Pub Date : 2023-08-01DOI: 10.1097/ju9.0000000000000043
Charla Holdren, Christopher Pulford, Kevin T. Keating, David Peifer, R. Eames, S. Wisnewski, T. Maatman
The purpose of this study was to evaluate the prevalence of positive periurethral lymph nodes during robotic-assisted radical prostatectomy (RARP) and to investigate the relationship between secondary end points of tumor staging, PSA, and Gleason score. This study is a retrospective review of 1177 RARPs performed from October 2011 to February 2022. Using pathology reports, the study population was condensed to 58 patients who had periurethral lymph node tissue. This population was then analyzed for the prevalence of malignant tissue in the specimen. A secondary analysis was performed for data on PSA, Gleason score (preoperative and postoperative), and tumor-nodes-metastases (TNM) staging. Retrospective analysis demonstrated 9 of 58 specimens (15.5%) to be positive for malignancy. There was a statistically significant (P < .004) correlation between lymph node status and PSA. The average PSA was 17.60 (SD = 15.54) for those with positive periurethral lymph nodes and 7.96 (SD = 6.65) for those with negative periurethral lymph nodes. There was no statistically significant association between lymph node status and preoperative Gleason scores. There was, however, a statistically significant difference across lymph node status and postoperative Gleason scores (X2 (3) = 11.09, P = .01). Positive periurethral lymph nodes demonstrated higher average PSAs, postoperative Gleason scores, and TNM staging. Further analysis is required to evaluate potential prognostic implications.
{"title":"Retrospective Review of Periurethral Lymph Node Dissection in Clinically Localized Prostate Cancer","authors":"Charla Holdren, Christopher Pulford, Kevin T. Keating, David Peifer, R. Eames, S. Wisnewski, T. Maatman","doi":"10.1097/ju9.0000000000000043","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000043","url":null,"abstract":"\u0000 \u0000 \u0000 The purpose of this study was to evaluate the prevalence of positive periurethral lymph nodes during robotic-assisted radical prostatectomy (RARP) and to investigate the relationship between secondary end points of tumor staging, PSA, and Gleason score.\u0000 \u0000 \u0000 \u0000 This study is a retrospective review of 1177 RARPs performed from October 2011 to February 2022. Using pathology reports, the study population was condensed to 58 patients who had periurethral lymph node tissue. This population was then analyzed for the prevalence of malignant tissue in the specimen. A secondary analysis was performed for data on PSA, Gleason score (preoperative and postoperative), and tumor-nodes-metastases (TNM) staging.\u0000 \u0000 \u0000 \u0000 Retrospective analysis demonstrated 9 of 58 specimens (15.5%) to be positive for malignancy. There was a statistically significant (P < .004) correlation between lymph node status and PSA. The average PSA was 17.60 (SD = 15.54) for those with positive periurethral lymph nodes and 7.96 (SD = 6.65) for those with negative periurethral lymph nodes. There was no statistically significant association between lymph node status and preoperative Gleason scores. There was, however, a statistically significant difference across lymph node status and postoperative Gleason scores (X2 (3) = 11.09, P = .01).\u0000 \u0000 \u0000 \u0000 Positive periurethral lymph nodes demonstrated higher average PSAs, postoperative Gleason scores, and TNM staging. Further analysis is required to evaluate potential prognostic implications.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41318000","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 : 2023-08-01Epub Date: 2023-08-02DOI: 10.1097/ju9.0000000000000035
Runzhuo Ma, Steven Cen, Edward Forsyth, Patrick Probst, Aeen Asghar, William Townsend, Alvin Hui, Aditya Desai, Michael Tzeng, Emily Cheng, Ashwin Ramaswamy, Christian Wagner, Jim C Hu, Andrew J Hung
Purpose: To examine the association between the quality of neurovascular bundle dissection and urinary continence recovery after robotic-assisted radical prostatectomy.
Materials and methods: Patients who underwent RARPs from 2016 to 2018 in two institutions with ≥1-year postoperative follow-up were included. The primary outcomes were time to urinary continence recovery. Surgical videos were independently assessed by 3 blinded raters using the validated Dissection Assessment for Robotic Technique (DART) tool after standardized training. Cox regression was used to test the association between DART scores and urinary continence recovery while adjusting for relevant patient features.
Results: 121 RARP performed by 23 surgeons with various experience levels were included. The median follow-up was 24 months (95% CI 20 - 28 months). The median time to continence recovery was 7.3 months (95% CI 4.7 - 9.8 months). After adjusting for patient age, higher scores of certain DART domains, specifically tissue retraction and efficiency, were significantly associated with increased odds of continence recovery (p<0.05).
Conclusions: Technical skill scores of neurovascular bundle dissection vary among surgeons and correlate with urinary continence recovery. Unveiling the specific robotic dissection skillsets which impact patient outcomes has the potential to focus surgical training.
{"title":"Technical surgical skill assessment of neurovascular bundle dissection and urinary continence recovery after robotic-assisted radical prostatectomy.","authors":"Runzhuo Ma, Steven Cen, Edward Forsyth, Patrick Probst, Aeen Asghar, William Townsend, Alvin Hui, Aditya Desai, Michael Tzeng, Emily Cheng, Ashwin Ramaswamy, Christian Wagner, Jim C Hu, Andrew J Hung","doi":"10.1097/ju9.0000000000000035","DOIUrl":"10.1097/ju9.0000000000000035","url":null,"abstract":"<p><strong>Purpose: </strong>To examine the association between the <i>quality</i> of neurovascular bundle dissection and urinary continence recovery after robotic-assisted radical prostatectomy.</p><p><strong>Materials and methods: </strong>Patients who underwent RARPs from 2016 to 2018 in two institutions with ≥1-year postoperative follow-up were included. The primary outcomes were time to urinary continence recovery. Surgical videos were independently assessed by 3 blinded raters using the validated <i>Dissection Assessment for Robotic Technique (DART)</i> tool after standardized training. Cox regression was used to test the association between DART scores and urinary continence recovery while adjusting for relevant patient features.</p><p><strong>Results: </strong>121 RARP performed by 23 surgeons with various experience levels were included. The median follow-up was 24 months (95% CI 20 - 28 months). The median time to continence recovery was 7.3 months (95% CI 4.7 - 9.8 months). After adjusting for patient age, higher scores of certain DART domains, specifically <i>tissue retraction</i> and <i>efficiency</i>, were significantly associated with increased odds of continence recovery (p<0.05).</p><p><strong>Conclusions: </strong>Technical skill scores of neurovascular bundle dissection vary among surgeons and correlate with urinary continence recovery. Unveiling the specific robotic dissection skillsets which impact patient outcomes has the potential to focus surgical training.</p>","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10768840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49626475","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}
Pub Date : 2023-07-01DOI: 10.1097/ju9.0000000000000039
Pasin Limudomporn, N. Sathirapongsasuti, S. Worawichawong, Pokket Sirisreetreeru, W. Kongcharoensombat, K. Kijvikai, Samapat Jittawera, Jitpanu Kocharoenwat, P. Jenjitranant
To examine the diagnostic accuracy of the urinary prostate cancer gene 3 score for prostate cancer in Thai patients with prostate-specific antigen levels of 3 to 10 ng/ml undergoing an initial prostate biopsy. In this prospective, single-center study, urine samples were collected after prostate massage. Urinary prostate cancer gene 3 mRNA levels were measured by real-time quantitative polymerase chain reaction. Data, including age, biopsy results, preoperative prostate-specific antigen levels, prostate-specific antigen density, prostate-specific antigen velocity, prostate volume, and prostate imaging findings, were collected between June 1, 2020, and May 15, 2021. The median prostate-specific antigen level of the 70 included patients was 6.31 ng/ml. Sixteen patients had positive biopsy results (22.9%). The prostate cancer gene 3 score (695.09 vs 268.79, P < .01), prostate-specific antigen density (0.19 vs 0.13, P < .01), and prostate-specific antigen velocity (2.68 vs 0.44, P < .01) significantly differed between the positive and negative biopsy groups. The predictive power of the prostate cancer gene 3 score was evaluated using receiver operating characteristic curves. At a prostate cancer gene 3 score threshold of 366.02, the sensitivity and specificity were 78.57% and 79.25%, respectively. Meanwhile, the areas under the curve of the prostate cancer gene 3 score, prostate-specific antigen velocity, and prostate-specific antigen density were better than that of prostate-specific antigen for predicting a positive biopsy. Our study confirmed the diagnostic accuracy of prostate cancer gene 3 for predicting a positive biopsy in Thai men with prostate-specific antigen levels of 3 to 10 ng/mL. Combining the prostate cancer gene 3 score and prostate-specific antigen derivatives might be helpful for identifying patients who can avoid unnecessary biopsies and subsequent complications.
在接受初步前列腺活检的前列腺特异性抗原水平为3至10ng/ml的泰国患者中，检查前列腺癌症基因3评分对前列腺癌症的诊断准确性。在这项前瞻性的单中心研究中，前列腺按摩后采集尿液样本。采用实时定量聚合酶链反应测定尿前列腺癌症基因3 mRNA水平。2020年6月1日至2021年5月15日期间收集的数据包括年龄、活检结果、术前前列腺特异性抗原水平、前列腺特异性抗体密度、前列腺特异抗原速度、前列腺体积和前列腺成像结果。70名纳入患者的前列腺特异性抗原水平中位数为6.31 ng/ml。16例患者活检结果为阳性（22.9%）。前列腺癌症基因3评分（695.09 vs 268.79，P＜0.01）、前列腺特异性抗原密度（0.19 vs 0.13，P＜.01）和前列腺特异性抗体速度（2.68 vs 0.44，P＜.001）在阳性和阴性活检组之间有显著差异。使用受试者操作特征曲线评估前列腺癌症基因3评分的预测能力。在前列腺癌症基因3评分阈值为366.02时，敏感性和特异性分别为78.57%和79.25%。同时，前列腺癌症基因3评分、前列腺特异性抗原速度和前列腺特异性抗体密度的曲线下面积在预测阳性活检方面优于前列腺特异性蛋白。我们的研究证实了前列腺癌症基因3预测前列腺特异性抗原水平为3至10ng/mL的泰国男性活检阳性的诊断准确性。结合前列腺癌症基因3评分和前列腺特异性抗原衍生物可能有助于识别可以避免不必要的活检和随后并发症的患者。
{"title":"Diagnostic Accuracy of Urinary PCA3 for Prostate Cancer in Thai Patients With PSA Levels of 3 to 10 ng/ml Undergoing an Initial Prostate Biopsy","authors":"Pasin Limudomporn, N. Sathirapongsasuti, S. Worawichawong, Pokket Sirisreetreeru, W. Kongcharoensombat, K. Kijvikai, Samapat Jittawera, Jitpanu Kocharoenwat, P. Jenjitranant","doi":"10.1097/ju9.0000000000000039","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000039","url":null,"abstract":"\u0000 \u0000 To examine the diagnostic accuracy of the urinary prostate cancer gene 3 score for prostate cancer in Thai patients with prostate-specific antigen levels of 3 to 10 ng/ml undergoing an initial prostate biopsy.\u0000 \u0000 \u0000 \u0000 In this prospective, single-center study, urine samples were collected after prostate massage. Urinary prostate cancer gene 3 mRNA levels were measured by real-time quantitative polymerase chain reaction. Data, including age, biopsy results, preoperative prostate-specific antigen levels, prostate-specific antigen density, prostate-specific antigen velocity, prostate volume, and prostate imaging findings, were collected between June 1, 2020, and May 15, 2021.\u0000 \u0000 \u0000 \u0000 The median prostate-specific antigen level of the 70 included patients was 6.31 ng/ml. Sixteen patients had positive biopsy results (22.9%). The prostate cancer gene 3 score (695.09 vs 268.79, P < .01), prostate-specific antigen density (0.19 vs 0.13, P < .01), and prostate-specific antigen velocity (2.68 vs 0.44, P < .01) significantly differed between the positive and negative biopsy groups. The predictive power of the prostate cancer gene 3 score was evaluated using receiver operating characteristic curves. At a prostate cancer gene 3 score threshold of 366.02, the sensitivity and specificity were 78.57% and 79.25%, respectively. Meanwhile, the areas under the curve of the prostate cancer gene 3 score, prostate-specific antigen velocity, and prostate-specific antigen density were better than that of prostate-specific antigen for predicting a positive biopsy.\u0000 \u0000 \u0000 \u0000 Our study confirmed the diagnostic accuracy of prostate cancer gene 3 for predicting a positive biopsy in Thai men with prostate-specific antigen levels of 3 to 10 ng/mL. Combining the prostate cancer gene 3 score and prostate-specific antigen derivatives might be helpful for identifying patients who can avoid unnecessary biopsies and subsequent complications.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45531807","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 : 2023-07-01DOI: 10.1097/ju9.0000000000000033
S. Rojanasarot, Julie Baxter, Emi Suzuki, J. Bresee, B. Chughtai
Prostatic urethral lift (PUL) and water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) differ in treatment durability and cost of disposables, possibly leading to different long-term costs. This study compares the budget impact of PUL and WVTT for US payers in 6 states (Alabama, New Jersey, New York, Oregon, Pennsylvania, and Washington) over a 5-year time horizon. An Excel-based budget impact model was developed to estimate average total medical costs per patient of PUL and WVTT at years 1 and 5 for men with moderate-to-severe BPH. After undergoing an index procedure, men could experience adverse events (AEs) or retreatment while accumulating costs over time. Clinical inputs were derived from PUL and WVTT clinical trials while cost inputs were derived from 2021 Medicare reimbursement rates. At year 1, per-patient costs of PUL ranged from $5690 (Alabama) to $7323 (New Jersey) compared with year 1 costs of WVTT that ranged from $1829 (Alabama) to $2330 (New Jersey). The lower year 1 costs of WVTT stemmed from both lower procedural costs relative to PUL and better durability (lower costs associated with fewer retreatments and AEs). The cost differences between the 2 treatments continued to diverge in years 2 to 5. Through year 5, the cost savings associated with WVTT vs PUL ranged from $4383 (Alabama) to $5649 (New Jersey). Compared with PUL, the use of WVTT could potentially allow payers to cover BPH treatments for more members without compromising clinical outcomes or increasing budgets.
{"title":"Budget Impact of Minimally Invasive Surgical Treatments of Benign Prostatic Hyperplasia: An Analysis of 6 States With Limited New Technology Coverage","authors":"S. Rojanasarot, Julie Baxter, Emi Suzuki, J. Bresee, B. Chughtai","doi":"10.1097/ju9.0000000000000033","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000033","url":null,"abstract":"\u0000 \u0000 Prostatic urethral lift (PUL) and water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) differ in treatment durability and cost of disposables, possibly leading to different long-term costs. This study compares the budget impact of PUL and WVTT for US payers in 6 states (Alabama, New Jersey, New York, Oregon, Pennsylvania, and Washington) over a 5-year time horizon.\u0000 \u0000 \u0000 \u0000 An Excel-based budget impact model was developed to estimate average total medical costs per patient of PUL and WVTT at years 1 and 5 for men with moderate-to-severe BPH. After undergoing an index procedure, men could experience adverse events (AEs) or retreatment while accumulating costs over time. Clinical inputs were derived from PUL and WVTT clinical trials while cost inputs were derived from 2021 Medicare reimbursement rates.\u0000 \u0000 \u0000 \u0000 At year 1, per-patient costs of PUL ranged from $5690 (Alabama) to $7323 (New Jersey) compared with year 1 costs of WVTT that ranged from $1829 (Alabama) to $2330 (New Jersey). The lower year 1 costs of WVTT stemmed from both lower procedural costs relative to PUL and better durability (lower costs associated with fewer retreatments and AEs). The cost differences between the 2 treatments continued to diverge in years 2 to 5. Through year 5, the cost savings associated with WVTT vs PUL ranged from $4383 (Alabama) to $5649 (New Jersey).\u0000 \u0000 \u0000 \u0000 Compared with PUL, the use of WVTT could potentially allow payers to cover BPH treatments for more members without compromising clinical outcomes or increasing budgets.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42461550","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 : 2023-07-01DOI: 10.1097/ju9.0000000000000038
N. Bhojani, N. Shalabi, A. Reicherz, R. Herout, Kyle Searles, K. Wong, B. Chew
To compare the attributes of the next-generation LithoVue Elite (LVE, Boston Scientific Corporation) with current state-of-the-art single-use and reusable flexible ureteroscopes. LithoVue Elite is the latest single-use flexible ureteroscope with improved functionality and a novel ability to measure intrarenal pressure. In this study, we compare LVE with 3 single-use ureteroscopes (Pusen, WiScope, and Anqing) and 1 reusable ureteroscope (Olympus). A bench model was used to measure the physical characteristics (tip deflection and irrigation) and image quality (resolution, color accuracy, field of view, and latency). A human cadaveric model was used to score the maneuverability and ergonomics. This abstract shows the least square means from multiway ANOVAs used for analysis. The ureteroscopes showed a tip deflection ranging from 243° to 306° with LVE at 279°. The irrigation rates ranged from 28 to 44 mL/min with LVE at 40 ml/min. LVE had a resolution of 6.34 line pair/mm, while the other scopes ranged from 4.86 to 5.77 line pairs/mm. The color accuracy was quantified with Delta E, an image analysis variable, which ranged from 14 to 42 with LVE at 28. The field of view ranged from 55° to 89°, and LVE was at 89°. The image latency ranged from 41 to 92 ms with LVE at 58 ms. Finally, the maneuverability scores ranged from 3.8 to 4.1 of 5 with LVE scoring 4.1 while the ergonomics scores ranged from 2.4 to 4.8 with LVE scoring 4.4. LithoVue Elite had above average performance compared with single-use and reusable ureteroscopes and upper-range scores for resolution, field of view, maneuverability, and ergonomics. Accordingly, LVE shows promise; however, further research is needed to assess the impact of intrarenal pressure on the standard of care.
{"title":"LithoVue Elite Compared With Single-Use and Reusable Ureteroscopes: A Bench and Human Cadaver Study","authors":"N. Bhojani, N. Shalabi, A. Reicherz, R. Herout, Kyle Searles, K. Wong, B. Chew","doi":"10.1097/ju9.0000000000000038","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000038","url":null,"abstract":"\u0000 \u0000 To compare the attributes of the next-generation LithoVue Elite (LVE, Boston Scientific Corporation) with current state-of-the-art single-use and reusable flexible ureteroscopes.\u0000 \u0000 \u0000 \u0000 LithoVue Elite is the latest single-use flexible ureteroscope with improved functionality and a novel ability to measure intrarenal pressure. In this study, we compare LVE with 3 single-use ureteroscopes (Pusen, WiScope, and Anqing) and 1 reusable ureteroscope (Olympus). A bench model was used to measure the physical characteristics (tip deflection and irrigation) and image quality (resolution, color accuracy, field of view, and latency). A human cadaveric model was used to score the maneuverability and ergonomics. This abstract shows the least square means from multiway ANOVAs used for analysis.\u0000 \u0000 \u0000 \u0000 The ureteroscopes showed a tip deflection ranging from 243° to 306° with LVE at 279°. The irrigation rates ranged from 28 to 44 mL/min with LVE at 40 ml/min. LVE had a resolution of 6.34 line pair/mm, while the other scopes ranged from 4.86 to 5.77 line pairs/mm. The color accuracy was quantified with Delta E, an image analysis variable, which ranged from 14 to 42 with LVE at 28. The field of view ranged from 55° to 89°, and LVE was at 89°. The image latency ranged from 41 to 92 ms with LVE at 58 ms. Finally, the maneuverability scores ranged from 3.8 to 4.1 of 5 with LVE scoring 4.1 while the ergonomics scores ranged from 2.4 to 4.8 with LVE scoring 4.4.\u0000 \u0000 \u0000 \u0000 LithoVue Elite had above average performance compared with single-use and reusable ureteroscopes and upper-range scores for resolution, field of view, maneuverability, and ergonomics. Accordingly, LVE shows promise; however, further research is needed to assess the impact of intrarenal pressure on the standard of care.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48947646","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 : 2023-07-01DOI: 10.1097/ju9.0000000000000048
John W. Davis
{"title":"JU Open Plus: The Urologic Training Graduation Season","authors":"John W. Davis","doi":"10.1097/ju9.0000000000000048","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000048","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43651138","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 : 2023-07-01DOI: 10.1097/ju9.0000000000000034
G. Hatiboglu, S. Nair, J. Relle, J. Hafron, Z. Kassam, K. Nandalur, M. Mueller-Wolf, D. Bonekamp, P. Doerwald, G. Clarke, H. Schlemmer, Matthias Roethke, S. Pahernik, Joseph L K Chin
Long-term data on functional outcomes after MRI-guided transurethral ultrasound ablation (TULSA) are limited. We assess the 5-year post-TULSA durability of outcomes for patient-reported genitourinary function, bowel function, and adverse events in 30 patients with primary, localized prostate cancer treated with TULSA across 3 centers. Patients received a conservative treatment plan in a phase 1 study designed to assess safety and feasibility. Follow-up visits took place at 1, 3, 6, 12 months, and biannually up to 5 years. Median (interquartile range) age at baseline was 69 (67-71) years. Erectile dysfunction (International Index of Erectile Function [IIEF] ≤17) was prevalent at baseline, with a mean (95% confidence interval [CI]) score of 16 (12-19), decreasing to 9 (4-14) at 5 years. At the 5-year visit, 71% of men who attempted intercourse in the recall period reported preservation of IIEF Q2 ≥2 erections sufficient for penetration. The mean (95% CI) International Prostate Symptom Score (IPSS) decreased from 9.0 (7.0-11) to 7.1 (5.0-9.1) from baseline to 5 years; IPSS-quality of life, maximum urinary flow rate, and post-void residual urine were stable or improved. Maintenance of bowel function and urinary continence was 100%. There was no new attributable serious or severe adverse event from 1 to 5 years. With a durably favorable safety profile, TULSA has the potential to treat cancer conservatively while simultaneously alleviating lower urinary tract symptoms. Data from larger studies are pending.
{"title":"Durability of Functional Outcomes After MRI-Guided Transurethral Ultrasound Ablation of the Prostate","authors":"G. Hatiboglu, S. Nair, J. Relle, J. Hafron, Z. Kassam, K. Nandalur, M. Mueller-Wolf, D. Bonekamp, P. Doerwald, G. Clarke, H. Schlemmer, Matthias Roethke, S. Pahernik, Joseph L K Chin","doi":"10.1097/ju9.0000000000000034","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000034","url":null,"abstract":"\u0000 \u0000 Long-term data on functional outcomes after MRI-guided transurethral ultrasound ablation (TULSA) are limited. We assess the 5-year post-TULSA durability of outcomes for patient-reported genitourinary function, bowel function, and adverse events in 30 patients with primary, localized prostate cancer treated with TULSA across 3 centers. Patients received a conservative treatment plan in a phase 1 study designed to assess safety and feasibility. Follow-up visits took place at 1, 3, 6, 12 months, and biannually up to 5 years. Median (interquartile range) age at baseline was 69 (67-71) years. Erectile dysfunction (International Index of Erectile Function [IIEF] ≤17) was prevalent at baseline, with a mean (95% confidence interval [CI]) score of 16 (12-19), decreasing to 9 (4-14) at 5 years. At the 5-year visit, 71% of men who attempted intercourse in the recall period reported preservation of IIEF Q2 ≥2 erections sufficient for penetration. The mean (95% CI) International Prostate Symptom Score (IPSS) decreased from 9.0 (7.0-11) to 7.1 (5.0-9.1) from baseline to 5 years; IPSS-quality of life, maximum urinary flow rate, and post-void residual urine were stable or improved. Maintenance of bowel function and urinary continence was 100%. There was no new attributable serious or severe adverse event from 1 to 5 years. With a durably favorable safety profile, TULSA has the potential to treat cancer conservatively while simultaneously alleviating lower urinary tract symptoms. Data from larger studies are pending.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42833865","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 : 2023-07-01DOI: 10.1097/ju9.0000000000000042
Y. Miyazawa, M. Nomura, Nozomi Matsumura, Y. Fujizuka, Y. Sekine, Y. Tsuji, T. Syuto, H. Yokoo, Kazuhiro Suzuki
Perinephric fat removal is essential for safe and effective robotic-assisted partial nephrectomy (RAPN). Adherent perinephric fat (APF) occasionally compromises RAPN, but the relationship between such fat and sex hormone levels is unclear. We explored a possible association between APF and sex hormone levels in serum and APF tissue. We conducted a prospective study from 2021 to 2022 at Gunma University Hospital. Fifty patients treated using RAPN were analyzed. We measured the testosterone (T) and estradiol (E) levels in serum and perinephric fat using liquid chromatography-mass spectrometry (LC-MS/MS). The correlations between the extent of adherence measured intraoperatively and hormone concentrations were examined. Of the 50 cases, 36 were male, and 14 were female. APF was observed in 16 of the male patients but in no female patients. In male patients, the T levels in perinephric fat were significantly higher in patients with APF. E2 levels in perinephric fat tissue were also significantly higher in patients with APF. In the 36 male patients lacking APF, there were no significant differences in the serum levels of T compared with those with APF, but a significant difference was apparent in APF tissue. The changed T level in APF tissue may have affected APF development.
{"title":"Relationship Between Adherent Perinephric Fat and Sex Hormone Levels in Serum and Fat in Patients Undergoing Robotic-Assisted Partial Nephrectomy: A Prospective Study","authors":"Y. Miyazawa, M. Nomura, Nozomi Matsumura, Y. Fujizuka, Y. Sekine, Y. Tsuji, T. Syuto, H. Yokoo, Kazuhiro Suzuki","doi":"10.1097/ju9.0000000000000042","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000042","url":null,"abstract":"\u0000 \u0000 Perinephric fat removal is essential for safe and effective robotic-assisted partial nephrectomy (RAPN). Adherent perinephric fat (APF) occasionally compromises RAPN, but the relationship between such fat and sex hormone levels is unclear. We explored a possible association between APF and sex hormone levels in serum and APF tissue.\u0000 \u0000 \u0000 \u0000 We conducted a prospective study from 2021 to 2022 at Gunma University Hospital. Fifty patients treated using RAPN were analyzed. We measured the testosterone (T) and estradiol (E) levels in serum and perinephric fat using liquid chromatography-mass spectrometry (LC-MS/MS). The correlations between the extent of adherence measured intraoperatively and hormone concentrations were examined.\u0000 \u0000 \u0000 \u0000 Of the 50 cases, 36 were male, and 14 were female. APF was observed in 16 of the male patients but in no female patients. In male patients, the T levels in perinephric fat were significantly higher in patients with APF. E2 levels in perinephric fat tissue were also significantly higher in patients with APF.\u0000 \u0000 \u0000 \u0000 In the 36 male patients lacking APF, there were no significant differences in the serum levels of T compared with those with APF, but a significant difference was apparent in APF tissue. The changed T level in APF tissue may have affected APF development.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42441381","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 : 2023-07-01DOI: 10.1097/ju9.0000000000000036
Constantin Rieger, Max Hübers, Lucas Kastner, D. Pfister, H. Holling, Axel Heidenreich
Fournier gangrene is a life-threatening urological disease that requires rapid surgical intervention. Despite major improvements in medical therapy, the mortality of Fournier gangrene has not changed during the past 25 years. To potentially improve the outcome, we analyzed different medical processes for overall mortality in the treatment of Fournier gangrene. We performed a retrospective single-center study of 21 patients with Fournier gangrene. Patients were grouped according to initial symptoms, first medical advice, blood tests, medical history, and further clinical processes and compared using a t test, χ2 test, or Fisher exact test. A t test for heterogeneous variances was used if a Levene test showed significantly different variances, otherwise a t test for homogeneous variances was used. The log-rank test was applied for survival analysis. Logistic regression was applied to identify potential clinical predictors for mortality. Follow-up was performed until 130 days after the first surgical intervention. There were no significant differences in the mortality rate of patients depending on the day and time of presentation in the hospital. Of the patients first consulting a urologist (either outpatient or hospital), no patient died within the first 120 days. By contrast, approximately 70% of patients who were transferred by a hospital without urologic specialization or a nonurologic outpatient clinic (P = .008) died within the first 130 days after surgery. Multivariate survival analysis showed that the type of first doctor's advice could serve as a significant factor in determining patients' mortality (P = .031), which also correlated with a significantly shorter duration of the first surgical procedure (110 vs 54 minutes, P = .019). Despite the small cohort, we were able to show a significant correlation between the initial doctor's advice, either by a urologist or nonurologist, and the patient's mortality. Considering the life-threatening potential of Fournier gangrene, professionals should develop strategies to educate nonurologists and raise awareness about this disease and its clinical presentation to optimize rapid intervention and reduce mortality.
富尼尔坏疽是一种危及生命的泌尿系统疾病，需要快速手术干预。尽管医学治疗取得了重大进展，但在过去25年中，富尼耶坏疽的死亡率并没有改变。为了潜在地改善结果，我们分析了富尼耶坏疽治疗中不同的医疗过程对总死亡率的影响。我们对21例富尼尔坏疽患者进行了回顾性单中心研究。根据患者的初始症状、首次医疗建议、血液检查、病史和进一步的临床过程进行分组，并使用t检验、χ2检验或Fisher精确检验进行比较。如果Levene检验显示显著不同的方差，则使用异质性方差的t检验，否则使用同质方差的t检验。生存分析采用log-rank检验。应用逻辑回归来确定死亡率的潜在临床预测因素。随访至第一次手术干预后130天。在医院就诊的日期和时间不同，患者的死亡率没有显著差异。在首次咨询泌尿科医生(门诊或住院)的患者中，没有患者在前120天内死亡。相比之下，由非泌尿科专科医院或非泌尿科门诊转院的患者中约有70% (P = 0.008)在手术后130天内死亡。多变量生存分析显示，首次医生建议的类型可能是决定患者死亡率的重要因素(P = 0.031)，这也与首次手术时间明显缩短相关(110 vs 54分钟，P = 0.019)。尽管这个队列很小，但我们能够证明，泌尿科医生或非泌尿科医生最初的医生建议与患者的死亡率之间存在显著的相关性。考虑到富尼耶坏疽可能危及生命，专业人员应该制定策略来教育非泌尿科医生，提高对这种疾病及其临床表现的认识，以优化快速干预和降低死亡率。
{"title":"Center-based First-line Therapy Is a Significant Predictor for Mortality of Fournier Gangrene","authors":"Constantin Rieger, Max Hübers, Lucas Kastner, D. Pfister, H. Holling, Axel Heidenreich","doi":"10.1097/ju9.0000000000000036","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000036","url":null,"abstract":"\u0000 \u0000 Fournier gangrene is a life-threatening urological disease that requires rapid surgical intervention. Despite major improvements in medical therapy, the mortality of Fournier gangrene has not changed during the past 25 years. To potentially improve the outcome, we analyzed different medical processes for overall mortality in the treatment of Fournier gangrene.\u0000 \u0000 \u0000 \u0000 We performed a retrospective single-center study of 21 patients with Fournier gangrene. Patients were grouped according to initial symptoms, first medical advice, blood tests, medical history, and further clinical processes and compared using a t test, χ2 test, or Fisher exact test. A t test for heterogeneous variances was used if a Levene test showed significantly different variances, otherwise a t test for homogeneous variances was used. The log-rank test was applied for survival analysis. Logistic regression was applied to identify potential clinical predictors for mortality. Follow-up was performed until 130 days after the first surgical intervention.\u0000 \u0000 \u0000 \u0000 There were no significant differences in the mortality rate of patients depending on the day and time of presentation in the hospital. Of the patients first consulting a urologist (either outpatient or hospital), no patient died within the first 120 days. By contrast, approximately 70% of patients who were transferred by a hospital without urologic specialization or a nonurologic outpatient clinic (P = .008) died within the first 130 days after surgery. Multivariate survival analysis showed that the type of first doctor's advice could serve as a significant factor in determining patients' mortality (P = .031), which also correlated with a significantly shorter duration of the first surgical procedure (110 vs 54 minutes, P = .019).\u0000 \u0000 \u0000 \u0000 Despite the small cohort, we were able to show a significant correlation between the initial doctor's advice, either by a urologist or nonurologist, and the patient's mortality. Considering the life-threatening potential of Fournier gangrene, professionals should develop strategies to educate nonurologists and raise awareness about this disease and its clinical presentation to optimize rapid intervention and reduce mortality.\u0000","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48883132","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 : 2023-06-01DOI: 10.1097/ju9.0000000000000030
K. Krughoff, Morgan R. Sturgis, Kristen Logan, A. Peterson
{"title":"Bladder Postoperative Spindle Cell Nodule: Malignant Mimicry in the Postoperative Setting","authors":"K. Krughoff, Morgan R. Sturgis, Kristen Logan, A. Peterson","doi":"10.1097/ju9.0000000000000030","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000030","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61631595","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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