Objectives Recurrent UTI (rUTI) is a debilitating health condition that is associated with persistent mental, physical, and social burdens. People living with rUTI face inconsistencies in diagnostic testing and fragmented treatment pathways alongside their symptoms, which are likely to add considerably to their illness-related burdens. This study aimed to characterize the factors negatively impacting this population using the qualitative perspectives of people living with the condition. Methods Qualitative data were collected via free-text responses using an online survey hosted by an rUTI patient advocacy website. Female participants with self-reported rUTI ( n = 1,983) described the factors that were most salient to their experience of living with the condition. Data were analyzed using a coding reliability approach to thematic analysis. Results Two overarching themes were identified: (1) the patient burden of rUTI, which describes the multifaceted biopsychosocial impact of the illness, and (2) healthcare disillusionment, which describes patient dissatisfaction with healthcare received, both in terms of the treatments offered and communication with healthcare professionals. The patient burden of rUTI encompassed four subordinate themes: facing ongoing uncertainty; symptom salience; sex is not simple anymore; and perceived UTI stigma. Healthcare disillusionment included three subordinate themes: discomfort with frequent antibiotic use; fragmented treatment pathways; and devalued patient perspectives. Conclusions The findings demonstrated that ambiguity in the diagnosis of rUTI and inconsistencies in the subsequent treatment pathway are exacerbated by poor patient–clinician communication. The extent of the female-specific burden of rUTI symptoms confirmed the harmful effects of illness-related stigma. This novel qualitative reporting of rUTI symptom burden and life impact highlights the urgent need for increased patient-centered care for those living with rUTI. More effective rUTI management could have a major impact on treatment outcomes and patient-reported psychosocial wellbeing.
{"title":"Psychosocial burden and healthcare disillusionment in recurrent UTI: a large-scale international survey of patient perspectives","authors":"Kayleigh Maxwell, Lindsey Roberts, Melissa Kramer, Jessica Price, Abigail Newlands, Katherine A. Finlay","doi":"10.3389/fruro.2023.1264299","DOIUrl":"https://doi.org/10.3389/fruro.2023.1264299","url":null,"abstract":"Objectives Recurrent UTI (rUTI) is a debilitating health condition that is associated with persistent mental, physical, and social burdens. People living with rUTI face inconsistencies in diagnostic testing and fragmented treatment pathways alongside their symptoms, which are likely to add considerably to their illness-related burdens. This study aimed to characterize the factors negatively impacting this population using the qualitative perspectives of people living with the condition. Methods Qualitative data were collected via free-text responses using an online survey hosted by an rUTI patient advocacy website. Female participants with self-reported rUTI ( n = 1,983) described the factors that were most salient to their experience of living with the condition. Data were analyzed using a coding reliability approach to thematic analysis. Results Two overarching themes were identified: (1) the patient burden of rUTI, which describes the multifaceted biopsychosocial impact of the illness, and (2) healthcare disillusionment, which describes patient dissatisfaction with healthcare received, both in terms of the treatments offered and communication with healthcare professionals. The patient burden of rUTI encompassed four subordinate themes: facing ongoing uncertainty; symptom salience; sex is not simple anymore; and perceived UTI stigma. Healthcare disillusionment included three subordinate themes: discomfort with frequent antibiotic use; fragmented treatment pathways; and devalued patient perspectives. Conclusions The findings demonstrated that ambiguity in the diagnosis of rUTI and inconsistencies in the subsequent treatment pathway are exacerbated by poor patient–clinician communication. The extent of the female-specific burden of rUTI symptoms confirmed the harmful effects of illness-related stigma. This novel qualitative reporting of rUTI symptom burden and life impact highlights the urgent need for increased patient-centered care for those living with rUTI. More effective rUTI management could have a major impact on treatment outcomes and patient-reported psychosocial wellbeing.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"157 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136313051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muscle-invasive bladder tumors pose a grave mortality risk due to their propensity for distant metastases. The therapeutic spectrum for such tumors encompasses surgery, chemotherapy, and radiation, tailored to the cancer’s severity. In the context of high-risk Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle invasive bladder cancer (NMIBC), a novel treatment has emerged as a beacon of hope. Nadofaragene firadenovec, a pioneering gene therapy, has gained worldwide approval for combating this condition, marking a watershed moment in bladder cancer therapy. Nadofaragene firadenovec is ingeniously designed to address high-risk BCG-unresponsive NMIBC, particularly carcinoma in situ (CIS) with or without papillary tumors, in adult patients. Rooted in a vector DNA, this therapy encodes interferon (IFN)-2b, which imparts urothelial cells with the ability to generate IFN-2b. The resulting cascade of events triggers a multifaceted assault on cancer, characterized by its immunostimulatory, antiangiogenic, and apoptotic effects. The therapeutic efficacy of nadofaragene firadenovec rests on its capacity to exploit the transformed urothelial cells to deliver these targeted anticancer activities. The evolutionary trajectory of nadofaragene firadenovec culminated in its monumental approval in December 2022 by the United States, signifying a pivotal juncture in the field. Notably, a segment of patients, approximately 30%, prove refractory to BCG treatment. For these individuals, alternative therapeutic avenues are imperative. Presently, the landscape for patients with non-muscle invasive bladder cancer lacks a definitive, enduring solution. Against this backdrop, the introduction of nadofaragene firadenovec heralds a momentous stride toward the global availability of an authorized therapeutic intervention.
{"title":"Nadofaragene firadenovec: a breakthrough in the field of bladder oncology","authors":"Abdullah Nadeem, Khulud Qamar, Wajeeha Bilal, Laiba Imran Vohra, Areeba Ahsan, Rabeea Tariq","doi":"10.3389/fruro.2023.1206398","DOIUrl":"https://doi.org/10.3389/fruro.2023.1206398","url":null,"abstract":"Muscle-invasive bladder tumors pose a grave mortality risk due to their propensity for distant metastases. The therapeutic spectrum for such tumors encompasses surgery, chemotherapy, and radiation, tailored to the cancer’s severity. In the context of high-risk Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle invasive bladder cancer (NMIBC), a novel treatment has emerged as a beacon of hope. Nadofaragene firadenovec, a pioneering gene therapy, has gained worldwide approval for combating this condition, marking a watershed moment in bladder cancer therapy. Nadofaragene firadenovec is ingeniously designed to address high-risk BCG-unresponsive NMIBC, particularly carcinoma in situ (CIS) with or without papillary tumors, in adult patients. Rooted in a vector DNA, this therapy encodes interferon (IFN)-2b, which imparts urothelial cells with the ability to generate IFN-2b. The resulting cascade of events triggers a multifaceted assault on cancer, characterized by its immunostimulatory, antiangiogenic, and apoptotic effects. The therapeutic efficacy of nadofaragene firadenovec rests on its capacity to exploit the transformed urothelial cells to deliver these targeted anticancer activities. The evolutionary trajectory of nadofaragene firadenovec culminated in its monumental approval in December 2022 by the United States, signifying a pivotal juncture in the field. Notably, a segment of patients, approximately 30%, prove refractory to BCG treatment. For these individuals, alternative therapeutic avenues are imperative. Presently, the landscape for patients with non-muscle invasive bladder cancer lacks a definitive, enduring solution. Against this backdrop, the introduction of nadofaragene firadenovec heralds a momentous stride toward the global availability of an authorized therapeutic intervention.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135437822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-13DOI: 10.3389/fruro.2023.1238293
Orgeness J. Mbwambo, Moses Lyatuu, Geofrey Ngocho, Khadija Abdallah, Patricia Godfrey, Bartholomeo N. Ngowi, Alex Mremi, Evangelista Malindisa, Maryam Amour, James Ngocho, Emmanuel Balandya, Gideon Kwesigabo, Rachel Manongi, Benson R. Kidenya, Stephen E. Mshana, Eligius F. Lyamuya, Bruno F. Sunguya, John Bartlett, Blandina Theophil Mmbaga, Alfred K. Mteta
Background The extent of the burden of erectile dysfunction and its associated factors remains unclear. The aim of this study was to investigate the factors associated with ED and its prevalence among MLHIV in northern Tanzania. Methods A hospital-based, multi-center, cross-sectional study was conducted on MLHIV aged 18 years and above in northern Tanzania. Outcome The risk factors for ED and the prevalence of such risk factors among MLHIV was assessed and evaluated through a multivariate logistic regression analysis adjusted for depression symptoms using the Patient Health Questionnaire-9 (PHQ9) scale; anxiety disorders using the Generalized Anxiety Disorder Assessment (GAD-7); ART adherence; viral load; initial regimen date; ART regimen; and sexual risk behaviors. Results Data for 366 participants with a median age of 50 years (IQR 38–57 years) were available for analysis. Approximately three in four (74.6%) MLHIV had ED (of any severity), whereas 37.7% had mild ED. The majority (96.5%) of the participants had low testosterone, two in three (66.7%) had depressive symptoms, and close to half of the participants (48.4%) had anxiety. Age, lack of engagement in vigorous physical activity, depression, and self-reported good adherence to antiretroviral therapy (ART) were associated with ED in a multivariate logistic regression analysis ( p =0.004, p =0.006, p =0.07, p =0.006, and p =0.004, respectively). Conclusion There is a high prevalence of ED among MLHIV in northern Tanzania. Erectile dysfunction should be regarded as one of the comorbidities associated with HIV and should be routinely screened for among MLHIV in CTC clinics.
{"title":"The high burden of erectile dysfunction among men living with HIV in northern Tanzania: a call for evidence-based interventions","authors":"Orgeness J. Mbwambo, Moses Lyatuu, Geofrey Ngocho, Khadija Abdallah, Patricia Godfrey, Bartholomeo N. Ngowi, Alex Mremi, Evangelista Malindisa, Maryam Amour, James Ngocho, Emmanuel Balandya, Gideon Kwesigabo, Rachel Manongi, Benson R. Kidenya, Stephen E. Mshana, Eligius F. Lyamuya, Bruno F. Sunguya, John Bartlett, Blandina Theophil Mmbaga, Alfred K. Mteta","doi":"10.3389/fruro.2023.1238293","DOIUrl":"https://doi.org/10.3389/fruro.2023.1238293","url":null,"abstract":"Background The extent of the burden of erectile dysfunction and its associated factors remains unclear. The aim of this study was to investigate the factors associated with ED and its prevalence among MLHIV in northern Tanzania. Methods A hospital-based, multi-center, cross-sectional study was conducted on MLHIV aged 18 years and above in northern Tanzania. Outcome The risk factors for ED and the prevalence of such risk factors among MLHIV was assessed and evaluated through a multivariate logistic regression analysis adjusted for depression symptoms using the Patient Health Questionnaire-9 (PHQ9) scale; anxiety disorders using the Generalized Anxiety Disorder Assessment (GAD-7); ART adherence; viral load; initial regimen date; ART regimen; and sexual risk behaviors. Results Data for 366 participants with a median age of 50 years (IQR 38–57 years) were available for analysis. Approximately three in four (74.6%) MLHIV had ED (of any severity), whereas 37.7% had mild ED. The majority (96.5%) of the participants had low testosterone, two in three (66.7%) had depressive symptoms, and close to half of the participants (48.4%) had anxiety. Age, lack of engagement in vigorous physical activity, depression, and self-reported good adherence to antiretroviral therapy (ART) were associated with ED in a multivariate logistic regression analysis ( p =0.004, p =0.006, p =0.07, p =0.006, and p =0.004, respectively). Conclusion There is a high prevalence of ED among MLHIV in northern Tanzania. Erectile dysfunction should be regarded as one of the comorbidities associated with HIV and should be routinely screened for among MLHIV in CTC clinics.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135781262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Globally, millions of women develop pelvic floor disorder. It imposes a considerable emotional, social, and financial burden on women’s lives. Despite this, in developing countries, nearly half of women with pelvic floor disorder do not seek any help due to feelings of isolation, depression, shame, and loss of control. Thus, the magnitude of the problem is largely unknown. The aim of this study was to assess the prevalence of pelvic floor disorder and associated factors among women at Arba Minch Health and Demographic surveillance site. Methods A cross-sectional study with a simple random sampling technique was employed on a community basis. The data were entered into EpiData version 3.1 and then exported to Statistical Package for Social Sciences version 25 for data cleaning and analysis. Bivariate and multivariable analyses using binary logistic regressions were carried out to identify factors associated with pelvic floor disorder. The level of significance was declared at a p -value of < 0.05. Results The prevalence of pelvic floor disorder was 31.4% (95% CI = 26.9% to 35.8%). Being grand multiparous (AOR = 3.919, 95% CI = 1.495–10.276), having a history of instrumental delivery (AOR = 3.042, 95% CI = 1.483 to 6.241), having a history of perianal tearing (AOR = 2.972, 95% CI = 1.491 to 5.927), and having a medical disease (AOR= 2.698, 95% CI = 1.526 to 4.770) were factors associated with pelvic floor disorder. Conclusions and recommendations The prevalence of pelvic floor disorder was high in the study area. Parity, instrumental delivery, perianal tears, and medical problems were factors affecting the prevalence of pelvic floor disorder. There is a need for an improvement of policies and strategies focusing on prevention and treatment services to alleviate the problem.
在全球范围内，数以百万计的女性患有盆底疾病。它给妇女的生活带来了相当大的情感、社会和经济负担。尽管如此，在发展中国家，近一半患有盆底障碍的妇女由于感到孤立、抑郁、羞耻和失去控制而不寻求任何帮助。因此，这个问题的严重程度在很大程度上是未知的。本研究的目的是评估Arba Minch健康和人口监测站妇女盆底疾病的患病率及其相关因素。方法以社区为单位，采用简单随机抽样的横断面调查方法。将数据输入EpiData 3.1版本，然后导出到Statistical Package for Social Sciences version 25进行数据清洗和分析。采用二元逻辑回归进行双变量和多变量分析，以确定与盆底疾病相关的因素。显著性水平的p值为<0.05. 结果盆底疾病患病率为31.4% (95% CI = 26.9% ~ 35.8%)。大产子(AOR= 3.919, 95% CI = 1.495 ~ 10.276)、有器械分娩史(AOR= 3.042, 95% CI = 1.483 ~ 6.241)、有肛周撕裂史(AOR= 2.972, 95% CI = 1.491 ~ 5.927)、有内科疾病(AOR= 2.698, 95% CI = 1.526 ~ 4.770)是盆底障碍的相关因素。结论和建议研究地区盆底疾病的患病率较高。胎次、辅助分娩、肛周撕裂和医疗问题是影响盆底疾病患病率的因素。有必要改进以预防和治疗服务为重点的政策和战略，以缓解这一问题。
{"title":"Prevalence of pelvic floor disorder and associated factors among women in Arba Minch Health and Demographic Surveillance Site, Gamo Zone, Southern Ethiopia, 2021","authors":"Berhanu Negese Kebede, Desta Haftu Hayelom, Gebremaryam Temesgen Birgoda, Awol Arega Yimer, Bezawit Afework Mesfin, Mesfin Difer Tetema, Solomon Seyife Alemu, Kassaw Beyene Getahun","doi":"10.3389/fruro.2023.1196925","DOIUrl":"https://doi.org/10.3389/fruro.2023.1196925","url":null,"abstract":"Background Globally, millions of women develop pelvic floor disorder. It imposes a considerable emotional, social, and financial burden on women’s lives. Despite this, in developing countries, nearly half of women with pelvic floor disorder do not seek any help due to feelings of isolation, depression, shame, and loss of control. Thus, the magnitude of the problem is largely unknown. The aim of this study was to assess the prevalence of pelvic floor disorder and associated factors among women at Arba Minch Health and Demographic surveillance site. Methods A cross-sectional study with a simple random sampling technique was employed on a community basis. The data were entered into EpiData version 3.1 and then exported to Statistical Package for Social Sciences version 25 for data cleaning and analysis. Bivariate and multivariable analyses using binary logistic regressions were carried out to identify factors associated with pelvic floor disorder. The level of significance was declared at a p -value of &lt; 0.05. Results The prevalence of pelvic floor disorder was 31.4% (95% CI = 26.9% to 35.8%). Being grand multiparous (AOR = 3.919, 95% CI = 1.495–10.276), having a history of instrumental delivery (AOR = 3.042, 95% CI = 1.483 to 6.241), having a history of perianal tearing (AOR = 2.972, 95% CI = 1.491 to 5.927), and having a medical disease (AOR= 2.698, 95% CI = 1.526 to 4.770) were factors associated with pelvic floor disorder. Conclusions and recommendations The prevalence of pelvic floor disorder was high in the study area. Parity, instrumental delivery, perianal tears, and medical problems were factors affecting the prevalence of pelvic floor disorder. There is a need for an improvement of policies and strategies focusing on prevention and treatment services to alleviate the problem.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135981956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-11DOI: 10.3389/fruro.2023.1272810
Lauren E. Corona, Kate H. Kraft, C. Jaeger, T. Posid, Benjamin N Breyer
{"title":"Editorial: Current perspectives in urology education","authors":"Lauren E. Corona, Kate H. Kraft, C. Jaeger, T. Posid, Benjamin N Breyer","doi":"10.3389/fruro.2023.1272810","DOIUrl":"https://doi.org/10.3389/fruro.2023.1272810","url":null,"abstract":"","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139341189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.3389/fruro.2023.1182919
Harry C. A. Reynolds, B. Turney, S. Waters, D. Moulton
In ureteroscopy, a common method for kidney stone removal, a ureteroscope is inserted into the patient’s kidney, through which working tools such as a laser are inserted. During the procedure, the renal space proximal to the scope tip is irrigated with fluid in order to clear stone particles and debris. However, even with continual fluid flow into and out of the kidney, stone dust may become trapped in vortical structures, significantly impairing the operating clinician’s field of view. Key to overcoming this challenge is a clear understanding of the flow patterns within an irrigated kidney calyx, and a modelling framework that enables to interrogate how different flow conditions impact on the wash-out time of debris. Previous theoretical studies have uncovered the interplay between fluid structure, in particular the presence of vortical regions, and dust washout, but only in a regime of steady inlet flow conditions. In this paper we model a kidney calyx in an idealised 2D cavity geometry, in which we investigate the presence and potential disturbance of vortical structures due to an oscillatory inlet condition, and the impact on dust washout, modelled as a passive tracer in the flow. By varying the flow amplitude and frequency at the inlet, we uncover a delicate relationship with vortex size and vortex disturbance, and we demonstrate the potential for significant decrease in wash-out time with low-frequency high-amplitude conditions. We then compare this result to the commonly used practice of flushing, a discrete and temporary increase in flow, and we also demonstrate the qualitative robustness of our findings to changes in cavity geometry.
{"title":"Harnessing oscillatory fluid behaviour to improve debris wash-out in ureteroscopy","authors":"Harry C. A. Reynolds, B. Turney, S. Waters, D. Moulton","doi":"10.3389/fruro.2023.1182919","DOIUrl":"https://doi.org/10.3389/fruro.2023.1182919","url":null,"abstract":"In ureteroscopy, a common method for kidney stone removal, a ureteroscope is inserted into the patient’s kidney, through which working tools such as a laser are inserted. During the procedure, the renal space proximal to the scope tip is irrigated with fluid in order to clear stone particles and debris. However, even with continual fluid flow into and out of the kidney, stone dust may become trapped in vortical structures, significantly impairing the operating clinician’s field of view. Key to overcoming this challenge is a clear understanding of the flow patterns within an irrigated kidney calyx, and a modelling framework that enables to interrogate how different flow conditions impact on the wash-out time of debris. Previous theoretical studies have uncovered the interplay between fluid structure, in particular the presence of vortical regions, and dust washout, but only in a regime of steady inlet flow conditions. In this paper we model a kidney calyx in an idealised 2D cavity geometry, in which we investigate the presence and potential disturbance of vortical structures due to an oscillatory inlet condition, and the impact on dust washout, modelled as a passive tracer in the flow. By varying the flow amplitude and frequency at the inlet, we uncover a delicate relationship with vortex size and vortex disturbance, and we demonstrate the potential for significant decrease in wash-out time with low-frequency high-amplitude conditions. We then compare this result to the commonly used practice of flushing, a discrete and temporary increase in flow, and we also demonstrate the qualitative robustness of our findings to changes in cavity geometry.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48318699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-25DOI: 10.3389/fruro.2023.1272592
Xiaolong Wang, Qingfeng Yu, M. Michel
{"title":"Editorial: Benign prostatic hyperplasia and overactive bladder: new members of metabolic syndrome","authors":"Xiaolong Wang, Qingfeng Yu, M. Michel","doi":"10.3389/fruro.2023.1272592","DOIUrl":"https://doi.org/10.3389/fruro.2023.1272592","url":null,"abstract":"","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44148266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-09DOI: 10.3389/fruro.2023.1229709
P. Yonover, Ceressa T. Ward, Brian C Mazzarella, K. Phillips, Brad W Jensen, Vincent T. Bicocca, K. Duffy, Jaden Yonover, Ava Cherry, Trevor G Levin
Metachronous upper tract urothelial carcinoma (UTUC) is a rare yet aggressive malignancy that is often multifocal and invasive at the time of diagnosis. Unfortunately, the rarity of metachronous UTUC results in a paucity of targeted data, as current literature and clinical management of this tumor is largely extrapolated from that of bladder cancer. Urinary comprehensive genomic profiling with the UroAmp assay identifies six general classes of tumor-mutations present in the urine and thus, may aid in detecting UTUC when the limitations of current tools impede definitive diagnosis. We describe the utility of urinary comprehensive genomic profiling in confirming the provider’s suspicion for metachronous UTUC and recommending radical nephroureterectomy.A 68-year-old male with a history of recurrent carcinoma in situ (CIS) of the bladder presented to the urology clinic in 2022 for continued surveillance. Abnormal soft tissue thickening surrounding the proximal right ureter, revealed on computerized tomography urography, prompted further evaluation. Selective right upper tract cytology was indeterminate, and urinary comprehensive genomic profiling was ordered to adjudicate. No tumor was visualized on ureteroscopy however the cytologic brush biopsy of the renal pelvis and proximal ureter were positive for urothelial carcinoma (UC) and/or CIS. UroAmp testing identified genomic features associated with high-grade UC, risk of invasion, and a high genomic disease burden.The patient underwent a right kidney and ureter nephroureterectomy in September 2022. Surgical pathology confirmed non-invasive multifocal urothelial CIS. A postoperative urinary comprehensive genomic profiling in February and May of 2023 detected no evidence of residual disease, consistent with complete resection of the tumor. The provider will continue intensive urinary comprehensive genomic profile monitoring coupled with conventional surveillance.Urinary measurement of mutated UC genes correlate with disease burden, pathologic grade, and invasion risk and provide clinical utility when reliance on visual confirmation and cytology were not definitive or feasible.
{"title":"Clinical utility of urinary comprehensive genomic profiling in diagnosing metachronous upper tract urothelial carcinoma: a case report","authors":"P. Yonover, Ceressa T. Ward, Brian C Mazzarella, K. Phillips, Brad W Jensen, Vincent T. Bicocca, K. Duffy, Jaden Yonover, Ava Cherry, Trevor G Levin","doi":"10.3389/fruro.2023.1229709","DOIUrl":"https://doi.org/10.3389/fruro.2023.1229709","url":null,"abstract":"Metachronous upper tract urothelial carcinoma (UTUC) is a rare yet aggressive malignancy that is often multifocal and invasive at the time of diagnosis. Unfortunately, the rarity of metachronous UTUC results in a paucity of targeted data, as current literature and clinical management of this tumor is largely extrapolated from that of bladder cancer. Urinary comprehensive genomic profiling with the UroAmp assay identifies six general classes of tumor-mutations present in the urine and thus, may aid in detecting UTUC when the limitations of current tools impede definitive diagnosis. We describe the utility of urinary comprehensive genomic profiling in confirming the provider’s suspicion for metachronous UTUC and recommending radical nephroureterectomy.A 68-year-old male with a history of recurrent carcinoma in situ (CIS) of the bladder presented to the urology clinic in 2022 for continued surveillance. Abnormal soft tissue thickening surrounding the proximal right ureter, revealed on computerized tomography urography, prompted further evaluation. Selective right upper tract cytology was indeterminate, and urinary comprehensive genomic profiling was ordered to adjudicate. No tumor was visualized on ureteroscopy however the cytologic brush biopsy of the renal pelvis and proximal ureter were positive for urothelial carcinoma (UC) and/or CIS. UroAmp testing identified genomic features associated with high-grade UC, risk of invasion, and a high genomic disease burden.The patient underwent a right kidney and ureter nephroureterectomy in September 2022. Surgical pathology confirmed non-invasive multifocal urothelial CIS. A postoperative urinary comprehensive genomic profiling in February and May of 2023 detected no evidence of residual disease, consistent with complete resection of the tumor. The provider will continue intensive urinary comprehensive genomic profile monitoring coupled with conventional surveillance.Urinary measurement of mutated UC genes correlate with disease burden, pathologic grade, and invasion risk and provide clinical utility when reliance on visual confirmation and cytology were not definitive or feasible.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43414095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-02DOI: 10.3389/fruro.2023.1240362
Olivia Krivitsky, K. Badani, T. Patel
{"title":"Editorial: Insights in urologic oncology, volume I","authors":"Olivia Krivitsky, K. Badani, T. Patel","doi":"10.3389/fruro.2023.1240362","DOIUrl":"https://doi.org/10.3389/fruro.2023.1240362","url":null,"abstract":"","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48694209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.3389/fruro.2023.1174626
Walter Cazzaniga, Janette Kinsella, Adam Kieran Pearce, Masood Moghul, Louis Fox, Mieke Van Hemelrijck, Alison Reid, Robert Huddart, David Nicol
Introduction Despite the excellent long-term prognosis after treatment for testicular cancer (TCa), therapy-related side effects can be persistent and severe. The aim of this study was to determine the nature and prevalence of post-treatment symptoms and their impact on health-related quality of life (HRQoL) in TCa patients 12 to 24 months after treatment. Materials and methods Cross-sectional, single-center study. All patients who were aged 18 and over, had completed TCa treatment 12–24 months previously and had no evidence of disease recurrence were considered eligible. Participants were stratified into four groups: 1) orchidectomy only; 2) orchidectomy and single dose adjuvant carboplatin; 3) multi-agent induction chemotherapy (CBOP-BEP, BEPx3 or x4, or Epx4 regimens); and 4) post-chemo retroperitoneal lymph node dissection (PC-RPLND). Eligible patients were asked to complete the EQ-5D-5L questionnaire and the EORTC QLQ-TC26 questionnaire. We performed a thematic analysis of free-text commentary to evaluate the sensitivity of PROMs used across the treatment groups. Descriptive results were reported. For categorical variables, numbers and percentages were used, and for continuous variables median and IQR values were used. Results The EQ-5D-5L questionnaire showed that patients treated with orchidectomy only and orchidectomy and adjuvant carboplatin experienced only minor physical medium- to long-term side-effects. In contrast, more intensive treatment regimens, such as multi-agent chemotherapy or PC-RPLND, were associated with a higher burden of medium- to long-term side-effects. Similar results were obtained with the EORTC QLQ-TC26 questionnaire. Conclusions This study reports the medium- to long-term HRQoL and side effects of TCa treatments, using both EQ-5D-5L and EORTC QLQ-TC26 questionnaires, and identifies possibly “unasked” questions from a patient perspective in relation to supportive care needs following TCa treatment. This information will help clinicians to better understand the consequences of treatment and in turn provide better patient counseling before treatment.
{"title":"Understanding the health-related quality of life and treatment-related side-effects in patients who have been in remission from testicular cancer for 12–24 months","authors":"Walter Cazzaniga, Janette Kinsella, Adam Kieran Pearce, Masood Moghul, Louis Fox, Mieke Van Hemelrijck, Alison Reid, Robert Huddart, David Nicol","doi":"10.3389/fruro.2023.1174626","DOIUrl":"https://doi.org/10.3389/fruro.2023.1174626","url":null,"abstract":"Introduction Despite the excellent long-term prognosis after treatment for testicular cancer (TCa), therapy-related side effects can be persistent and severe. The aim of this study was to determine the nature and prevalence of post-treatment symptoms and their impact on health-related quality of life (HRQoL) in TCa patients 12 to 24 months after treatment. Materials and methods Cross-sectional, single-center study. All patients who were aged 18 and over, had completed TCa treatment 12–24 months previously and had no evidence of disease recurrence were considered eligible. Participants were stratified into four groups: 1) orchidectomy only; 2) orchidectomy and single dose adjuvant carboplatin; 3) multi-agent induction chemotherapy (CBOP-BEP, BEPx3 or x4, or Epx4 regimens); and 4) post-chemo retroperitoneal lymph node dissection (PC-RPLND). Eligible patients were asked to complete the EQ-5D-5L questionnaire and the EORTC QLQ-TC26 questionnaire. We performed a thematic analysis of free-text commentary to evaluate the sensitivity of PROMs used across the treatment groups. Descriptive results were reported. For categorical variables, numbers and percentages were used, and for continuous variables median and IQR values were used. Results The EQ-5D-5L questionnaire showed that patients treated with orchidectomy only and orchidectomy and adjuvant carboplatin experienced only minor physical medium- to long-term side-effects. In contrast, more intensive treatment regimens, such as multi-agent chemotherapy or PC-RPLND, were associated with a higher burden of medium- to long-term side-effects. Similar results were obtained with the EORTC QLQ-TC26 questionnaire. Conclusions This study reports the medium- to long-term HRQoL and side effects of TCa treatments, using both EQ-5D-5L and EORTC QLQ-TC26 questionnaires, and identifies possibly “unasked” questions from a patient perspective in relation to supportive care needs following TCa treatment. This information will help clinicians to better understand the consequences of treatment and in turn provide better patient counseling before treatment.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135209558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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