Canadian Journal of Urology最新文献

Introduction: Prostate cancer is the third leading cause of death from cancer among Canadian men. High intensity focused ultrasound (HIFU) is a novel approach for primary treatment of localized prostate cancer. Little is known, however, about its costs. We aimed to collect the direct costs and health-related quality of life (HRQoL) data of HIFU in primary treatment of localized low and intermediate risk prostate cancer in Ontario.

Materials and methods: We collected direct costs and HRQoL data of 20 patients with localized low or intermediate risk prostate cancer who received whole-gland HIFU at a privately owned clinic in Ontario. We compared the direct costs of HIFU, open radical prostatectomy (ORP), robot assisted radical prostatectomy (RARP), and external beam radiation therapy (RT) in primary treatment of localized low and intermediate risk prostate cancer.

Results: The average direct costs of HIFU, ORP, RARP, and RT per case in 2023 are $14,886.78, $14,192.26, $21,794.55, and $17,377.51, respectively. The median and interquartile range (IQR) of the study participants' age and HRQoL data prior to the HIFU procedure were 64.5 (11.25) years, 94.5 (8.65), 38.5 (4), 6.0 (4.46), and 22.5 (8.32), respectively.

Conclusion: Our healthcare payer's perspective costing study revealed median direct costs per case of HIFU and favorable HRQoL outcomes compared to other treatment options for primary treatment of localized low and intermediate risk prostate cancer in Ontario. A health economic model is warranted to analyze the cost-effectiveness of HIFU compared to other treatment options in primary treatment of localized low and intermediate risk prostate cancer.

Introduction: Immune checkpoint inhibitors (ICIs) are approved for advanced urothelial cancer alone and as first-line in combination with enfortumab vedotin. Platinum based chemotherapy which is another frontline choice is often not a treatment option for older patients due to comorbidities that increase with age. Despite ICIs being better tolerated compared to traditional chemotherapy little is known about their efficacy and toxicity in patients ≥ 90 years due to the rarity of this population in clinical trials. Our objective was to analyze the efficacy and toxicity of immune checkpoint inhibitors in patients ≥ 90 years.

Materials and methods: We conducted a single center retrospective review of patients ≥ 90 years treated between July 2019 and September 2023 with standard of care ICIs for advanced urothelial cancer.

Results: Six patients treated with pembrolizumab were identified. Four (66.7%) were male and mean age was 93.5 years at the time of treatment initiation. Response rate was 66.7% (4 patients) with 3 complete responses, which were durable off therapy. Median follow up was 18.2 months. Median progression free survival (PFS) was 10.2 months [95%confidence interval (95%CI): 1.77, not reached (NR)] and median overall survival (OS) was 18.2 months (95%CI: 12.1, NR). Side effects presented in 4 (66.7%) patients and included hypothyroidism, diarrhea, anemia, thrombocytopenia, rash, and bullous dermatitis. One patient developed grade 3 anemia and no patients experienced grade 4 events or required hospitalization due to treatment side effects.

Conclusions: Our experience in a small cohort of patients ≥ 90 years indicate that ICIs are well tolerated and effective for the treatment of advanced urothelial carcinoma in this patient population.

Introduction: Interstitial cystitis/bladder pain syndrome (IC/BPS) is characterized by chronic pelvic pain and usually accompanies lower urinary tract symptoms. We have previously reported that amniotic bladder therapy (ABT) provides symptomatic improvement in refractory IC/BPS patients for up to 3 months. Herein, we evaluated the durability of ABT up to 6 months.

Materials and methods: Consecutive IC/BPS patients received intra-detrusor injections of 100 mg micronized amniotic membrane. Clinical evaluation and patient-reported outcome measurements including Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Bladder Pain/ Interstitial Cystitis Symptom Score (BPIC-SS) and Overactive Bladder Assessment Tool (OAB) were assessed.

Results: Twenty-five consecutive recalcitrant IC/BPS patients were included in the study with an average age of 47.4 ± 14.4 years (29-67 years). After ABT, the IC/BPS symptoms improved gradually up to 3 months in all patients with an average improvement in ICSI, ICPI, BPIC-SS and OAB score of 72.8%, 71.9%, and 66.6%, (p < 0.001) respectively, at 3 months. At 4 months after ABT, 7 patients experienced a rebound in symptoms and requested another injection which resulted in a significant improvement in IC/BPS symptoms after 2, 4, and 8 weeks (p < 0.01). For the 18 patients who received only one injection, the IC/BPS symptoms were still significantly lower at 5 and 6 months compared to baseline (p < 0.01), suggesting a possible durable effect based on the ICSI, ICPI, BPIC-SS, and OAB questionnaire scores.

Conclusions: ABT provided an improvement in pain and lower urinary tract symptoms up to 6 months post-treatment in some refractory IC/BPS patients.

Introduction: To define the smallest prostate needle biopsy (PNB) template necessary for accurate tissue diagnosis in men with markedly elevated PSA while decreasing procedural morbidity.

Materials and methods: We performed a chart review of 80 men presenting with a newly elevated PSA > 100 ng/mL who underwent biopsy (PNB or metastatic site). For patients who underwent a full 12-core biopsy, simulated templates of 2- to 10-cores were generated by randomly drawing subsets of biopsies from their full-template findings. Templates were iterated to randomize core location and generate theoretical smaller template outcomes. Simulated biopsy results were compared to full-template findings to determine accuracy to maximal Grade Group (GG) diagnosis.

Results: Amongst those that underwent PNB, 93% had GG 4 or 5 disease. Twenty-two (40%) underwent a full 12-core biopsy, 20 (37%) a 6-core biopsy, and only 8 (15%) had fewer than six biopsy cores sampled at our hospital. Simulated templates with 2-, 4-, 6-, and 8-cores correctly diagnosed prostate cancer in all patients, and accurately identified the maximal GG in 82%, 91%, 95%, and 97% of patients, respectively. The biopsy locations most likely to detect maximal GG were medial mid and base sites bilaterally. A 4-core template of these sites would have accurately detected the maximal GG in 95% of patients relative to a full 12-core template.

Conclusions: In men presenting with PSA > 100 ng/mL, decreasing from a 12-core to a 4-core prostate biopsy template results in universal cancer detection and minimal under-grading while theoretically decreasing procedural morbidity and cost.

Urethral injuries are rare among the pediatric population, and the majority occur after trauma. This is the case of an eight-year-old female with complete proximal urethral disruption and ruptured bladder neck without pelvic fracture after a motor vehicle crash. After the accident, her bladder neck was reapproximated and a suprapubic tube was placed. Three months later, she underwent reconstruction for a bladder neck closure and appendicovesicostomy. In managing these patients, focus should first be directed at achieving a safe means of urinary drainage, and next to repair the lower urinary tract to maximize continence and minimize complications.

Holmium enucleation of the prostate (HoLEP) is a gold-standard, size-independent surgical treatment for benign prostatic hyperplasia (BPH) distinguished for its efficacy in tissue removal, shorter catheterization durations, lower transfusion rates, and decreased hospital stays when compared to transurethral resection of the prostate (TURP). The objective of this article is to demonstrate the step-by-step procedure of holmium laser cystolitholapaxy and enucleation of the prostate for BPH, emphasizing a top-down modified two-lobe technique with early apical release which enhances visualization and irrigation flow during the enucleation process.