Pub Date : 2023-11-01DOI: 10.1097/ju9.0000000000000052
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
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.
{"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}
Pub Date : 2023-11-01DOI: 10.1097/ju9.0000000000000074
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
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.
{"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}
Pub Date : 2023-11-01DOI: 10.1097/ju9.0000000000000076
Susan M. MacDonald
{"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}
Pub Date : 2023-11-01DOI: 10.1097/ju9.0000000000000070
Amy Zheng, Austin K. Bramwell, Jennifer A. Kane, Jonathan T. Pham, Susan M. MacDonald
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.
{"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}
Pub Date : 2023-11-01DOI: 10.1097/ju9.0000000000000071
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
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.
{"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}
Pub Date : 2023-11-01DOI: 10.1097/ju9.0000000000000078
Leo Puhalla, Scott D. Lundy
{"title":"Editorial Comment: Pelvic Floor Dysfunction: A Common Cause of Chronic Orchialgia","authors":"Leo Puhalla, Scott D. Lundy","doi":"10.1097/ju9.0000000000000078","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000078","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139292963","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 : 2023-11-01DOI: 10.1097/ju9.0000000000000094
John W. Davis
{"title":"JU Open Plus: Beyond Borders","authors":"John W. Davis","doi":"10.1097/ju9.0000000000000094","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000094","url":null,"abstract":"","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"13 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139294745","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 : 2023-10-01DOI: 10.1097/ju9.0000000000000059
Jasper C. Bash, Solange Bassale, Sudhir Isharwal
Introduction: Ureteropelvic junction obstruction is a common cause of upper tract obstruction that often necessitates surgical intervention because of its severe implications. A high proportion of these surgeries include pathologic analysis of this tissue with unclear clinical value. We examined our institution's practices concerning sending the ureteropelvic junction (UPJ) specimens for pathology analysis, its clinical value, and the associated costs for both pediatric and adult cases. Methods: We performed retrospective chart review using Current Procedural Terminology codes for pyeloplasty over 8 years. Clinical variables were extracted from operative reports, path reports, and postoperative clinic notes. Pathology results were classified dichotomously as “benign” or “malignant” and subsequently assigned to 1 of 4 categories—inflammation, fibrosis, muscular hyperplasia, or no atypical findings. Results: Two hundred sixty-nine pyeloplasty surgeries were included, 68% of which were in children. Pathologic analysis was requested in most of the cases (91%), and this was slightly more common in adults (94%) than in pediatric patients (90%). All available pathology reports found benign findings in the UPJ specimen, mostly commonly categorized as “normal.” No cases of malignancy were noted. At the list price for pathologic analysis, $103,027 was spent over 8 years without the discovery of clinically significant pathology findings. Conclusions: There was a lack of clinically meaningful results from pathologic analysis of UPJ specimens excised during pyeloplasty. A UPJ specimen should not be routinely sent for pathologic analysis rather selectively if there is clinical concern for nonbenign etiology of UPJ obstruction.
{"title":"The Minimal Utility of Analyzing Ureteropelvic Junction Tissue at the Time of Pyeloplasty","authors":"Jasper C. Bash, Solange Bassale, Sudhir Isharwal","doi":"10.1097/ju9.0000000000000059","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000059","url":null,"abstract":"Introduction: Ureteropelvic junction obstruction is a common cause of upper tract obstruction that often necessitates surgical intervention because of its severe implications. A high proportion of these surgeries include pathologic analysis of this tissue with unclear clinical value. We examined our institution's practices concerning sending the ureteropelvic junction (UPJ) specimens for pathology analysis, its clinical value, and the associated costs for both pediatric and adult cases. Methods: We performed retrospective chart review using Current Procedural Terminology codes for pyeloplasty over 8 years. Clinical variables were extracted from operative reports, path reports, and postoperative clinic notes. Pathology results were classified dichotomously as “benign” or “malignant” and subsequently assigned to 1 of 4 categories—inflammation, fibrosis, muscular hyperplasia, or no atypical findings. Results: Two hundred sixty-nine pyeloplasty surgeries were included, 68% of which were in children. Pathologic analysis was requested in most of the cases (91%), and this was slightly more common in adults (94%) than in pediatric patients (90%). All available pathology reports found benign findings in the UPJ specimen, mostly commonly categorized as “normal.” No cases of malignancy were noted. At the list price for pathologic analysis, $103,027 was spent over 8 years without the discovery of clinically significant pathology findings. Conclusions: There was a lack of clinically meaningful results from pathologic analysis of UPJ specimens excised during pyeloplasty. A UPJ specimen should not be routinely sent for pathologic analysis rather selectively if there is clinical concern for nonbenign etiology of UPJ obstruction.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"2015 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135663315","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 : 2023-10-01DOI: 10.1097/ju9.0000000000000075
John W. Davis
SEPTEMBER 2023 ISSUE REVIEW We start our September issue review with the research communication from Takahara et al from Japan.1 The article reviews the needs for minimally invasive surgeons to offer partial nephrectomy, when indicated, and to achieve a trifecta of warm ischemia time <25 minutes, negative surgical margins, and no complications. They report on an early experience with a 3D workstation product called Atrena. I am sure you have to see it in person to appreciate its contribution. From the article's figure, the surgeon can have this program on a tablet nearby and rotate, zoom, and make some structures translucent. Images can then be pushed into the daVinci console with TilePro. They present an early experience of 15 cases, with 14 achieving the “trifecta.” Intraoperative navigation will certainly be a hot topic for the foreseeable future to augment the improvements realized thus far in surgical vision and ergonomics. JU Open Plus will have several articles types to publish research including reviews, hypothesis-generating study, clinical trials, and videos as manuscripts. We have 2 interesting case reports. Cohen et al2 report on a rare case of metastatic clear cell renal cell carcinoma within Birt-Hogg-Dube syndrome. The interests in the case are the genetic mutations identified that were common to bilateral renal lesions and a brain metastasis. The discussion emphasizes germline testing for multifocal or bilateral renal cell carcinoma and the possibility of clear cell histology with Birt-Hogg-Dube syndrome. Faber et al3 report on primary renal neuroendocrine tumor causing Zollinger-Ellison syndrome. Primary renal neuroendocrine tumors are very rare and generally treated surgically. The gastrin-secreting tumors will have gastrointestinal symptoms as described. With early detection, this lesion was amenable for partial nephrectomy. If you are in board review mode, see their figure 2 with an octreotide scan–positive lesion due to somatostatin receptor avidity. For original articles, Rasheed et al4 studied the emerging field of telemedicine: What are the barriers to successful connections? For our system, I see patients mostly struggling with how to turn on their camera or microphone. In this study, a volunteer medical student group was working with groups including geriatric and pediatric patients. They break it down into 4 themes: completing registration, familiarity and access to video conference software, proxy access for pediatric patients, and various technical questions. They present an algorithm and discussion on pathways to success. As a sign of the times, my institution is not only expanding telemedicine visits and access but also starting to credential the staff in multiple states to expand our reach. Norman et al5 pose a long-standing question in prostate cancer diagnostics—What to do with results that are not cancer but are not “not” cancer either. The tracked patients had high-grade prostatic intraepithelial neoplasm, atyp
然而，我不是第一个在1940年到1941年服役的约翰·戴维斯——和我的名字没有关系!AUA部分服务于许多关键目的。科学和实践建设的内容是重要的所有执业和学术泌尿科医生。许多泌尿外科住院医师在分会会议上展示他们的第一次研究。网络是非常有益的-无论是在泌尿科医生和许多配偶/重要的其他人每年来参加。在这一期，我将重点介绍我们最近在德克萨斯州奥斯汀举行的第102次会议上的一些人/地方/事物的图片，这次会议是在Chad LaGrange主席(内布拉斯加州)和Fernando Kim(科罗拉多州，也是我们的JU Open Plus副主编)的领导下举行的。对于特写人物来说，在这样的会议上有很多照片可供选择。图1和图2来自董事会/历任总裁晚宴。图3突出了流行的全体会议辩论形式和具有挑战性的案例讨论。图4-6突出了值得注意的会议活动，如墨西哥泌尿外科协会早餐、早晨瑜伽和嘉宾演讲。对于地点，图7突出显示了奥斯汀的一些景点，如市中心的天际线和德克萨斯大学奥斯汀分校。图8突出显示了一些添加到会议体验中的有趣的“事物”。图1所示。:人。2023年美国大学协会中南部赛区以董事会/前任主席晚宴拉开帷幕。该活动的特色是前任总统的“有趣”主题演讲。今年，来自墨西哥的Arturo Mendoza-Valdes(2004-2005年总裁)为我们介绍了龙舌兰酒的历史、生产和品尝。图2。:人。出席2023年奥斯汀会议的历届主席:从左至右:约翰·戴维斯(2022年)、迈克·库克森(2021年)、蒂姆·兰福德(2018年)、托马斯·格里布林(2019年)、德玛拉·卡普兰(2015年)、詹姆斯·温德尔肯(2002年)、阿图罗·门多萨-瓦尔德斯(2005年)、布莱恩·弗林(2017年)、艾伦·莫雷(2013年)、詹姆斯·卡明斯(2020年)。图3。:人。功能性泌尿外科阻滞:Oluwarotimi Nettey(休斯顿)讨论了如何修复放射性瘘。图4。:人。墨西哥泌尿外科学会总是带来一大群教员、住院医师和摘要。他们有自己的早餐会议，如图所示。他们的特邀全体会议发言人是Grisel Hernandez博士(坐在左边)。图5。:人。晨间瑜伽，俯瞰奥斯汀市中心。健康一直是SCS项目的焦点。图6。:人。游客!所有小组会议的一个亮点是向小组专家学习。约翰·马尔霍尔(纽约)。杰夫·卡恩斯(明尼苏达州)。6c: Inderbir Gill(加州)。6d:查德·拉格朗日总统与特邀发言人卢·卡武西(纽约)。图7。:地方。德克萨斯州的奥斯汀是一个举办小组会议的好地方——一个以户外活动、烧烤、德克萨斯州国会大厦和德克萨斯大学奥斯汀分校为特色的新兴城市。图7a:奥斯汀的天际线和伯德小姐湖。图7b:利特菲尔德喷泉——位于通往德克萨斯大学奥斯汀塔的南广场上的第一次世界大战纪念碑。在庆祝的日子里，这座塔被点燃成橘黄色——既有学术庆祝，也有体育庆祝。图8。:东西。图8a:龙舌兰酒品尝。图8b: Dr. Damara Kaplan赢得了一个SCS品牌的Yeti Tumbler。图8c:主题夜间娱乐活动包括犰狳比赛。
{"title":"JU Open Plus: Section Meetings—Science, Practice Improvement, and Networking","authors":"John W. Davis","doi":"10.1097/ju9.0000000000000075","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000075","url":null,"abstract":"SEPTEMBER 2023 ISSUE REVIEW We start our September issue review with the research communication from Takahara et al from Japan.1 The article reviews the needs for minimally invasive surgeons to offer partial nephrectomy, when indicated, and to achieve a trifecta of warm ischemia time <25 minutes, negative surgical margins, and no complications. They report on an early experience with a 3D workstation product called Atrena. I am sure you have to see it in person to appreciate its contribution. From the article's figure, the surgeon can have this program on a tablet nearby and rotate, zoom, and make some structures translucent. Images can then be pushed into the daVinci console with TilePro. They present an early experience of 15 cases, with 14 achieving the “trifecta.” Intraoperative navigation will certainly be a hot topic for the foreseeable future to augment the improvements realized thus far in surgical vision and ergonomics. JU Open Plus will have several articles types to publish research including reviews, hypothesis-generating study, clinical trials, and videos as manuscripts. We have 2 interesting case reports. Cohen et al2 report on a rare case of metastatic clear cell renal cell carcinoma within Birt-Hogg-Dube syndrome. The interests in the case are the genetic mutations identified that were common to bilateral renal lesions and a brain metastasis. The discussion emphasizes germline testing for multifocal or bilateral renal cell carcinoma and the possibility of clear cell histology with Birt-Hogg-Dube syndrome. Faber et al3 report on primary renal neuroendocrine tumor causing Zollinger-Ellison syndrome. Primary renal neuroendocrine tumors are very rare and generally treated surgically. The gastrin-secreting tumors will have gastrointestinal symptoms as described. With early detection, this lesion was amenable for partial nephrectomy. If you are in board review mode, see their figure 2 with an octreotide scan–positive lesion due to somatostatin receptor avidity. For original articles, Rasheed et al4 studied the emerging field of telemedicine: What are the barriers to successful connections? For our system, I see patients mostly struggling with how to turn on their camera or microphone. In this study, a volunteer medical student group was working with groups including geriatric and pediatric patients. They break it down into 4 themes: completing registration, familiarity and access to video conference software, proxy access for pediatric patients, and various technical questions. They present an algorithm and discussion on pathways to success. As a sign of the times, my institution is not only expanding telemedicine visits and access but also starting to credential the staff in multiple states to expand our reach. Norman et al5 pose a long-standing question in prostate cancer diagnostics—What to do with results that are not cancer but are not “not” cancer either. The tracked patients had high-grade prostatic intraepithelial neoplasm, atyp","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"2021 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136054648","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 : 2023-10-01DOI: 10.1097/ju9.0000000000000062
Richard E. Link
Patients with renal cell carcinoma (RCC) often feel struck by lightning. Unsatisfied by relatively modest associations of RCC with advancing age, male sex, tobacco exposure, and Western diets rich in red meat,1,2 patients reach for causative connections to occupational exposures and drugs. Exposure to trichloroethylene and chronic analgesic use has perhaps the most compelling association with RCC.3 However, many other drugs have been implicated in contributing to RCC without convincing proof. Urologists must be prepared to field these questions from their patients when they arise. The cautionary tale of the rise and fall of ranitidine, once the highest-selling drug on the planet, is fascinating and of particular interest to patients with RCC and their physicians. The downfall of ranitidine derived from the detection of a known carcinogen in the medication, nitrosodimethylamine (NDMA), linked to RCC and other tumors in animals. The authors describe the preclinical evidence for NDMA contamination in ranitidine, its connection to carcinogenesis in animals, and the challenges inherent in asking the critical clinical question: “Did ranitidine ingestion contribute to RCC tumorigenesis in humans?” The available population cohort data exploring this association are clouded by short follow-up, inhomogeneous data collection, the lack of screening imaging to detect subclinical tumors, and a range of other confounders. Moreover, NDMA levels were not actually measured in any of these studies. The story highlights the inherent difficulty in connecting an extremely pervasive drug exposure to a specific type of cancer unless the associated risk is exceptionally high. For practicing urologists, the take home message of this well-written review is that no clear association between ranitidine exposure and the development of RCC currently exists.4 However, the authors appropriately recommend that we view this conclusion, based entirely on observational studies with significant weaknesses, with caution when counseling our patients.
{"title":"Carcinogenic Effects of Nitrosodimethylamine Contamination in Ranitidine: Defining the Relationship With Renal Malignancies","authors":"Richard E. Link","doi":"10.1097/ju9.0000000000000062","DOIUrl":"https://doi.org/10.1097/ju9.0000000000000062","url":null,"abstract":"Patients with renal cell carcinoma (RCC) often feel struck by lightning. Unsatisfied by relatively modest associations of RCC with advancing age, male sex, tobacco exposure, and Western diets rich in red meat,1,2 patients reach for causative connections to occupational exposures and drugs. Exposure to trichloroethylene and chronic analgesic use has perhaps the most compelling association with RCC.3 However, many other drugs have been implicated in contributing to RCC without convincing proof. Urologists must be prepared to field these questions from their patients when they arise. The cautionary tale of the rise and fall of ranitidine, once the highest-selling drug on the planet, is fascinating and of particular interest to patients with RCC and their physicians. The downfall of ranitidine derived from the detection of a known carcinogen in the medication, nitrosodimethylamine (NDMA), linked to RCC and other tumors in animals. The authors describe the preclinical evidence for NDMA contamination in ranitidine, its connection to carcinogenesis in animals, and the challenges inherent in asking the critical clinical question: “Did ranitidine ingestion contribute to RCC tumorigenesis in humans?” The available population cohort data exploring this association are clouded by short follow-up, inhomogeneous data collection, the lack of screening imaging to detect subclinical tumors, and a range of other confounders. Moreover, NDMA levels were not actually measured in any of these studies. The story highlights the inherent difficulty in connecting an extremely pervasive drug exposure to a specific type of cancer unless the associated risk is exceptionally high. For practicing urologists, the take home message of this well-written review is that no clear association between ranitidine exposure and the development of RCC currently exists.4 However, the authors appropriately recommend that we view this conclusion, based entirely on observational studies with significant weaknesses, with caution when counseling our patients.","PeriodicalId":74033,"journal":{"name":"JU open plus","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136117946","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：