Cuaj-Canadian Urological Association Journal最新文献

Introduction: This study aimed to evaluate the cost-effectiveness of the Prostate Cancer Patient Empowerment Program (PC-PEP), a six-month comprehensive intervention designed to enhance psychological well-being and reduce healthcare expenditures among prostate cancer patients.

Methods: In a crossover randomized clinical trial of 128 men aged 50-82 years scheduled for curative prostate cancer surgery or radiotherapy (± hormone treatment), 66 men received the PC-PEP intervention immediately, while 62 were randomized to a waitlist control arm and received standard care for six months before receiving PC-PEP. The intervention included daily activities targeting physical fitness, pelvic floor training, stress management, intimacy, social support, and dietary guidance. Cost-effectiveness was assessed from a healthcare payer perspective using billing data from Nova Scotia's Medical Services Insurance (MSI) and self-reported outcomes. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) were calculated using bootstrapped samples. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10), while quality-adjusted life years (QALYs) were estimated from SF-6D utility scores.

Results: PC-PEP resulted in cost savings of $411.53 CAD per patient at six months, with a 30% reduction in clinically significant psychological distress and a QALY gain of 0.013. At 12 months, savings increased to $660.89 CAD per patient, preventing 31% of distress cases and yielding a QALY gain of 0.034. These outcomes demonstrate that PC-PEP is a dominant intervention, achieving both improved clinical outcomes and reduced healthcare expenditures.

Conclusions: PC-PEP is a dominant, cost-effective strategy that significantly improves psychological well-being while lowering healthcare costs. Early implementation following prostate cancer diagnosis is strongly recommended to maximize both clinical and economic benefits.

Metastatic castration-resistant prostate cancer (mCRPC) is incurable, with tumors often relapsing after initial treatment and patients requiring subsequent lines of therapy. As the use of androgen receptor pathway inhibitors (ARPIs), with or without docetaxel, prior to the development of castration-resistant disease is increasing, the number of subsequent therapy options for mCRPC is limited.Poly (ADP-ribose) polymerase (PARP) inhibitors are one treatment option approved in Canada for patients with mCRPC and mutations in BRCA1/BRCA2 or other homologous recombination repair (HRR) genes. PARP inhibitors are generally well-tolerated but are associated with high rates of anemia. This can be difficult to manage in mCRPC, as common disease and patient characteristics, as well as prior therapy, also contribute to an increased risk of anemia. Appropriate management of anemia is important for maintaining quality of life; however, there is a paucity of data and guidelines to inform clinicians on how to best prevent and manage anemia associated with PARP inhibitor use in mCRPC.This narrative review and expert opinion provides key strategies for managing anemia related to PARP inhibitor use in mCRPC through prevention, monitoring, and supportive care.

Introduction: We aimed to evaluate whether generative large language models (LLMs) can accurately assess the methodologic quality of systematic reviews (SRs).

Methods: A total of 114 SRs from five leading urology journals were included in the study. Human reviewers graded each of the SRs in duplicate, with differences adjudicated by a third expert. We created a customized generative artificial intelligence (generative pre-trained transformer [GPT]), "Urology AMSTAR 2 Quality Assessor," and graded the 114 SRs in three iterations using a zero-shot method. We performed an enhanced trial focusing on critical criteria by giving GPT detailed, step-by-step instructions for each of the SRs using chain-of-thought method. Accuracy, sensitivity, specificity, and F1 score for each GPT trial were calculated against human results. Internal validity among three trials were computed.

Results: GPT had an overall congruence of 75%, with 77% in critical criteria and 73% in non-critical criteria when compared to human results. The average F1 score was 0.66. There was a high internal validity at 85% among three iterations. GPT accurately assigned 89% of studies into the correct overall category. When given specific, step-by-step instructions, congruence of critical criteria improved to 91%, and overall quality assessment accuracy to 93%.

Conclusions: GPT showed promising ability to efficiently and accurately assess the quality of SRs in urology.

Introduction: In patients with prostate cancer (PCa), the impact of extended pelvic lymph node dissection (E-PLND) during radical prostatectomy (RP) on oncologic outcomes remains controversial. This study examined the association between extended vs. standard PLND (S-PLND) and biochemical recurrence (BCR), an early outcome, as well as metastatic PCa (mPCa), and castration-resistant PCa (CRPC) development, late outcomes, in a multi-institutional cohort.

Methods: High-risk post-RP patients from a Canadian PCa database were analyzed from January 1, 2005, to December 31, 2016. The association between PLND and BCR, mPCa, and CRPC development and complication rate was examined using regression and correlation analysis.

Results: Data were collected from patients who underwent S-PLND (n=494) and E-PLND (n=107). The median followup was 40.1 months, and time to BCR, mPC, and CRPC development was 9.8, 46.0, and 52.1 months, respectively. The median (interquartile range) number of lymph nodes extirpated was 7 (7) and 14 (11) for the S-PLND and E-PLND groups, respectively. E-PLND was associated with increased intraoperative blood loss and higher postoperative complication rate. There were no differences in BCR-free survival based on PLND approach, with 67.1% of S-PLND cases and 71.1% of E-PLND cases reaching BCR-free survival at the end of the followup period (hazard ratio [HR] 0.784 [0.506, 1.215], p=0.28). PLND extent was not a predictor for mPCa progression (p=0.963). Similarly, there were no differences in CRPC-free survival based on dissection type (S-PLND 90.9% vs. E-PLND 89.1%, p=0.561). Lymph node positivity was predictive of BCR, mPCa, and CRPC progression.

Conclusions: E-PLND did not show significant differences in the rates of BCR, mPCa, or CRPC progression when compared to S-PLND. E-PLND was associated with higher complication rates. This study adds to the data exploring the association between PLND and PCa oncologic outcomes.

Muscle-invasive bladder cancer is a common malignancy, and its standard of care treatment often involves neoadjuvant chemotherapy and radical cystectomy. These treatments are invasive and associated with significant mortality and morbidity. Neoadjuvant chemotherapy is associated with skeletal muscle atrophy and reduced body mass, while radical cystectomy is associated with high-risk blood loss necessitating blood transfusion.Despite an established relationship between androgens and prostate cancer, it is unclear whether androgens impact other types of cancer, including bladder cancer. In fact, decades of research on the relationship between anti-androgens and cancer prevention/treatment have provided conflicting or inconclusive results. Preoperative testosterone could prevent surgery-related skeletal muscle atrophy and help maintain normal hematocrit levels. Preoperative testosterone is an inexpensive and feasible intervention and seems to improve postoperative recovery with minimal adverse effects in different patient populations.To date, no clinical trial has been conducted evaluating preoperative testosterone in bladder cancer patients. In this review, we present a rationale for the use of preoperative testosterone in bladder cancer patients, which we believe may serve as the basis for the development of a future clinical trial.

Introduction: Penile prosthesis implantation is a well-established treatment for refractory erectile dysfunction; however, significant variations exist in surgical techniques and practice patterns, often influenced by individual surgeon experience and training. Our study aimed to identify these variations among Canadian implanters, assessing their approach to penile prosthesis surgery.

Methods: A cross-sectional, questionnaire-based study was conducted to evaluate the practice patterns of Canadian surgeons performing penile prosthesis implantation. The study included implanters from all provinces who perform more than five cases annually. An anonymous electronic survey was distributed, assessing practice patterns, surgical approach, and recommendations for improving penile prosthesis surgery in Canada.

Results: Seventeen Canadian urologists performing over five annual cases participated in the study, with the annual volume varying among respondents. The majority (88.2%, n=15) routinely checked HbA1c levels, with 54.5% (n=6) using a cutoff of 8%. Additionally, 58.8% (n=10) routinely ordered a urine culture, and 94.1% (n=16) performed a preoperative scrub. Just over half (52.9%, n=9) prescribed preoperative antibiotics, the majority (88.2%, n=15) used an antibiotic dip, and postoperatively, 94.1% (n=16) of respondents prescribed antibiotics. Most implanters (76.5%, n=13) primarily used a penoscrotal approach, and 47.1% (n=8) did not routinely place a drain. Respondents also indicated perceived ways to improve penile prosthesis education across Canada, focusing on patient education and surgical simulation.

Conclusions: While key aspects, such as the ideal surgical approach, HbA1c cutoffs, antibiotic regimens, and intraoperative techniques, remain debated, our findings underscore the need for further standardization. High-quality educational resources and consensus guidelines could help implanters refine their practice and improve patient outcomes.

Introduction: We aimed to assess the association between stent placement during ureteral reimplantation for vesicoureteral reflux (VUR) and short-term postoperative outcomes.

Methods: We conducted a retrospective analysis of National Surgical Quality Improvement Program-Pediatrics (NSQIP-P). Independent variables included stent placement, age, sex, urologic comorbidity, prior VUR procedures, severity of reflux, preoperative urinary tract infections (UTIs), American Society of Anesthesiologists (ASA) classification, and operative approach. Outcomes of interest were emergency department (ED) visits, operative time, readmissions, unplanned operations, length of hospital stay (LOS), and postoperative UTIs. Descriptive statistics were performed, and Chi-squared and Mann-Whitney U tests were used for univariate analysis. For multivariate analyses, logistic regression, linear regression, and negative binomial models were applied.

Results: A total of 4550 patients were identified (median age 47.36 months, 68.7% female, 48.8% stented). In multivariate analyses, ureteral stenting was significantly associated with higher rates of ED visits (p=0.0019), related readmissions (p<0.0001), and postoperative UTIs (p<0.0001). The expected length of hospitalization for the stent group was 37% longer than for the non-stent group (p<0.0001), and the operative time was, on average, 31 minutes longer (p<0.0001).

Conclusions: This study reveals an association between ureteral stenting and short-term adverse postoperative outcomes following ureteral reimplantation for VUR. Consideration should be given to the selective use of stents at the time of ureteral reimplantation for VUR. There are limitations to the study due to the absence of some surgical data in the database, such as type of reimplant, long-term success rate, and type of stent used.

Introduction: Water vapor thermal therapy (WVTT), Rezūm, is a minimally invasive therapy that uses water vapor to ablate benign prostatic tissue. This study aimed to present the prospective, multicenter outcomes of the largest cohort of prostates ≥80 mL treated with Rezūm.

Methods: This study involved a prospective, WVTT registry that collated information from two high-volume centers between April 2019 and August 2024. Baseline medical histories, uroflowmetry (peak flow rate [Qmax], postvoid residual [PVR], and validated questionnaires (International Prostate Symptom Score [IPSS], IPSS quality of life (QoL), Benign Prostatic Hyperplasia Impact Index [BPHII], International Index of Erectile Function [IIEF-15], Male Sexual Health Questionnaire for Ejaculatory Dysfunction [MSHQ-EjD]) were recorded. The main outcomes assessed included symptom scores, functional improvement, and safety at baseline, six, 12, and 24 months.

Results: A total of 259 patients with a prostate volume ≥80 mL were treated with Rezūm. The median prostate volume was 105 mL, with 207 patients (81.2%) exhibiting a median lobe. The IPSS improved from 21.8 at baseline to 5.7 at 24 months. The IPSS QoL score improved from 4.5 at baseline to 1.1 at 24 months. At baseline, the Qmax rate was 8.2 mL/s, increasing to 14.9 mL/s at 24 months. PVR volume decreased from 132.5 mL at baseline to 90 mL at 24 months. The BPHII decreased from 7.5 at baseline to 2.3 at 24 months. There was no significant change in sexual function as measured by IIEF and MSHQ.

Conclusions: Rezūm therapy is a safe, effective, and minimally invasive option for managing large prostates (≥80 mL), providing significant and sustained improvements in urinary symptoms with minimal impact on sexual function.