90 km. Most of those that travelled >90 km were for extracorporeal shock wave lithotripsy (ESWL) (59%). Type of procedure and region of residence were the only variables that appeared to have a clinically relevant association with greater distance travelled. Unadjusted analysis suggested longer distance travelled was associated with a decrease in the need for a repeat procedure; however, this was likely confounded by an association between distance traveled and procedure type. In adjusted analysis, early post-procedure health resource use did not appear to be dramatically increased with greater distance from care. Indeed, readmission rates at 30 days were marginally lower among those who travelled 30-60 km vs. <30 km (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.80-0.92, and had no detectable difference at >90 km vs. <30 km (OR 0.97, 95% CI 0.88, 1.08). These observations of fewer or no difference in readmissions and emergency visits for those that travelled the greatest distances generally held true in the subgroup analysis for each surgical procedure.

Conclusions: This population-based study found no clinically remarkable associations between the distance travelled for urolithiasis treatment and early outcomes. In fact, some marginal decreases in resource use were observed with greater travel distance perhaps reflecting some effect of travel to higher volume referral centers or enhanced processes for those that needed to travel farther for care. This information could be important for clinicians to help appropriate counselling and health systems planning.

Introduction: The purpose of this study is to evaluate YouTube content about metoidioplasty on completeness of perioperative information, actionability, understandability, degree of misinformation, quality, and presence of commercial bias.

Methods: A YouTube search for "Metoidioplasty" was conducted and the first 100 video results were watched by five independent reviewers. Videos in English <30 minutes in length were included and videos primarily showing surgical footage were excluded. Videos were evaluated between January 2022 and June 2022. Each video was evaluated for presenter demographics, channel/video statistics, and whether it covered topics including anatomy, treatment options, outcomes, procedure risks, and misinformation, and whether it had a clickbait title. Calculated scores for validated DISCERN and Patient Education Materials Assessment Tool (PEMAT) metrics were the primary outcome variables used to quantify quality, actionability, and understandability. For PEMAT, a cutoff of 75% was used to differentiate between "poor" versus "good/sufficient." Multivariate and univariate logistic regressions were performed to assess correlations among primary outcome variables and other variables.

Results: Of the 79 videos analyzed, 24% (n=19) were of high quality; 99% (n=78) had poor understandability and 100% (n=79%) had poor actionability. Patients/consumers were the most common publisher type (n=71, 90%).

Conclusions: This study demonstrates metoidioplasty content available on YouTube is not comprehensive and is of poor quality, and poor actionability and understandability, demonstrating a clear need for more relevant, accessible, comprehensible, and accurate content.

Introduction: The Canadian Urological Association's (CUA) annual meeting is the largest gathering of Canadian urologists, and many abstracts that are presented go on to be published as peer-reviewed papers. Our objective is to determine the publication rates and impact of these abstracts, and examine predictors associated with their publication.

Methods: We identified abstracts presented at the 2010, 2013, 2014, 2015, 2018, 2020, and 2021 CUA meetings, and determined if there were matching manuscripts based on author and title using a comprehensive Medline search. Standardized data was extracted. Medians and interquartile ranges are presented, and regression models were used to determine factors associated with manuscript publication, journal impact factor, and time to publication.

Results: There were 1732 CUA abstracts in our years of interest. The overall publication rate was 45.4%. Median journal impact factor was 2.27 for all published abstracts and time to publication was 13.2 months. Type of presentation was significantly associated with publication rate (p<0.001), with 63.7% of podiums, 46.7% of moderated posters, and 39.5% of unmoderated posters published. The median journal impact factor was 3.45 for published podiums, 2.19 for moderated posters, and 2.10 for unmoderated posters.

Conclusions: Approximately 45% of CUA annual meeting abstracts are eventually published. The type of presentation correlates well with both publication and impact factor, suggesting the CUA review process and scientific program committee does a good job of judging abstract quality.

Introduction: Amidst substantial surgical waitlists, novel methods are needed to improve the delivery of surgical care in Canada. One strategy involves shifting select surgeries from hospitals into community ambulatory centers, which expedite procedures and allow hospitals to prioritize critical and complex patients. We sought to evaluate surgical outcomes at a novel Canadian urologic clinic and surgical center.

Methods: A retrospective study was conducted at a novel accredited surgical facility and outpatient ambulatory clinic from August 2022 to August 2023. Procedures ranged from scrotal and transurethral surgeries to inflatable penile prosthesis insertion. Traditional outpatient procedures, including vasectomy and cystoscopy, were excluded. All patients were discharged the same day and seen 4-6 weeks post-procedure. Variables of interest included surgery type, anesthesia administered, additional clinic appointments, unplanned family physician appointments, visits to the emergency department (ED), and hospital admissions.

Results: In a 12-month period, 519 surgeries were performed. The mean patient age was 49.6±17.3 years, with most classified as American Society of Anesthesiologists (ASA) 1-2 (88.8%). Most (95.8%, n=497) patients did not require medical care outside the clinic before scheduled followup; 2.5% (n=13) visited the ED presenting for wound concerns, postoperative pain, query infection, or catheter-related concerns. Only 1.7% (n=9) required an unscheduled appointment with their family physician, with concerns being inadequate postoperative pain management (n=4) or suspected infection (n=4). No patient required hospital admission.

Conclusions: Many urologic surgeries classically performed in hospital operating rooms can be safely performed in a non-hospital, outpatient surgical facility with preservation of good outcomes. This strategy can potentially improve the efficiency of urologic healthcare delivery in select patients.