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.

Introduction: We aimed to assess the impact of age of the initial dextranomer/hyaluronic acid (Dx/HA) injection on the subsequent outcome, including the need for repeated injections.

Methods: The charts of patients who underwent Dx/HA injection from 2010-2020 were retrospectively reviewed. Two groups were created according to the number of Dx/HA injections: single vs. repeated injections. Patients who presented with antenatal hydronephrosis, neurogenic bladder, and followup less than one year after the first injection were excluded. Repeated Dx/HA injections were indicated in patients with documented vesicoureteric reflux (VUR) who experienced recurrent febrile urinary tract infection (fUTI) postoperatively.

Results: A total of 172 patients with 189 renal units were included; 139 (73.5%) units underwent single injections, whereas 50 (26.5%) had repeated injections. Twenty-three (48.9%) patients with repeated injections presented before the age of one year vs. 24 (51.1%) after the age of one year (p=0.02). Of the repeated group, 34 (68%) units received two injections, 14 (28%) were injected three times or more, and two (4%) had other treatment modalities. Forty-four percent of units requiring repeated injections had high-grade VUR (grades 4 and 5), compared to only 22.3% of those successfully treated with a single injection (p=0.003).

Conclusions: In our cohort, 26.5% of renal units underwent repeated Dx/HA injections. Forty-four percent of units with repeated injections had grade 4-5 VUR. Patients with VUR who were injected or presented with fUTI before the age of one year old were at higher risk of repeated injections than those who were injected or presented later.

Introduction: We conducted a budget impact analysis to evaluate the cost of removing double J catheters using single-use flexible digital cystoscopes compared to reusable cystoscopes at the CHU de Québec.

Methods: The UETMIS of CHU de Québec estimated average costs per intervention for both reusable and single-use flexible cystoscopes in the endoscopy room. Costs included purchase, repair, reprocessing, and sterilization for reusable cystoscopes based on data from 2017-2019. For single-use cystoscopes, the unit price and technical platform costs were considered. Annual costs were calculated using the average cost per procedure and the annual volume of double J catheter removals.

Results: The average cost per intervention for reusable flexible cystoscopes was estimated at $148.55, while for single-use digital flexible cystoscopes, it was $293.38. For 385 annual double J catheter removals, the total cost would be $57 191.75 with reusable cystoscopes and $112 951.30 with single-use cystoscopes. This represents an additional cost of $144.83 per procedure or $55 760 annually when using single-use cystoscopes.

Conclusions: The use of single-use flexible digital cystoscopes for double J catheter removal at CHU de Québec would nearly double the cost per procedure compared to reusable cystoscopes. This cost difference is primarily due to the purchase price of single-use devices. While cystoscope breakage is infrequent, the potential for higher breakage risk during double J catheter removal could reduce the cost differential. Future implementation of patient-focused financing might alter the economic evaluation of single-use cystoscopes.

Introduction: Low vitamin D is a possible risk factor among calcium oxalate (CaOx) stone formers, although its routine assessment and the role for supplementation remain controversial. This study aimed to examine the prevalence of low vitamin D in a large Canadian cohort and to assess the impact of replacement therapy on metabolic and radiographic outcomes.

Methods: A retrospective review of patients with CaOx stones who underwent a full metabolic evaluation, including two 24-hour urine collections in a multidisciplinary metabolic stone clinic, was conducted to determine the prevalence of 25-hydroxy vitamin D (25-OH vitamin D) deficiency/insufficiency. A subset of patients receiving vitamin D supplementation was assessed longitudinally for changes in metabolic parameters and stone growth and compared to a cohort with normal values.

Results: Among 748 patients, 64% had low vitamin D levels at baseline. These patients were more likely to be younger (53 [42.5-61] years vs. 57 [44-67], p<0.001), have a higher body mass index (BMI) (29.3 [25.7-33.3) kg/m² vs. 27.5 [24.3-31.9], p<0.001), and to be male (53.6 vs 44.4%, p=0.019). Among 83 patients receiving vitamin D with a mean followup of 4.8 years, none became hypercalcemic. Serial imaging demonstrated 41% had an increase in stone burden over time, which was not significantly different from those not requiring supplementation.

Conclusions: Low vitamin D is very common among Canadian CaOx stone formers and should be a routine part of an in-depth metabolic workup. Vitamin D administration can be safely recommended to stone formers without risk of inducing stone progression.