Leo D. Dreyfuss, Farnoosh Nik-Ahd, Lufan Wang, Abigail Shatkin-Margolis, Kenneth Covinsky, W. John Boscardin, Anne M. Suskind
Objectives
To determine predictors of treatment success and complications following intradetrusor onabotulinumtoxinA injections among a large cohort of nursing home (NH) residents, representing one of the most frail and vulnerable populations in the United States.
Materials and methods
This is a retrospective cohort study of long-stay NH residents who underwent onabotulinumtoxinA injections between 2014 and 2016. Residents were identified using the Minimum Data Set (MDS) linked to Medicare claims. Frailty was measured using the Claims-based Frailty Index and socioeconomic status using the Area Deprivation Index (ADI; higher ADI = increasing social deprivation). The primary outcome was treatment success, defined as repeat onabotulinumtoxinA injection within 1 year of index injection. Secondary outcomes included 30-day complications and urinary retention, defined as new indwelling urinary catheters identified on the MDS at 3 months.
Results
OnabotulinumtoxinA injections were performed in 1683 NH residents. Mean age was 78.2 years, 74% were female and 22.8% had an indwelling urinary catheter at baseline. A total of 38.4% of residents had ≥1 30-day complication and 14.6% had a new catheter at 3 months. Repeat injections were performed in 34.3% of residents within 1 year. Repeat injections were more likely among residents who were female [adjusted relative risk (aRR) 1.29; 95% CI 1.08–1.54] and who had a baseline catheter (aRR 1.30; 95% CI 1.11–1.52). Residents who were ≥85 years (aRR 0.78; 95% CI 0.64–0.96) and those in the lowest quartile ADI (aRR 0.75; 95% CI 0.61–0.93) were less likely to undergo repeat injections.
Conclusion
Among this population of NH residents, who are by definition frail and comorbid, rates of repeat onabotulinumtoxinA injections are comparable to retrospective analyses of younger adults and independent of frailty and comorbidity. Based on these findings, surgeons should consider the entire clinical picture when evaluating patients for onabotulinumtoxinA injections and should not necessarily exclude those who are frail or comorbid from this potentially quality-of-life-improving therapy.
{"title":"Outcomes following intradetrusor onabotulinumtoxinA in a national cohort of nursing home residents","authors":"Leo D. Dreyfuss, Farnoosh Nik-Ahd, Lufan Wang, Abigail Shatkin-Margolis, Kenneth Covinsky, W. John Boscardin, Anne M. Suskind","doi":"10.1002/bco2.472","DOIUrl":"10.1002/bco2.472","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To determine predictors of treatment success and complications following intradetrusor onabotulinumtoxinA injections among a large cohort of nursing home (NH) residents, representing one of the most frail and vulnerable populations in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>This is a retrospective cohort study of long-stay NH residents who underwent onabotulinumtoxinA injections between 2014 and 2016. Residents were identified using the Minimum Data Set (MDS) linked to Medicare claims. Frailty was measured using the Claims-based Frailty Index and socioeconomic status using the Area Deprivation Index (ADI; higher ADI = increasing social deprivation). The primary outcome was treatment success, defined as repeat onabotulinumtoxinA injection within 1 year of index injection. Secondary outcomes included 30-day complications and urinary retention, defined as new indwelling urinary catheters identified on the MDS at 3 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>OnabotulinumtoxinA injections were performed in 1683 NH residents. Mean age was 78.2 years, 74% were female and 22.8% had an indwelling urinary catheter at baseline. A total of 38.4% of residents had ≥1 30-day complication and 14.6% had a new catheter at 3 months. Repeat injections were performed in 34.3% of residents within 1 year. Repeat injections were more likely among residents who were female [adjusted relative risk (aRR) 1.29; 95% CI 1.08–1.54] and who had a baseline catheter (aRR 1.30; 95% CI 1.11–1.52). Residents who were ≥85 years (aRR 0.78; 95% CI 0.64–0.96) and those in the lowest quartile ADI (aRR 0.75; 95% CI 0.61–0.93) were less likely to undergo repeat injections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among this population of NH residents, who are by definition frail and comorbid, rates of repeat onabotulinumtoxinA injections are comparable to retrospective analyses of younger adults and independent of frailty and comorbidity. Based on these findings, surgeons should consider the entire clinical picture when evaluating patients for onabotulinumtoxinA injections and should not necessarily exclude those who are frail or comorbid from this potentially quality-of-life-improving therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wayne G. Brisbane, Alan M. Priester, Anissa V. Nguyen, Mark Topoozian, Sakina Mota, Merdie K. Delfin, Samantha Gonzalez, Kyla P. Grunden, Shannon Richardson, Shyam Natarajan, Leonard S. Marks
Objectives
The aim of this study is to evaluate new software (Unfold AI) in the estimation of prostate tumour volume (TV) and prediction of focal therapy outcomes.
Subjects/patients and methods
Subjects were 204 men with prostate cancer (PCa) of grade groups 2–4 (GG ≥ 2), who were enrolled in a trial of partial gland cryoablation (PGA) at UCLA from 2017 to 2022. Magnetic resonance imaging (MRI)-guided biopsy (MRGB) was performed at diagnosis and at 6 and 18 months following PGA. Utilising Unfold AI (FDA-cleared 2022), which generates a 3D map of GG ≥ 2 PCa margins, we retrospectively estimated TV for each patient. TV was compared against conventional baseline variables as a correlate of a successful primary outcome—defined here as the absence of GG ≥ 2 on follow-up MRGB at 6 months. Secondary outcomes were MRGB at 18 months and failure-free survival, that is, lack of metastasis or salvage whole gland therapy. Receiver operating curves and multivariate analysis were used to determine significance.
Results
A successful primary outcome was observed in 77.7% of patients. Significant correlates of a successful ablation were percent pattern 4 and TV; areas under the curve (AUCs) were 0.60 and 0.73, respectively. GG was not a correlate of success (AUC = 0.51). A TV of 1.5 cc provided the optimal combination of sensitivity (55.8%) and specificity (85.7%) at 6 months. TV was also significantly associated with secondary outcomes. In multivariate analysis, TV was the variable most associated with 6- and 18-month biopsy success (adjusted odds ratios [aORs] were 6.1 and 4.2). Utilising TV ≤ 1.5 cc as a PGA criterion would have prevented 72% of failures at the cost of 42% of successes.
Conclusion
The AI-based software Unfold AI estimates TV, which is significantly associated with biopsy outcomes after focal cryoablation. The rate of treatment success is inversely related to TV.
{"title":"Focal therapy of prostate cancer: Use of artificial intelligence to define tumour volume and predict treatment outcomes","authors":"Wayne G. Brisbane, Alan M. Priester, Anissa V. Nguyen, Mark Topoozian, Sakina Mota, Merdie K. Delfin, Samantha Gonzalez, Kyla P. Grunden, Shannon Richardson, Shyam Natarajan, Leonard S. Marks","doi":"10.1002/bco2.456","DOIUrl":"10.1002/bco2.456","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim of this study is to evaluate new software (Unfold AI) in the estimation of prostate tumour volume (TV) and prediction of focal therapy outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects/patients and methods</h3>\u0000 \u0000 <p>Subjects were 204 men with prostate cancer (PCa) of grade groups 2–4 (GG ≥ 2), who were enrolled in a trial of partial gland cryoablation (PGA) at UCLA from 2017 to 2022. Magnetic resonance imaging (MRI)-guided biopsy (MRGB) was performed at diagnosis and at 6 and 18 months following PGA. Utilising Unfold AI (FDA-cleared 2022), which generates a 3D map of GG ≥ 2 PCa margins, we retrospectively estimated TV for each patient. TV was compared against conventional baseline variables as a correlate of a successful primary outcome—defined here as the absence of GG ≥ 2 on follow-up MRGB at 6 months. Secondary outcomes were MRGB at 18 months and failure-free survival, that is, lack of metastasis or salvage whole gland therapy. Receiver operating curves and multivariate analysis were used to determine significance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A successful primary outcome was observed in 77.7% of patients. Significant correlates of a successful ablation were percent pattern 4 and TV; areas under the curve (AUCs) were 0.60 and 0.73, respectively. GG was not a correlate of success (AUC = 0.51). A TV of 1.5 cc provided the optimal combination of sensitivity (55.8%) and specificity (85.7%) at 6 months. TV was also significantly associated with secondary outcomes. In multivariate analysis, TV was the variable most associated with 6- and 18-month biopsy success (adjusted odds ratios [aORs] were 6.1 and 4.2). Utilising TV ≤ 1.5 cc as a PGA criterion would have prevented 72% of failures at the cost of 42% of successes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The AI-based software Unfold AI estimates TV, which is significantly associated with biopsy outcomes after focal cryoablation. The rate of treatment success is inversely related to TV.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anthony Emmanuel, Abi Kanthabalan, Cameron Alexander, Nikita Bhatt, Vinson Chan, Odunayo Kalejaiye, Krishna Narahari, Veeru Kasivisvanathan, Majed Shabbir
Objectives
This study aimed to assess current international clinician practices, attitudes and barriers related to testicular prosthesis implantation in patients with testicular cancer at the time of radical inguinal orchidectomy.
Methods
An international online survey of urologists who perform radical orchidectomy for testicular cancer was developed. The recruitment process used social media and the emailing lists of national urological societies. Responses were collected between 10 February 2021 and 31 May 2021. The primary outcome was the proportion of urologists who always offered testicular prosthesis implantation to patients undergoing radical orchidectomy. Secondary outcomes included the reasons for not offering testicular prosthesis implantation.
Results
A total of 393 respondents took part in the online survey; of these, the majority were from the UK (66%), with the remaining international respondents (34%) from six different continents. Urologists (53%) reported they always offer testicular prosthesis implantation. Of those that offered testicular prosthesis implantation, 28% did so as a secondary procedure after radical orchidectomy, rather than the time of radical orchidectomy (72%). The most frequently selected reasons for not offering testicular prosthesis implantation included concerns about delaying chemotherapy (41%), infection (33%), impaired cosmesis (17%) and lack of availability (17%).
Conclusion
Despite evidence confirming the safety and the psychological benefit of testicular prosthesis implantation during radical orchidectomy, current international practice suggests just over half of urologists always offer this to their patients. Increased clinician awareness of the low risk of complications and high patient satisfaction may act to reduce the perceived barriers in offering testicular prosthesis implantation.
{"title":"Current attitudes to testicular prosthesis insertion during radical orchidectomy—An international perspective","authors":"Anthony Emmanuel, Abi Kanthabalan, Cameron Alexander, Nikita Bhatt, Vinson Chan, Odunayo Kalejaiye, Krishna Narahari, Veeru Kasivisvanathan, Majed Shabbir","doi":"10.1002/bco2.465","DOIUrl":"10.1002/bco2.465","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to assess current international clinician practices, attitudes and barriers related to testicular prosthesis implantation in patients with testicular cancer at the time of radical inguinal orchidectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An international online survey of urologists who perform radical orchidectomy for testicular cancer was developed. The recruitment process used social media and the emailing lists of national urological societies. Responses were collected between 10 February 2021 and 31 May 2021. The primary outcome was the proportion of urologists who always offered testicular prosthesis implantation to patients undergoing radical orchidectomy. Secondary outcomes included the reasons for not offering testicular prosthesis implantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 393 respondents took part in the online survey; of these, the majority were from the UK (66%), with the remaining international respondents (34%) from six different continents. Urologists (53%) reported they always offer testicular prosthesis implantation. Of those that offered testicular prosthesis implantation, 28% did so as a secondary procedure after radical orchidectomy, rather than the time of radical orchidectomy (72%). The most frequently selected reasons for not offering testicular prosthesis implantation included concerns about delaying chemotherapy (41%), infection (33%), impaired cosmesis (17%) and lack of availability (17%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite evidence confirming the safety and the psychological benefit of testicular prosthesis implantation during radical orchidectomy, current international practice suggests just over half of urologists always offer this to their patients. Increased clinician awareness of the low risk of complications and high patient satisfaction may act to reduce the perceived barriers in offering testicular prosthesis implantation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Takashi Yoshioka, Kenji Omae, Satoshi Funada, Tetsuji Minami, Rei Goto
Objectives
To determine the health utility values (HUVs) of overactive bladder (OAB), defined as urinary urgency, usually accompanied by urinary daytime or nocturnal frequency, with or without urinary incontinence, among adults aged ≥65 years and to assess the HUV decrements (disutilities) of OAB according to its severity.
Methods
This cross-sectional Internet-based study was conducted between 2 and 9 November 2023, with quota sampling with equal probability for each sex and age group (age 65–74 years and ≥75 years). OAB was defined as an urgency score of ≥2 points and a total score of ≥3 points based on the Overactive Bladder Symptom Score. OAB severity was categorized as mild (total score, ≤5 points) or moderate-to-severe (total score, 6–15 points). HUVs were measured using the EuroQol five-dimension five-level value set for the Japanese population. Multivariable linear regression models were fitted to estimate the covariate-adjusted disutilities of OAB. We selected eight covariates (age, sex, body mass index, education, income, smoking, alcohol use, and comorbidities) as potential confounders based on previous studies. The sample size was determined based on previous studies without statistical power calculations.
Results
Among the 998 participants (51.9% male; mean age, 73.2 years), 158 (15.9%) had OAB, of whom 87 (8.8%) had moderate-to-severe OAB. The mean HUVs for participants with mild and moderate-to-severe OAB were 0.874 and 0.840, respectively, which were lower compared with the HUV for those without OAB (0.913). After adjusting for relevant covariates, disutilities (95% confidence intervals [CIs] and p values) for mild and moderate-to-severe OAB were −0.0334 (−0.0602 to −0.0066, p = 0.014) and −0.0591 (−0.0844 to −0.0339, p < 0.001), respectively.
Conclusions
Consistent with previous HUV studies on OAB, our results demonstrated that the prevalence of OAB was associated with substantially lower HUV. The results demonstrate that increased OAB severity is associated with greater disutility.
{"title":"Health utility value of overactive bladder in Japanese older adults","authors":"Takashi Yoshioka, Kenji Omae, Satoshi Funada, Tetsuji Minami, Rei Goto","doi":"10.1002/bco2.471","DOIUrl":"10.1002/bco2.471","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To determine the health utility values (HUVs) of overactive bladder (OAB), defined as urinary urgency, usually accompanied by urinary daytime or nocturnal frequency, with or without urinary incontinence, among adults aged ≥65 years and to assess the HUV decrements (disutilities) of OAB according to its severity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional Internet-based study was conducted between 2 and 9 November 2023, with quota sampling with equal probability for each sex and age group (age 65–74 years and ≥75 years). OAB was defined as an urgency score of ≥2 points and a total score of ≥3 points based on the Overactive Bladder Symptom Score. OAB severity was categorized as mild (total score, ≤5 points) or moderate-to-severe (total score, 6–15 points). HUVs were measured using the EuroQol five-dimension five-level value set for the Japanese population. Multivariable linear regression models were fitted to estimate the covariate-adjusted disutilities of OAB. We selected eight covariates (age, sex, body mass index, education, income, smoking, alcohol use, and comorbidities) as potential confounders based on previous studies. The sample size was determined based on previous studies without statistical power calculations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 998 participants (51.9% male; mean age, 73.2 years), 158 (15.9%) had OAB, of whom 87 (8.8%) had moderate-to-severe OAB. The mean HUVs for participants with mild and moderate-to-severe OAB were 0.874 and 0.840, respectively, which were lower compared with the HUV for those without OAB (0.913). After adjusting for relevant covariates, disutilities (95% confidence intervals [CIs] and <i>p</i> values) for mild and moderate-to-severe OAB were −0.0334 (−0.0602 to −0.0066, <i>p</i> = 0.014) and −0.0591 (−0.0844 to −0.0339, <i>p</i> < 0.001), respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Consistent with previous HUV studies on OAB, our results demonstrated that the prevalence of OAB was associated with substantially lower HUV. The results demonstrate that increased OAB severity is associated with greater disutility.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Frances Harley, Rasa Ruseckaite, Eva Fong, Henry Han-I Yao, Hashim Hashim, Helen E. O'Connell
Objectives
This study aims to define criteria for robotic reconstructive and functional urology credentialing using expert consensus. A recent narrative review identified a lack of standardised minimal requirements for performing robotic-assisted surgery procedures. The substantial variability or absence of a standardised curriculum and credentialing process within a highly specialised surgical field is often insufficient to guarantee surgeon proficiency and could potentially jeopardise patient safety.
Subjects and Methods
Thirty-five international robotic surgery experts in urology and urogynaecology, selected based on surgical and research expertise, were invited to participate as expert panellists. Using a modified Delphi process the experts were asked to indicate their agreement with the proposed list of recommendations that was identified from the literature and review of relevant international credentialing policies in three electronic survey rounds.
Results
Fourteen experts participated in round 1 of online surveys, 9 in round 2 and 13 in round 3. From 50 statements presented to the Delphi panel in round 1, a total of 39 recommendations (32 from round 1, 4 from round 2 and 3 from round 3) with median importance (MI) ≥ 7 and disagreement index (DI) < 1 were proposed for inclusion into the final draft set and were reviewed by the project team. Panellists agreed reconstructive and functional urology required its own specific modular training curriculum as the foundation for robotic training and a surgeon must have appropriate training i.e., fellowship or evidence of speciality training in functional urology.
Conclusions
This was the first study to develop preliminary guidelines on credentialing for robotic surgery in reconstructive and functional urology. A Delphi approach was employed to establish comprehensive credentialing criteria for robotic-assisted surgery. The consistent adoption of these criteria across institutions will foster the proficiency of robotic surgeons and has the potential to bring improvements in patient outcomes.
{"title":"Guidelines for robotic credentialling in reconstructive and functional urology. Consensus study","authors":"Frances Harley, Rasa Ruseckaite, Eva Fong, Henry Han-I Yao, Hashim Hashim, Helen E. O'Connell","doi":"10.1002/bco2.467","DOIUrl":"10.1002/bco2.467","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aims to define criteria for robotic reconstructive and functional urology credentialing using expert consensus. A recent narrative review identified a lack of standardised minimal requirements for performing robotic-assisted surgery procedures. The substantial variability or absence of a standardised curriculum and credentialing process within a highly specialised surgical field is often insufficient to guarantee surgeon proficiency and could potentially jeopardise patient safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects and Methods</h3>\u0000 \u0000 <p>Thirty-five international robotic surgery experts in urology and urogynaecology, selected based on surgical and research expertise, were invited to participate as expert panellists. Using a modified Delphi process the experts were asked to indicate their agreement with the proposed list of recommendations that was identified from the literature and review of relevant international credentialing policies in three electronic survey rounds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fourteen experts participated in round 1 of online surveys, 9 in round 2 and 13 in round 3. From 50 statements presented to the Delphi panel in round 1, a total of 39 recommendations (32 from round 1, 4 from round 2 and 3 from round 3) with median importance (MI) ≥ 7 and disagreement index (DI) < 1 were proposed for inclusion into the final draft set and were reviewed by the project team. Panellists agreed reconstructive and functional urology required its own specific modular training curriculum as the foundation for robotic training and a surgeon must have appropriate training i.e., fellowship or evidence of speciality training in functional urology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This was the first study to develop preliminary guidelines on credentialing for robotic surgery in reconstructive and functional urology. A Delphi approach was employed to establish comprehensive credentialing criteria for robotic-assisted surgery. The consistent adoption of these criteria across institutions will foster the proficiency of robotic surgeons and has the potential to bring improvements in patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Keith R. S. Simpson, Jamie Krishnan, Linda Taylor, Alan McNeill, Daniel W. Good
Objectives
This study aimed to assess the impact of anterior hood-sparing robot-assisted radical prostatectomy (RARP) with posterior-anterior reconstruction in a single-surgeon series by analysing oncological and functional continence outcomes.
Patients and Methods
We carried out a cohort comparison study of a prospectively collected single-surgeon series. The surgeon was an ‘in-training’ fellowship trained surgeon in their first 2 years of independent practice. There were three cohorts identified from electronic and scanned paper operation notes. The first cohort of standard anterior RARP (no hood sparing) included initial patients and any patient in the consecutive series who had completed 3 month FU after RARP. The second cohort was hemi-hood-sparing RARP again within the consecutive database of patients and lastly full-hood-sparing RARP. Early continence was defined by patients reporting being ‘dry’ and with 0 pad or 1 confidence/security pad. Data was collected in an Excel spreadsheet, and SPSS was used to assess distribution with non-parametric data being analysed using a Mann Whitney U test and parametric data with an unpaired t-test.
Results
We identified 174 patients from March 2020 to February 2022 who were operated on. Full pathology and 6-week follow-up pad use data was available for all patients. At 12 months, some data for EPIC-26 was not available (lack of response/clinic non-attendance). The results demonstrate doubling in early continence to over 75% at 6-week follow-up with comparable positive margin rates. This difference was statistically significantly better in the dorsal venous complex RARP sparing group in comparison to standard RARP (p < 0.001).
Conclusion
Anterior hood-sparing RARP with anterior reconstruction is a modification to the standard anterior RARP approach with a short learning curve which provides patients with better early and late continence without compromise to oncological outcomes.
{"title":"The learning curve for hood-sparing robotic-assisted radical prostatectomy: A single-surgeon experience","authors":"Keith R. S. Simpson, Jamie Krishnan, Linda Taylor, Alan McNeill, Daniel W. Good","doi":"10.1002/bco2.463","DOIUrl":"10.1002/bco2.463","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to assess the impact of anterior hood-sparing robot-assisted radical prostatectomy (RARP) with posterior-anterior reconstruction in a single-surgeon series by analysing oncological and functional continence outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We carried out a cohort comparison study of a prospectively collected single-surgeon series. The surgeon was an ‘in-training’ fellowship trained surgeon in their first 2 years of independent practice. There were three cohorts identified from electronic and scanned paper operation notes. The first cohort of standard anterior RARP (no hood sparing) included initial patients and any patient in the consecutive series who had completed 3 month FU after RARP. The second cohort was hemi-hood-sparing RARP again within the consecutive database of patients and lastly full-hood-sparing RARP. Early continence was defined by patients reporting being ‘dry’ and with 0 pad or 1 confidence/security pad. Data was collected in an Excel spreadsheet, and SPSS was used to assess distribution with non-parametric data being analysed using a Mann Whitney <i>U</i> test and parametric data with an unpaired <i>t</i>-test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 174 patients from March 2020 to February 2022 who were operated on. Full pathology and 6-week follow-up pad use data was available for all patients. At 12 months, some data for EPIC-26 was not available (lack of response/clinic non-attendance). The results demonstrate doubling in early continence to over 75% at 6-week follow-up with comparable positive margin rates. This difference was statistically significantly better in the dorsal venous complex RARP sparing group in comparison to standard RARP (<i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Anterior hood-sparing RARP with anterior reconstruction is a modification to the standard anterior RARP approach with a short learning curve which provides patients with better early and late continence without compromise to oncological outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chalairat Suk-Ouichai, Mitchell M. Huang, Clayton Neill, Christopher K. Mehta, Ashley E. Ross, Shilajit D. Kundu, Kent T. Perry Jr, Duc T. Pham, Hiten D. Patel
Objectives
The objective of this study is to evaluate preoperative factors associated with cardiopulmonary bypass (CPB) utilization and outcomes for patients with renal cell carcinoma (RCC) and tumour thrombus (TT). Radical nephrectomy with thrombectomy is a standard treatment for patients with RCC and associated TT. Morbidity and mortality rates tend to correlate with aggressiveness of tumour and TT level.
Methods
Patients undergoing radical nephrectomy with thrombectomy (2006–2023) were retrospectively identified. Inclusion criteria included RCC histology and preoperative imaging available for thrombus-level categorization based on the Mayo Clinic grading system. Logistic regression assessed predictors for utilizing CPB, and Cox regression identified factors associated with survival.
Results
A total of 72 patients with RCC and associated TT were identified. The median age was 67 years. RCC-related symptoms were present in 83%, and 28% had Levels 3 and 4 thrombi. Eleven patients (15.3%) had undergone neoadjuvant therapy, and 81% had clear-cell RCC. CPB was utilized in eight (11.1%) cases. The median tumour size was 10.5 cm. Metastatic disease was greater in the CPB cohort (75% vs. 28%, p = 0.008). All cases performed on CPB were Levels 3 and 4 thrombi (100% vs. 19% in the non-CPB group, p < 0.001). CPB cases had significantly longer operative time, and hospital stays and rates of Clavien ≥ 3 complications. On multivariate analysis, metastatic disease was a predictor of CPB utilization. Median survival was 74 and 25 months in the non-CPB and CPB cohorts, respectively (p = 0.01). Pulmonary disease and metastatic disease with CPB utilization were significantly associated with worse survival on multivariate analysis.
Conclusions
Surgical extirpation of kidney tumours with associated TT remains the standard of care among patients with locally advanced RCC. CPB can be utilized to increase the feasibility of resection for high-level thrombi. Preoperative planning and cooperation among surgical teams are key given the perioperative morbidity and mortality.
{"title":"Utilization of cardiopulmonary bypass at radical nephrectomy for renal cell carcinoma with tumour thrombus","authors":"Chalairat Suk-Ouichai, Mitchell M. Huang, Clayton Neill, Christopher K. Mehta, Ashley E. Ross, Shilajit D. Kundu, Kent T. Perry Jr, Duc T. Pham, Hiten D. Patel","doi":"10.1002/bco2.460","DOIUrl":"10.1002/bco2.460","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objective of this study is to evaluate preoperative factors associated with cardiopulmonary bypass (CPB) utilization and outcomes for patients with renal cell carcinoma (RCC) and tumour thrombus (TT). Radical nephrectomy with thrombectomy is a standard treatment for patients with RCC and associated TT. Morbidity and mortality rates tend to correlate with aggressiveness of tumour and TT level.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients undergoing radical nephrectomy with thrombectomy (2006–2023) were retrospectively identified. Inclusion criteria included RCC histology and preoperative imaging available for thrombus-level categorization based on the Mayo Clinic grading system. Logistic regression assessed predictors for utilizing CPB, and Cox regression identified factors associated with survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 72 patients with RCC and associated TT were identified. The median age was 67 years. RCC-related symptoms were present in 83%, and 28% had Levels 3 and 4 thrombi. Eleven patients (15.3%) had undergone neoadjuvant therapy, and 81% had clear-cell RCC. CPB was utilized in eight (11.1%) cases. The median tumour size was 10.5 cm. Metastatic disease was greater in the CPB cohort (75% vs. 28%, <i>p</i> = 0.008). All cases performed on CPB were Levels 3 and 4 thrombi (100% vs. 19% in the non-CPB group, <i>p</i> < 0.001). CPB cases had significantly longer operative time, and hospital stays and rates of Clavien ≥ 3 complications. On multivariate analysis, metastatic disease was a predictor of CPB utilization. Median survival was 74 and 25 months in the non-CPB and CPB cohorts, respectively (<i>p</i> = 0.01). Pulmonary disease and metastatic disease with CPB utilization were significantly associated with worse survival on multivariate analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Surgical extirpation of kidney tumours with associated TT remains the standard of care among patients with locally advanced RCC. CPB can be utilized to increase the feasibility of resection for high-level thrombi. Preoperative planning and cooperation among surgical teams are key given the perioperative morbidity and mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The objective of this study is to evaluate the diagnostic performance of perineal access cannulas tethered to a biplanar ultrasound probe in cognitive transperineal prostate biopsies of targets identified by multiparametric magnetic resonance imaging (mpMRI) by comparing the results of the PrecisionPoint (PP) Transperineal Access System with the double-freehand (DFH) technique.
Patients and methods
All patients who underwent cognitive transperineal prostate biopsy of mpMRI targets using the PP or DFH technique between November 2020 and September 2023 were enrolled. All data related to mpMRI target biopsies were stratified by technique, visibility in transrectal ultrasound and analysed by comparing PP versus DFH. A standardised anaesthesia protocol with 1% mepivacaine was used in all biopsies. The tolerability of the procedures was assessed using a visual analogue scale (VAS).
Results
The number of mpMRI targets sampled was 166 in PP and 242 in DFH. In target biopsies, the PP system was associated with better diagnostic performance for clinically significant prostate cancer (Gleason score ≥3 + 4) compared to DFH for both ultrasound-visible targets (61.4% vs. 48.0%) and non-visible targets (41.4% vs. 14.9%) (p = 0.02). A higher rate of positive cores was obtained from targets sampled with PP (57.7% vs. 49.6%, p = 0.0002). The PP system was associated with the retrieval of significantly longer cores (p < 0.0001). There was no significant difference between the techniques regarding pain reported during the biopsy, with a median VAS of 2.7/10, although the PP device required a lower amount of anaesthetic in the periprostatic planes (4.3 ± 2.0 mL vs. 5.9 ± 1.9 mL, p < 0.0001).
Conclusion
The PrecisionPoint Transperineal Access System enabled more precise and higher quality biopsies, resulting in improved histological characterisation of prostate cancer compared to the DFH approach. The use of a perineal cannula did not increase the pain perceived by patients and also required less local anaesthetic during the biopsy.
{"title":"Prospective per-target analysis of the added value of the PrecisionPoint Transperineal Access System in cognitive prostate biopsy of MRI targets","authors":"Luca Orecchia, Stefano Germani, Gaia Colalillo, Angelica Fasano, Matteo Ricci, Eleonora Rosato, Anastasios D. Asimakopoulos, Simone Albisinni, Enrico Finazzi Agrò, Guglielmo Manenti, Roberto Miano","doi":"10.1002/bco2.462","DOIUrl":"10.1002/bco2.462","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objective of this study is to evaluate the diagnostic performance of perineal access cannulas tethered to a biplanar ultrasound probe in cognitive transperineal prostate biopsies of targets identified by multiparametric magnetic resonance imaging (mpMRI) by comparing the results of the PrecisionPoint (PP) Transperineal Access System with the double-freehand (DFH) technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>All patients who underwent cognitive transperineal prostate biopsy of mpMRI targets using the PP or DFH technique between November 2020 and September 2023 were enrolled. All data related to mpMRI target biopsies were stratified by technique, visibility in transrectal ultrasound and analysed by comparing PP versus DFH. A standardised anaesthesia protocol with 1% mepivacaine was used in all biopsies. The tolerability of the procedures was assessed using a visual analogue scale (VAS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The number of mpMRI targets sampled was 166 in PP and 242 in DFH. In target biopsies, the PP system was associated with better diagnostic performance for clinically significant prostate cancer (Gleason score ≥3 + 4) compared to DFH for both ultrasound-visible targets (61.4% vs. 48.0%) and non-visible targets (41.4% vs. 14.9%) (<i>p</i> = 0.02). A higher rate of positive cores was obtained from targets sampled with PP (57.7% vs. 49.6%, <i>p</i> = 0.0002). The PP system was associated with the retrieval of significantly longer cores (<i>p</i> < 0.0001). There was no significant difference between the techniques regarding pain reported during the biopsy, with a median VAS of 2.7/10, although the PP device required a lower amount of anaesthetic in the periprostatic planes (4.3 ± 2.0 mL vs. 5.9 ± 1.9 mL, <i>p</i> < 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The PrecisionPoint Transperineal Access System enabled more precise and higher quality biopsies, resulting in improved histological characterisation of prostate cancer compared to the DFH approach. The use of a perineal cannula did not increase the pain perceived by patients and also required less local anaesthetic during the biopsy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 12","pages":"1288-1298"},"PeriodicalIF":1.6,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David Gilbert, Anastasia Christ, Kyle Barclay, Shubham Gupta, Kirtishri Mishra
<p>Historically, direct visual internal urethrotomy (DVIU) and balloon dilation (BD) have been preferred as first line interventions for certain urethral strictures. Urethroplasty is considered the gold standard following failed primary intervention; however, no recommendations exist for intervention following a failed urethroplasty.<span><sup>1</sup></span> Thus far, DVIU and BD have been shown to display comparable outcomes as primary treatments in terms of freedom from recurrent stricture, time to recurrence, and complications.<span><sup>2</sup></span> In this research letter, we provide evidence that in the case of secondary interventions following failed urethroplasty, BD shows significantly improved 3-year outcomes compared to DVIU.</p><p>Urethral strictures are fairly common with a prevalence of 229–627 per 100 000 males.<span><sup>3</sup></span> They typically impact men over the age of 65 and increase the risk for UTIs and incontinence. While some studies have compared the success of DVIU versus BD as primary interventions, reported success rates are highly variable with 32%–96% for DVIU and 35%–84% for BD.<span><sup>2, 4, 5</sup></span> Conversely, urethroplasty has a high reported success rate of 96%, though is a more complicated procedure requiring longer recovery and a skilled surgeon.<span><sup>1</sup></span></p><p>Due to the low frequency of recurrence following urethroplasty, recommendations for subsequent reoperations with DVIU or BD have not been adequately studied. Given the prevalence of urethral strictures and increasing use of urethroplasty, it is important to study the success of subsequent DVIU and BD. We performed a retrospective review using TriNetX (TriNetX, Inc., Cambridge, MA, USA), a clinical research platform that collects and stores over 125 million patients' electronic health record data, to determine whether urethroplasty patients with subsequent DVIU or BD had a higher chance of recurrent stricture. We are unaware of another study that directly compares success rates of DVIU versus BD as secondary interventions following urethroplasty.</p><p>Cohorts were constructed for both DVIU following urethroplasty and BD following urethroplasty. Patient ages ranged from 21 to 90, and exclusion criteria included benign prostatic hyperplasia, neurogenic bladder and bladder neck contracture. Specific inclusion and exclusion criteria can be found in Appendix S1. Given the small sample sizes, cohorts were not matched for comorbidities. Outcomes were defined as ≥1 instance of urethral stricture or stenosis, or retention of urine between 1 month and 3 years after DVIU or BD. Outcomes were assessed with Kaplan–Meier, hazard ratios (HR) and log-rank tests to determine significance (<i>p</i> < 0.05), and a Kaplan–Meier curve was generated.</p><p>DVIU (<i>N</i> = 45) had a significantly higher probability (<i>p</i> = 0.0353) of recurrent urethral stricture compared to BD (<i>N</i> = 25), with respective 3-year incidence probabilit
{"title":"Efficacy of direct visual internal urethrotomy versus balloon dilation to treat recurrent urethral stricture following failed urethroplasty","authors":"David Gilbert, Anastasia Christ, Kyle Barclay, Shubham Gupta, Kirtishri Mishra","doi":"10.1002/bco2.458","DOIUrl":"10.1002/bco2.458","url":null,"abstract":"<p>Historically, direct visual internal urethrotomy (DVIU) and balloon dilation (BD) have been preferred as first line interventions for certain urethral strictures. Urethroplasty is considered the gold standard following failed primary intervention; however, no recommendations exist for intervention following a failed urethroplasty.<span><sup>1</sup></span> Thus far, DVIU and BD have been shown to display comparable outcomes as primary treatments in terms of freedom from recurrent stricture, time to recurrence, and complications.<span><sup>2</sup></span> In this research letter, we provide evidence that in the case of secondary interventions following failed urethroplasty, BD shows significantly improved 3-year outcomes compared to DVIU.</p><p>Urethral strictures are fairly common with a prevalence of 229–627 per 100 000 males.<span><sup>3</sup></span> They typically impact men over the age of 65 and increase the risk for UTIs and incontinence. While some studies have compared the success of DVIU versus BD as primary interventions, reported success rates are highly variable with 32%–96% for DVIU and 35%–84% for BD.<span><sup>2, 4, 5</sup></span> Conversely, urethroplasty has a high reported success rate of 96%, though is a more complicated procedure requiring longer recovery and a skilled surgeon.<span><sup>1</sup></span></p><p>Due to the low frequency of recurrence following urethroplasty, recommendations for subsequent reoperations with DVIU or BD have not been adequately studied. Given the prevalence of urethral strictures and increasing use of urethroplasty, it is important to study the success of subsequent DVIU and BD. We performed a retrospective review using TriNetX (TriNetX, Inc., Cambridge, MA, USA), a clinical research platform that collects and stores over 125 million patients' electronic health record data, to determine whether urethroplasty patients with subsequent DVIU or BD had a higher chance of recurrent stricture. We are unaware of another study that directly compares success rates of DVIU versus BD as secondary interventions following urethroplasty.</p><p>Cohorts were constructed for both DVIU following urethroplasty and BD following urethroplasty. Patient ages ranged from 21 to 90, and exclusion criteria included benign prostatic hyperplasia, neurogenic bladder and bladder neck contracture. Specific inclusion and exclusion criteria can be found in Appendix S1. Given the small sample sizes, cohorts were not matched for comorbidities. Outcomes were defined as ≥1 instance of urethral stricture or stenosis, or retention of urine between 1 month and 3 years after DVIU or BD. Outcomes were assessed with Kaplan–Meier, hazard ratios (HR) and log-rank tests to determine significance (<i>p</i> < 0.05), and a Kaplan–Meier curve was generated.</p><p>DVIU (<i>N</i> = 45) had a significantly higher probability (<i>p</i> = 0.0353) of recurrent urethral stricture compared to BD (<i>N</i> = 25), with respective 3-year incidence probabilit","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dhruv Puri, Eric Cho, Kian Ahmadieh, Nishant Garg, Cesar Delgado, Benjamin Cedars, Michael Witthaus, Michael Pan, Jill C. Buckley
Introduction
Ureteral stricture disease (UTSD) poses significant challenges in reconstructive urology, with recent advances highlighting disparities in healthcare outcomes based on race and ethnicity. This study investigates the impact of race and ethnicity on clinical outcomes following ureteral reconstruction.
Methods
We conducted a single-centre prospective analysis of 233 patients who underwent ureteral reconstruction for UTSD from 2014 to 2023. Patient demographics, clinical characteristics, surgical details and outcomes were collected. Patients were stratified by race (White vs. non-White) and ethnicity (Hispanic vs. non-Hispanic). Statistical analyses included Kruskal–Wallis, Mann–Whitney U tests, ANOVA, Kaplan–Meier analysis and multivariate logistic regression.
Results
Our cohort included 233 patients who underwent ureteroplasty with 108 (46.4%) non-White patients, and 71 (30.5%) were Hispanic. No significant differences were found in recurrence rates, complications, or stricture-free survival between racial and ethnic groups. Prior reconstructions were more prevalent among non-White patients (26.9% vs. 16.0%; p = 0.043). Unadjusted and adjusted regressions showed significant associations between non-White race (unadjusted β = 0.76, p = 0.008; adjusted β = 0.82, p = 0.008) and Hispanic ethnicity (unadjusted β = 0.70, p = 0.025; adjusted β = 0.79, p = 0.020) with increased stricture lengths.
Conclusion
This study highlights that although recurrence and complication rates do not significantly differ by race or ethnicity, disparities exist in clinical presentations, with non-White and Hispanic patients presenting with longer stricture lengths and higher body mass index. These findings underscore the need for targeted interventions to address underlying disparities in healthcare delivery and access.
导读：输尿管狭窄疾病（UTSD）在泌尿外科重建中提出了重大挑战，最近的进展突出了基于种族和民族的医疗保健结果的差异。本研究探讨人种和民族对输尿管重建后临床结果的影响。方法：我们对2014年至2023年接受UTSD输尿管重建术的233例患者进行了单中心前瞻性分析。收集患者人口统计、临床特征、手术细节和结果。患者按种族（白人与非白人）和民族（西班牙裔与非西班牙裔）分层。统计分析包括Kruskal-Wallis检验、Mann-Whitney U检验、ANOVA、Kaplan-Meier分析和多元logistic回归。结果：我们的队列包括233例输尿管成形术患者，其中108例（46.4%）为非白人患者，71例（30.5%）为西班牙裔患者。在复发率、并发症或无狭窄生存方面，种族和民族之间没有显著差异。先前的重建在非白人患者中更为普遍(26.9% vs. 16.0%；p = 0.043)。未校正和校正回归均显示非白种人之间存在显著相关性(未校正β = 0.76, p = 0.008；调整后的β = 0.82, p = 0.008)和西班牙裔(未调整的β = 0.70, p = 0.025；调整后的β = 0.79, p = 0.020)，狭窄长度增加。结论：本研究强调，尽管复发和并发症发生率在种族或民族之间没有显著差异，但在临床表现上存在差异，非白人和西班牙裔患者表现为更长的狭窄长度和更高的体重指数。这些发现强调需要有针对性的干预措施，以解决医疗保健提供和获取方面的潜在差异。
{"title":"Impact of race and ethnicity on clinical outcomes and recurrence post-ureteral reconstruction","authors":"Dhruv Puri, Eric Cho, Kian Ahmadieh, Nishant Garg, Cesar Delgado, Benjamin Cedars, Michael Witthaus, Michael Pan, Jill C. Buckley","doi":"10.1002/bco2.450","DOIUrl":"10.1002/bco2.450","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Ureteral stricture disease (UTSD) poses significant challenges in reconstructive urology, with recent advances highlighting disparities in healthcare outcomes based on race and ethnicity. This study investigates the impact of race and ethnicity on clinical outcomes following ureteral reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-centre prospective analysis of 233 patients who underwent ureteral reconstruction for UTSD from 2014 to 2023. Patient demographics, clinical characteristics, surgical details and outcomes were collected. Patients were stratified by race (White vs. non-White) and ethnicity (Hispanic vs. non-Hispanic). Statistical analyses included Kruskal–Wallis, Mann–Whitney <i>U</i> tests, ANOVA, Kaplan–Meier analysis and multivariate logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our cohort included 233 patients who underwent ureteroplasty with 108 (46.4%) non-White patients, and 71 (30.5%) were Hispanic. No significant differences were found in recurrence rates, complications, or stricture-free survival between racial and ethnic groups. Prior reconstructions were more prevalent among non-White patients (26.9% vs. 16.0%; <i>p</i> = 0.043). Unadjusted and adjusted regressions showed significant associations between non-White race (unadjusted <i>β</i> = 0.76, <i>p</i> = 0.008; adjusted <i>β</i> = 0.82, <i>p</i> = 0.008) and Hispanic ethnicity (unadjusted <i>β</i> = 0.70, <i>p</i> = 0.025; adjusted <i>β</i> = 0.79, <i>p</i> = 0.020) with increased stricture lengths.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights that although recurrence and complication rates do not significantly differ by race or ethnicity, disparities exist in clinical presentations, with non-White and Hispanic patients presenting with longer stricture lengths and higher body mass index. These findings underscore the need for targeted interventions to address underlying disparities in healthcare delivery and access.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 12","pages":"1255-1262"},"PeriodicalIF":1.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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