JU open plus最新文献

{"title":"EDITORIAL COMMENT for: The Minimal Utility of Analyzing Ureteropelvic Junction Tissue at the Time of Pyeloplasty, Has Been Accepted for Publication in JU Open Plus","authors":"A. Shukla","doi":"10.1097/ju9.0000000000000064","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000064","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139305346","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}

{"title":"Underenrolled and Undertreated Advanced Bladder Cancer in Women: It is Time to Improve","authors":"Jesse Persily, Katie S. Murray","doi":"10.1097/ju9.0000000000000068","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000068","url":null,"abstract":"Female exclusion from clinical trials has been a topic of debate and discussion for well over 30 years, with an ever-growing body of literature to support ongoing disparities related to female patient enrollment, along with concerns about downstream effects on treatment efficacy and health outcomes in this patient population.1-3 Awareness of this disparity is the first step in correction. In this edition of JU Open Plus, Miyagi et al4 took a multipronged approach to assess gender representation in major urologic clinical trials, focusing on advanced bladder cancer (BC). To assess the scope of the problem, the team reviewed all trials included as evidence in the National Comprehensive Cancer Network BC guidelines on systemic therapies and found a lower percentage of female participants (20%) than would be expected based on the proportion of female patients with BC in the Surveillance, Epidemiology, and End Results database (26.9%, P < .001). There was also lower female representation in later-stage trials and randomized controlled trials. They then looked at the National Cancer Database (NCDB) to assess how these findings translated to actual patient care and found a significant difference between the proportion of male and female patients who received systemic and immunotherapy for advanced BC (42.6% vs 46% and 1.9% vs 2.8%, respectively, both P < .001). We commend the group for tackling this important and timely topic. The advanced BC management landscape has begun to shift from an almost exclusively chemotherapy-focused treatment paradigm to one that includes immunotherapy, targeted therapy, and antibody-drug conjugate-based therapies.5 A proper understanding of the state of clinical trial recruitment will allow for proactive strategy development to ensure recruitment of under-represented groups, thus ensuring adequate access to these emerging therapies. This is even more important in BC clinical trials. The Bacillus Calmette-Guerin shortage in non–muscle-invasive disease and platinum ineligibility in advanced BC each result in a larger cohort of patients who could potentially benefit from early clinical trial enrollment.6 By outlining the details of the gender disparity in one disease cohort, the authors lay the groundwork for working toward gender equality in trial recruitment. We offer some additional thoughts to build upon their analysis and discussion. Although we agree that factors influencing patient decision to participate in clinical trials should be assessed, we feel that the gender discrepancy likely extends beyond individual patient choice. The consistent and persistent finding of gender, racial, and ethnic disparities in clinical trial enrollment suggests the need for a systematic correction.7 This may come in the form of explicit differential recruitment of female participants and racial minorities with a goal of over-representation to combat historic under-representation. More dramatic adjustments to predetermined secondary or ev","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"4 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135614932","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}

{"title":"Postoperative Oral Care Pathways Are Not Required at the Time of Buccal Mucosa Harvest","authors":"Kevin Krughoff, Jordan Foreman, Thomas Dvergsten, Andrew C. Peterson","doi":"10.1097/ju9.0000000000000069","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000069","url":null,"abstract":"Purpose: For patients undergoing urethroplasty with buccal mucosa grafting, the impact of oral care pathways on infection and pain control remains unstudied. We hypothesize that the elimination of dietary restrictions and mouthwash regimens from the oral care pathway would not alter the rate of donor site complications. Materials and Methods: One hundred urethroplasty cases using buccal mucosa were retrospectively reviewed for donor site and perineal wound complications. No preoperative or intraoperative antibiotic oral cleanses were used in any case. Records were categorized by use of postoperative dietary restrictions and mouthwash regimens. Graft harvest size, preexisting oral issues, baseline comorbidities, dental assessments, perioperative antibiotics, and postoperative pain control regimens were accounted for. Results: Forty patients were included in the oral care pathway and 60 in the nonoral care pathway. Baseline demographics, dental assessment, and graft harvest details were similar between groups. There were no cases of graft site infection, with a median follow-up of 226 days. All graft site issues resolved in 3 to 4 weeks or less. Perineal wound infections for oral care pathway 2 (5%), and no oral care pathway 4 (6.7%), P = .6. Urinary tract infections for oral care pathway 7 (17.5%), and no oral care pathway 2 (3.3%), P = .027. Conclusions: Postoperative oral complications remain low without the use of oral cleanses, dietary restrictions, or mouthwash regimens. Routine use of donor site care pathways is likely unnecessary in this patient population.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"36 11","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136102249","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}

{"title":"Combination of an Anti-Vascular Endothelial Growth Factor Tyrosine Kinase Inhibitor and Immunotherapy as a Neoadjuvant Approach in Renal Cell Carcinoma With Associated Inferior Vena Cava Tumor Thrombus: A Single-Center Experience and Review of Literature","authors":"Nellowe C. Candelario, Ilana Kafer, Simon P. Kim, Elizabeth R. Kessler","doi":"10.1097/ju9.0000000000000073","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000073","url":null,"abstract":"Introduction: Renal cell carcinoma (RCC) has a predisposition to vascular invasion that manifest as an inferior vena cava tumor thrombus (IVC TT). Radical nephrectomy with an IVC thrombectomy is associated with high morbidity. We present our single-center experience on the neoadjuvant use of the combination of anti-vascular endothelial growth factor (VEGF) tyrosine kinase inhibitors (TKI) and immune check point inhibitor (IO) for patients with RCC with IVC TT. Patient and Methods: Five patients with RCC and associated IVC TT received a neoadjuvant combination anti-VEGF TKI and IO. The IVC TT reduction was evaluated. The extent of tumor thrombus was defined based on the Mayo Classification, and TT volume was measured by the largest anteroposterior diameter. The safety of therapy, perioperative outcome, and number of patients who were able to undergo definitive surgery are described. Results: Two (40%) had a reduction in IVC TT based on the Mayo Classification. Tumor thrombus volume reduction was seen in all patients (100%). Four of 5 patients (80%) were able to have surgery. Conclusion: The neoadjuvant combination of an anti-VEGF TKI and IO is effective in reducing the extent of IVC TT. Prospective research is needed to characterize the safety, and long-term outcomes of this approach.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"33 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136102257","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}

{"title":"Cutting of Entrapped Metal Penile Ring With Diamond Cutting Disk","authors":"Brian Stork, Ehab Eltahawy","doi":"10.1097/ju9.0000000000000060","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000060","url":null,"abstract":"{\"href\":\"Single Video Player\",\"role\":\"media-player-id\",\"content-type\":\"play-in-place\",\"position\":\"float\",\"orientation\":\"portrait\",\"label\":\"\",\"caption\":\"\",\"object-id\":[{\"pub-id-type\":\"doi\",\"id\":\"\"},{\"pub-id-type\":\"other\",\"content-type\":\"media-stream-id\",\"id\":\"1_1g0jdjaq\"},{\"pub-id-type\":\"other\",\"content-type\":\"media-source\",\"id\":\"Kaltura\"}]} Introduction A penile ring, or cock ring, is a mechanical device used by men to help maintain an erection. Penile rings are commercially available in a wide variety of different materials, shapes, and sizes. Once a man obtains an erection, the ring is positioned at the base of the penis. As such, it is important for men to choose a ring that is adjustable and fits comfortably. Penile rings work by occluding venous outflow from the penis.1 Rings should be removed as soon as possible after sexual activity to avoid ischemic damage to the corpora cavernosa.2 Rings left in place for extended periods of time cause progressive penile swelling, edema, and, ultimately, entrapment. Entrapped rings made of stretchable materials can often be slide over the penis or cut and removed. Rings made from metal, however, can be very challenging to remove. As a result, urologists are often called on to help manage these challenging cases. Methods A 72-year-old man with a medical history significant for hypertension developed increasing difficulty obtaining and maintaining an erection. His symptoms were refractory to phosphodiesterase-5 inhibitors. Prior to attempted intercourse, patient placed a 0.7-cm thick, stainless steel ring at the base of his penis. The patient had previously never tried penile occlusive therapy. He did not use any form of intracavernosal injection therapy in conjunction with the ring. After intercourse, he was unable to remove the ring. He presented to the emergency room 12 hours later with penile pain and swelling (Figure 1).Figure 1.: Penile entrapment with metal ring.The emergency room staff made multiple attempts to relieve the phimosis and remove the ring including lubrication and sliding, manual compression of the circumcised penis, wrapping the penis with gauze, and aspiration. An unsuccessful attempt was also made to cut the ring with a standard emergency room ring cutter. The patient went on to develop urinary retention, and a Foley catheter was placed. Options for management were discussed, and after obtaining informed consent, the patient was taken to the operating room. A general anesthetic was administered, and the Foley catheter was removed. The penis was prepped, and a cystoscopy drape was placed over the patient. The cystoscopy drape made it possible to contain and drain irrigation used during the procedure. A surgical time out was performed. Both corpora were then aspirated with 18 gauge needles. A total of 10 cc of dark blood was drained. The penis was then wrapped with gauze and manual compression was applied for 20 minutes in an attempt to reduce soft-tissue edema. After these maneuvers,","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135410329","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}

{"title":"Large Intra-abdominal Testicular Neoplasm Involving the Bladder and Ureter in an Adult Male with Bilateral Cryptorchidism","authors":"Pedro Rodrigues Beal, Tiago Aparecido Silva, Vitor Bonadia Buonfiglio, Luciana Saboya Brito Dal Col, Renato Meirelles Mariano Da Costa Junior, Luiz Henrique Correa Portari FIlho, Marcus Vinicius Sadi","doi":"10.1097/ju9.0000000000000074","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000074","url":null,"abstract":"Abstract Cryptorchidism remains as one of the most significant risk factors for the development of testicular cancer (TC). The occurrence of TC in undescended testes can represent challenges to both diagnosis and management because the clinical presentation can delay a definitive diagnosis, and surgical management of intra-abdominal masses can be difficult. We present a case of an adult male with bilateral cryptorchidism diagnosed with a large intra-abdominal TC which was subjected to surgical resection.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"13 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135613966","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}

{"title":"Gender Disparities in the Clinical Trials and Real-World Utilization of Systemic Therapy in the Management of Urothelial Carcinoma","authors":"Hiroko Miyagi, Shahab Bozorgmehri, Nikhil V. Batra, Jonathan A. Chatzkel, Brian Hemendra Ramnaraign, Kathryn Hitchcock, Robert A. Zlotecki, Wayne Brisbane, Paul L. Crispen, Padraic O'Malley","doi":"10.1097/ju9.0000000000000052","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000052","url":null,"abstract":"Objectives: The objectives of this study was (1) to examine the representation of women in clinical trials for systemic therapy in muscle-invasive (MIBC) or metastatic bladder cancer (BC) and (2) to determine the association between sex and systemic therapy in the treatment of MIBC or metastatic BC. Methods: A review of bladder cancer systemic therapy clinical trials cited by the National Comprehensive Cancer Network guidelines was performed. Proportions of women were compared with the corresponding proportions in the US population with bladder cancer between 1975 and 2018, based on the Surveillance, Epidemiology, and End Results database. We also used the National Cancer Database (NCDB) to identify 55,951 patients with American Joint Committee on Cancer clinical stage II, III, and IV bladder cancer between 2004 and 2015. We determined the predictors of systemic therapy for bladder cancer treatment using a multivariable logistic regression model. Results: 26.9% of the US bladder cancer population were women; however, only 17.7% of participants in US clinical trials and 19.9% of participants in all clinical trials were female, indicating an absolute difference of 9.2% (95% confidence interval [CI]: 6.2%-12.1%; P < .001) and 7.0% (95% CI: 6.1%-7.9%; P < .001), respectively. Multivariable analysis of the NCDB showed that women had decreased odds of receiving systemic therapy compared with male patients with MIBC or metastatic BC (odds ratio: 0.93, 95% CI: 0.89-0.96; P < .001). Conclusion: Women are underrepresented in MIBC and/or metastatic BC systemic therapy clinical trials. In addition, women are less likely than men to receive systemic therapy for the treatment of MIBC or metastatic BC. Further research is needed to investigate the reasons for gender disparities in treatment of MIBC or metastatic BC as well as the participation in clinical trials.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"36 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136102250","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}

{"title":"Editorial Comment in Response to: Postoperative Oral Care Pathways are Not Required at the Time of Buccal Mucosa Harvest","authors":"Susan M. MacDonald","doi":"10.1097/ju9.0000000000000076","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000076","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139295183","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}

{"title":"Pelvic Floor Dysfunction: A Common Cause of Chronic Orchialgia","authors":"Amy Zheng, Austin K. Bramwell, Jennifer A. Kane, Jonathan T. Pham, Susan M. MacDonald","doi":"10.1097/ju9.0000000000000070","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000070","url":null,"abstract":"Purpose: We determined the prevalence of pelvic floor dysfunction (PFD) as an etiology for chronic orchialgia in a single tertiary care practice and characterized the presenting symptoms of chronic orchialgia patients with PFD. Materials and Methods: An IRB-approved retrospective review was performed for patients diagnosed with chronic orchialgia from 2016 to 2021 using CPT codes N50.82 (scrotal pain), N50.819 (testicle pain), and G89.29 (chronic pain in testicle). Patients with acute orchialgia (<3 months) were excluded. PFD was diagnosed on a 360-degree digital rectal examination when increased tone or pain to palpation of the levator ani muscle group was noted. Suspected etiology of the orchialgia and accompanying urinary, bowel, or sexual symptoms were recorded. Unpaired t -tests were used to determine significant associations while accounting for differences in sample size. Results: Of 136 patients with chronic orchialgia, the most common etiologies were classified as idiopathic (37.7%); prior surgery (32.1%); varicocele, hydrocele, or spermatocele (28.3%); PFD (17.6%); and postinfection (11.3%). Chronic orchialgia patients with PFD (n = 24) were significantly more likely to present with accompanying urinary ( P < .01), bowel ( P < .01), and sexual dysfunction ( P = .04) symptoms. Orchialgia patients with PFD were more likely to report symptoms of functional obstruction, particularly urinary hesitancy ( P < .01), constipation ( P < .01), and painful ejaculation ( P < .01), compared with patients without PFD. Conclusions: PFD was determined to be the etiology in 1 in 6 patients with chronic orchialgia. All patients presenting with chronic orchialgia and obstructive symptoms warrant a 360-degree rectal examination as part of their initial evaluation. IRB Protocol Number: 10677.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"58 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135614941","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}

{"title":"Functional Follow-Up After Cystectomy and Urinary Diversion: A Narrative Review","authors":"Ernest Kaufmann, Peter C. Black, James W. F. Catto, H. Djaladat, S. Ghodoussipour, Jill M. Hamilton-Reeves, Bente Thoft Jensen, W. Kassouf, S. V. Lauridsen, S. P. Lerner, Carlos Llorente, Katherine Loftus, Ilaria Lucca, Alberto Martini, Mark A. Preston, S. P. Psutka, J. Sfakianos, Jay Shah, M. S. Wettstein, Stephen B. Williams, S. Daneshmand, C. Fankhauser","doi":"10.1097/ju9.0000000000000071","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000071","url":null,"abstract":"Follow-up after urinary diversion aims to detect functional complications to prevent harm and improve quality of life. We conducted a literature search and reviewed guidelines and institutional follow-up protocols. We included 14 studies providing data of 3282 patients. Functional complications can be seen in up to 90% of all patients within 15 years after urinary diversion and mainly include impairment of urinary or sexual function as well as renal/metabolic disturbances, but only limited evidence supporting any functional follow-up recommendation was identified. Current guideline recommendation should be rephrased to ensure routine implementation of functional follow-up investigation. Future research is required to assess whether, which, and how follow-up protocols after cystectomy affect functional results to inform optimal surveillance procedures after treatment. In this review of recommended follow-up protocols after cystectomy, we observed different recommendations and discuss future research areas.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139292831","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}