Cuaj-Canadian Urological Association Journal最新文献

Introduction: Same-day discharge (SDD) after robot-assisted radical prostatectomy (RARP) has been shown to be feasible and safe. In order to improve uptake of this ambulatory model in Canada, we aimed to update our experience of SDD after RARP and identify reasons for SDD pathway non-initiation and failure in a universal healthcare system.

Methods: A review of our prospectively collected database of patients undergoing RARP at a Canadian tertiary academic center from May 2021 to May 2023 was conducted. Binary logistic regression analysis determined predictors SDD pathway non-initiation and failure.

Results: We identified 387 patients, of which 198 were initiated on the SDD pathway. Of those initiated, 104 (52.5%) were successfully discharged home on the same day. Patients who travelled distances greater than 100 km, or who had non-CPAP (continuous positive airway pressure)-compliant obstructive sleep apnea were significantly less likely to be initiated on the SDD pathway (both p<0.05). Patients who were scheduled to be the second case or later had an estimated blood loss ≥300 mL, or had a postoperative abdominal drain, were predictive of failing SDD after initiation (all p<0.05). There were similar rates of readmissions, unscheduled office visits, and emergency department presentations, when compared to the traditional inpatient model (all p>0.05).

Conclusions: SDD after RARP in a Canadian healthcare system remains feasible and safe for selected patients. Predictors of failed SDD identified in this study inform the development of future ambulatory protocols and highlight areas of need in infrastructure to increase uptake of these outpatient pathways.

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.