Pub Date : 2024-07-01DOI: 10.1097/ju9.0000000000000160
Daisy Obiora, Bruce L. Jacobs
{"title":"Editorial Comment: Reductions in Prostate-Specific Antigen Screening During the COVID-19 Pandemic in a Universally Insured American Health System","authors":"Daisy Obiora, Bruce L. Jacobs","doi":"10.1097/ju9.0000000000000160","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000160","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"56 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710848","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 : 2024-07-01DOI: 10.1097/ju9.0000000000000174
Erin Ellison, Lauren Faber, Carolyn Ice, Joseph Glass, Jessica Ming, Michael J. Martinez
Melanosis is a rare entity described as brown-black tissue pigmentation secondary to melanin deposition. Presented here is the third reported case of melanosis diagnosed simultaneously with urothelial carcinoma of the bladder. This is only the sixth case associating melanosis with malignancy. The patient is a 78-year-old man who presented with lower urinary tract symptoms and on cystoscopy, was noted to have diffused brown-black bladder pigmentation. Initial pathology showed squamous cell carcinoma with melanosis present. The patient underwent robotic cystectomy with ileal conduit and on final pathology, had urothelial carcinoma with squamous differentiation. A literature review was performed for both benign-associated and malignant-associated melanosis. The review elucidated that melanosis may herald malignancy in 16% of available reported cases, suggesting even a patient with benign melanosis should undergo surveillance.
{"title":"Urinary Bladder Melanosis Diagnosed Simultaneously With Urothelial Carcinoma: A Case Report and Literature Review","authors":"Erin Ellison, Lauren Faber, Carolyn Ice, Joseph Glass, Jessica Ming, Michael J. Martinez","doi":"10.1097/ju9.0000000000000174","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000174","url":null,"abstract":"Melanosis is a rare entity described as brown-black tissue pigmentation secondary to melanin deposition. Presented here is the third reported case of melanosis diagnosed simultaneously with urothelial carcinoma of the bladder. This is only the sixth case associating melanosis with malignancy. The patient is a 78-year-old man who presented with lower urinary tract symptoms and on cystoscopy, was noted to have diffused brown-black bladder pigmentation. Initial pathology showed squamous cell carcinoma with melanosis present. The patient underwent robotic cystectomy with ileal conduit and on final pathology, had urothelial carcinoma with squamous differentiation. A literature review was performed for both benign-associated and malignant-associated melanosis. The review elucidated that melanosis may herald malignancy in 16% of available reported cases, suggesting even a patient with benign melanosis should undergo surveillance.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"36 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141690409","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 : 2024-07-01DOI: 10.1097/ju9.0000000000000163
Emily Ji, Jonathan Rosenfeld, Devin Boehm, Rebecca Arteaga, Aidan Raikar, Jaewoo Kim, Ziho Lee
Reconstruction of transplant ureteral stricture disease (USD) is a challenging surgical problem. In this article, we review our reconstructive ladder for robotic reconstruction of transplant USD and report our outcomes. We performed a retrospective review of patients undergoing robotic transplant reimplantation for USD after kidney transplantation at our institution between 11/2021 and 3/2023. Only patients with at least 1-year follow-up were included. The first rung of our reconstructive ladder is a side-to-side nontransecting reimplant. We prefer this method whenever possible because it avoids transection of the ureter, preserving the fragile blood supply. When this technique is not possible, because of long stricture length and/or limited bladder mobility, we proceed to the second rung of our reconstructive ladder, a Boari flap reconstruction. Surgical success in our cohort was defined as being hardware-free without evidence of ureteral obstruction on imaging. There were 6 patients in our cohort: 3 underwent side-to-side reconstruction and 3 underwent Boari flap reconstruction. Median console time was 139 minutes (interquartile range [IQR] 85-175), estimated blood loss was 25 milliliters (IQR 25-81), and length of stay was 1 day (IQR 1-3). We had one major (Clavien ≥ III) complication, which was an intensive care unit transfer postoperatively for hypertension requiring a nicardipine drip. Median follow-up was 14 months (IQR 13-18) with a 100% surgical success rate. Utilization of a reconstructive ladder for management of transplant USD may allow for a systematic approach based on reconstructive principles. Our approach was associated with excellent intermediate-term outcomes.
{"title":"Using a Reconstructive Ladder for Surgical Reconstruction of Transplant Ureteral Stricture Disease","authors":"Emily Ji, Jonathan Rosenfeld, Devin Boehm, Rebecca Arteaga, Aidan Raikar, Jaewoo Kim, Ziho Lee","doi":"10.1097/ju9.0000000000000163","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000163","url":null,"abstract":"\u0000 \u0000 Reconstruction of transplant ureteral stricture disease (USD) is a challenging surgical problem. In this article, we review our reconstructive ladder for robotic reconstruction of transplant USD and report our outcomes.\u0000 \u0000 \u0000 \u0000 We performed a retrospective review of patients undergoing robotic transplant reimplantation for USD after kidney transplantation at our institution between 11/2021 and 3/2023. Only patients with at least 1-year follow-up were included. The first rung of our reconstructive ladder is a side-to-side nontransecting reimplant. We prefer this method whenever possible because it avoids transection of the ureter, preserving the fragile blood supply. When this technique is not possible, because of long stricture length and/or limited bladder mobility, we proceed to the second rung of our reconstructive ladder, a Boari flap reconstruction. Surgical success in our cohort was defined as being hardware-free without evidence of ureteral obstruction on imaging.\u0000 \u0000 \u0000 \u0000 There were 6 patients in our cohort: 3 underwent side-to-side reconstruction and 3 underwent Boari flap reconstruction. Median console time was 139 minutes (interquartile range [IQR] 85-175), estimated blood loss was 25 milliliters (IQR 25-81), and length of stay was 1 day (IQR 1-3). We had one major (Clavien ≥ III) complication, which was an intensive care unit transfer postoperatively for hypertension requiring a nicardipine drip. Median follow-up was 14 months (IQR 13-18) with a 100% surgical success rate.\u0000 \u0000 \u0000 \u0000 Utilization of a reconstructive ladder for management of transplant USD may allow for a systematic approach based on reconstructive principles. Our approach was associated with excellent intermediate-term outcomes.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"2 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141699044","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 : 2024-07-01DOI: 10.1097/ju9.0000000000000169
Nigel J. Parr, Timothy Dudderidge
Recently, biodegradable spacers have been introduced to reduce rectal wall toxicity during external beam radiotherapy for prostate cancer. Rectal wall damage with fistula formation is a major complication of primary and salvage prostate cryotherapy. In theory, biodegradable spacers can be used to protect the rectum from the damage associated with cryotherapy. We describe a case of rectal spacer insertion for primary cryotherapy in a patient with high-risk localized prostate cancer who was unsuitable for other radical treatments because of previous treatment of rectal cancer, detailing the rationale for spacer selection, technique, and outcomes. A 57-year-old man was referred, following a regional specialist multidisciplinary team discussion, for an opinion regarding possible primary prostate cryotherapy. He had a history of anterior resection with chemoradiotherapy, followed by local relapse treated with total colectomy with ileoanal pouch formation and suffering from major postoperative complications. After further assessment and because of concern regarding damage to the efferent pouch limb during freezing, the possibility of spacer insertion between the ileoanal segment was considered and discussed. A hyaluronic acid gel spacer was selected and offered “off licence” on a compassionate basis. The spacer was introduced immediately before cryotherapy. Recovery was uncomplicated apart from transient intermittent perineal pain, with good early functional and oncological outcomes. This is the first report of synchronous insertion of a hyaluronic acid gel spacer in prostate cryotherapy. We believe that the technique merits further investigation, with the potential to reduce complications and enhance freezing of the posterior aspect of the gland during cryotherapy.
{"title":"Synchronous Insertion of Hyaluronic Acid-Based Biodegradable Rectal Spacer for Primary Prostate Cryotherapy","authors":"Nigel J. Parr, Timothy Dudderidge","doi":"10.1097/ju9.0000000000000169","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000169","url":null,"abstract":"\u0000 \u0000 Recently, biodegradable spacers have been introduced to reduce rectal wall toxicity during external beam radiotherapy for prostate cancer. Rectal wall damage with fistula formation is a major complication of primary and salvage prostate cryotherapy. In theory, biodegradable spacers can be used to protect the rectum from the damage associated with cryotherapy. We describe a case of rectal spacer insertion for primary cryotherapy in a patient with high-risk localized prostate cancer who was unsuitable for other radical treatments because of previous treatment of rectal cancer, detailing the rationale for spacer selection, technique, and outcomes.\u0000 \u0000 \u0000 \u0000 A 57-year-old man was referred, following a regional specialist multidisciplinary team discussion, for an opinion regarding possible primary prostate cryotherapy. He had a history of anterior resection with chemoradiotherapy, followed by local relapse treated with total colectomy with ileoanal pouch formation and suffering from major postoperative complications. After further assessment and because of concern regarding damage to the efferent pouch limb during freezing, the possibility of spacer insertion between the ileoanal segment was considered and discussed. A hyaluronic acid gel spacer was selected and offered “off licence” on a compassionate basis. The spacer was introduced immediately before cryotherapy.\u0000 \u0000 \u0000 \u0000 Recovery was uncomplicated apart from transient intermittent perineal pain, with good early functional and oncological outcomes.\u0000 \u0000 \u0000 \u0000 This is the first report of synchronous insertion of a hyaluronic acid gel spacer in prostate cryotherapy. We believe that the technique merits further investigation, with the potential to reduce complications and enhance freezing of the posterior aspect of the gland during cryotherapy.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"15 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713826","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 : 2024-07-01DOI: 10.1097/ju9.0000000000000179
Alfredo Aliaga, Mario I. Fernández
{"title":"Editorial Comment: Urinary Bladder Melanosis Diagnosed Simultaneously With Urothelial Carcinoma: A Case Report and Literature Review","authors":"Alfredo Aliaga, Mario I. Fernández","doi":"10.1097/ju9.0000000000000179","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000179","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"40 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710586","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 : 2024-07-01DOI: 10.1097/ju9.0000000000000166
Marwan Alkassis, Omer A. Raheem
{"title":"Editorial Comment: Using a Reconstructive Ladder for Surgical Reconstruction of Transplant Ureteral Stricture Disease","authors":"Marwan Alkassis, Omer A. Raheem","doi":"10.1097/ju9.0000000000000166","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000166","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"27 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710914","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 : 2024-07-01DOI: 10.1097/ju9.0000000000000167
Paolo M. Muraira, Annie Chen, Lori B. Lerner, Steven A. Kaplan, Kevin T. McVary, Franco M. Muraira, Ricardo R. Gonzalez
Generative Pre-Trained Transformer 4 (GPT-4) or ChatGPT, an artificial intelligence language generator, has been used in multiple applications in medicine. We seek to evaluate ChatGPT’s ability to generate appropriate responses consistent with guidelines when asked patient-generated questions regarding benign prostatic hyperplasia (BPH). GPT-4 (Open AI) was queried to answer 20 of the most frequently asked questions regarding BPH according to Google’s search engine. Questions were subclassified into 5 categories: pathophysiology, diagnosis, behavioral modification, procedural interventions, and medical treatments. These responses were graded by expert urologists involved in generating the AUA BPH Clinical Guidelines on 3 domains: accuracy, comprehensiveness, and contemporaneousness. Of the responses generated, 70% were accurate, 73% were comprehensive, and 63% were contemporary. Seventeen percent of GPT-4 responses were inaccurate, incomprehensive, and noncontemporary. The highest scores were in diagnosis (88.9%), pathophysiology (83.3%), and relative medical treatment (70.4%) subcategories. The most inaccurate, incomprehensive, and noncontemporary category was procedural treatments (31.7%). When rated by guideline experts in management of male lower urinary tract symptoms attributed to BPH, GPT-4 has been shown to provide some accurate, comprehensive, and updated information exceeding 80% accuracy, comprehensiveness and contemporaneousness in the categories of diagnosis, and pathophysiology. GPT-4 can serve as an adequate revising tool for patients to learn the basics about BPH regarding diagnosis and pathophysiology, but the current version fails patients in other subcategories such as relative medical treatments and procedural treatments. Given the rise in GPT-4’s ubiquity, it is imperative that the urologic community critically examines all sources of patient information to identify areas of improvement.
{"title":"Limitations of ChatGPT for Patient Education Regarding Frequently Searched Questions About Benign Prostatic Hyperplasia","authors":"Paolo M. Muraira, Annie Chen, Lori B. Lerner, Steven A. Kaplan, Kevin T. McVary, Franco M. Muraira, Ricardo R. Gonzalez","doi":"10.1097/ju9.0000000000000167","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000167","url":null,"abstract":"\u0000 \u0000 Generative Pre-Trained Transformer 4 (GPT-4) or ChatGPT, an artificial intelligence language generator, has been used in multiple applications in medicine. We seek to evaluate ChatGPT’s ability to generate appropriate responses consistent with guidelines when asked patient-generated questions regarding benign prostatic hyperplasia (BPH).\u0000 \u0000 \u0000 \u0000 GPT-4 (Open AI) was queried to answer 20 of the most frequently asked questions regarding BPH according to Google’s search engine. Questions were subclassified into 5 categories: pathophysiology, diagnosis, behavioral modification, procedural interventions, and medical treatments. These responses were graded by expert urologists involved in generating the AUA BPH Clinical Guidelines on 3 domains: accuracy, comprehensiveness, and contemporaneousness.\u0000 \u0000 \u0000 \u0000 Of the responses generated, 70% were accurate, 73% were comprehensive, and 63% were contemporary. Seventeen percent of GPT-4 responses were inaccurate, incomprehensive, and noncontemporary. The highest scores were in diagnosis (88.9%), pathophysiology (83.3%), and relative medical treatment (70.4%) subcategories. The most inaccurate, incomprehensive, and noncontemporary category was procedural treatments (31.7%).\u0000 \u0000 \u0000 \u0000 When rated by guideline experts in management of male lower urinary tract symptoms attributed to BPH, GPT-4 has been shown to provide some accurate, comprehensive, and updated information exceeding 80% accuracy, comprehensiveness and contemporaneousness in the categories of diagnosis, and pathophysiology. GPT-4 can serve as an adequate revising tool for patients to learn the basics about BPH regarding diagnosis and pathophysiology, but the current version fails patients in other subcategories such as relative medical treatments and procedural treatments. Given the rise in GPT-4’s ubiquity, it is imperative that the urologic community critically examines all sources of patient information to identify areas of improvement.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"2011 32","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706920","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 : 2024-07-01DOI: 10.1097/ju9.0000000000000152
Susan M. MacDonald
{"title":"Editorial Comment: Complex Buccal Graft Urethroplasty Combined With HoLEP in the Setting of Concomitant Urethral Stricture Disease and Severe Benign Prostatic Hyperplasia: A Case Report","authors":"Susan M. MacDonald","doi":"10.1097/ju9.0000000000000152","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000152","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"127 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141708614","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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