Cuaj-Canadian Urological Association Journal最新文献

Introduction: This study aimed to evaluate temporal trends in the medical complexity of urologic inpatients and investigate their implications for clinical care delivery.

Methods: A retrospective comparative chart review was conducted for urologic inpatients admitted to a tertiary care center during two time periods: 2006-2007 and 2019-2020. A random sample of 150 patient charts from each cohort (N=300) was analyzed using a structured data extraction protocol in REDCap. Indicators of medical complexity included comorbidities, polypharmacy, and healthcare resource utilization. Statistical analyses comprised independent-samples t-tests, logistic regression, and multiple linear regression modeling.

Results: Analysis of 300 patient records revealed a significant increase in medical complexity in the contemporary cohort compared to the historical cohort. Patients admitted in 2019-2020 exhibited higher Charlson comorbidity index scores, a greater number of chronic conditions, and increased polypharmacy. Utilization of home care services and specialist consultations during hospitalization was also more prevalent in the contemporary cohort. Although length of stay (LOS) remained comparable between cohorts, open abdominal surgery and the number of prescription medications were significant predictors of prolonged LOS (p<0.05).

Conclusions: The medical complexity of urologic inpatients has escalated over time, driven by increased comorbid burden and healthcare system interactions. Despite advances in surgical techniques that would traditionally reduce LOS, these improvements may be counterbalanced by the growing complexity of patient populations. Interventions, such as pre-admission optimization and integrated multidisciplinary care, are essential to address the challenges posed by this evolving clinical landscape.

Introduction: Accurate staging of prostate cancer is essential for treatment planning and prognosis. While digital rectal exam (DRE) has traditionally been used, its limitations in detecting extracapsular extension (ECE) have led to increased reliance on multiparametric magnetic resonance imaging (mpMRI).

Methods: This study compared outcomes between T3 prostate cancer diagnosed by DRE vs. mpMRI only (i.e., not T3 by DRE) using data from the Alberta Prostate Cancer Research Initiative. The cohort included all 536 patients with cT3NxMx prostate cancer diagnosed between July 2014 and July 2024. The primary outcome was overall survival, with secondary outcomes including age at diagnosis, prostate-specific antigen (PSA) at diagnosis, treatment modality, Gleason grade group, and metastasis at diagnosis.

Results: Patients diagnosed as T3 by DRE were significantly older (71.6 vs. 67.9, p<0.001), had higher PSA levels (32% vs. 11% PSA >20 ng/ml, p<0.001), and higher Gleason grade groups (39% vs. 15% GG4+, p<0.001) compared to those diagnosed by mpMRI. DRE-diagnosed patients underwent radiation therapy and primary androgen deprivation therapy more frequently than MRI-diagnosed patients. DRE-diagnosed patients also had higher rates of metastases at diagnosis (16% vs. 5%, p<0.001) and worse overall survival (hazard ratio 4.6, 95% confidence interval 1.4-15.0, p=0.002).

Conclusions: T3 prostate cancer diagnosed by DRE is associated with more advanced disease, higher metastasis rates, and worse survival compared to mpMRI-diagnosed T3 disease. These findings suggest that T3 disease identified by DRE represents a more aggressive cancer subtype and should be considered higher-risk in clinical decision-making.