Canadian Urological Association journal = Journal de l'Association des urologues du Canada最新文献

Introduction: Use of ambulatory holmium laser enucleation of the prostate (HoLEP) is uncommon among Canadian urologists. Our objectives were to determine the feasibility (ambulatory success rate) and safety (early complication rate) of ambulatory HoLEP in a Canadian population.

Methods: We prospectively evaluated consecutive patients from June 2020 to May 2022 presenting for ambulatory HoLEP using Moses™ technology at our institution (MoLEP). Ambulatory success was defined as no hospital admission within 48 hours following the procedure. Thirty-day adverse events were also identified and graded according to the Clavien-Dindo (CD) classification. All procedures were planned to be ambulatory regardless of prostate size or anticoagulant treatment. We generated a logistic regression model to identify factors associated with ambulatory failure.

Results: A total of 61 patients underwent MoLEP, 52 of whom met the eligibility criteria. The mean age was 71.0 years (standard deviation 6.2). Most patients (67%, 35/52) were catheter or self-catheterization-dependent. The ambulatory success rate was 87% (45/52); 6/52 (11.5%) required hospitalization following MoLEP and one patient (2%) was re-admitted within 48 hours of the procedure. Hematuria was the sole cause of ambulatory failure. Thirty-day major complication rate (CD ≥3) was 6% (3/52) and the minor complication rate (CD <3) was 37% (19/52). The identified adverse events included hematuria (10/52), urinary retention (6/52), and cystitis (4/52). Based on univariate analysis, we did not identify factors significantly associated with ambulatory failure.

Conclusions: The MoLEP ambulatory success rate is high, and the 30-day major adverse event rate is low. In this small, Canadian cohort, ambulatory MoLEP seems feasible and safe.

Introduction: Radical cystectomy (RC) is a complex oncological surgical procedure and population studies of routine surgical care have suggested suboptimal results compared to high-volume centers of excellence. A previous Canadian bladder cancer quality-of-care consensus led to adoption of multiple key quality-of-care indicators, with associated benchmarks created using available evidence and expert opinion to inform and measure future performance. Herein, we report real-life benchmark performance for the management of muscle-invasive bladder cancer (MIBC) relative to expert opinion guidance.

Methods: This is a population-based, retrospective, cohort study that used the Ontario Cancer Registry (OCR) to identify all incident patients who underwent RC from 2009-2013. Electronic records of treatment from 1573 patients were linked to OCR; pathology records were obtained for all cases and reviewed by a team of trained data abstractors. The primary objective was to describe benchmarks for identified indicators, first as median values obtained across hospitals or providers, as well as a "pared-mean" approach to identify a benchmark population of "top performance," as defined as the best outcome accomplished for at least 10% of the population.

Results: Overall, performance in Ontario across all indicators fell short of expert opinion-determined benchmarks. Annual surgical volume by each surgeon performing a RC (benchmark >6, percent of institutions meeting benchmark=20%), percent of patients with MIBC referred preoperatively to medical oncology (MO; benchmark>90%, percent of institutions meeting benchmark=2%) and radiation oncology (RO; benchmark>50%, percent of institutions meeting benchmark=0%), time to cystectomy within six weeks of transurethral resection of bladder tumor (TURBT) in patients without neoadjuvant chemotherapy (benchmark <6 weeks, percent of institutions meeting benchmark=0%), percent of patients with adequate lymph node dissection (defined as >14 nodes, benchmark>85%, percent of institutions meeting benchmark=0%), percent of patients with positive margins post-RC (benchmark <10%, percent of institutions meeting benchmark=46%), and 90-day mortality (benchmark<5%, percent of institutions meeting benchmark=37%) fell considerably short. Simply evaluating benchmarks across the province as median performance significantly underestimated benchmarks that were possible by top-performing hospitals.

Conclusions: Performance through most bladder cancer quality-of-care indicators fall short of benchmarks proposed by expert opinion. Different methodologies, such as a paredmean approach of top performers, may provide more realistic benchmarking.

Introduction: The coronavirus pandemic changed the way urology education was delivered. At Dalhousie University, third-year medical students (clinical clerks) undergoing a two-week urology elective had the historic in-person seminars changed to virtual seminars with pre-recorded lectures by staff. The academic abilities of the clerks were measured via a standardized written exam and clinical score assigned by a staff preceptor. This study aimed to measure the impact of virtual education on student performance.

Methods: Clerk clinical and exam scores have been recorded since 2014. The in-person seminar (pre-COVID) cohort included students from January 2014 to March 2020 (n=109), while the virtual seminar (post-COVID) cohort was recorded from April 2020 to August 2022 (n=60). Independent t-test was used to compare clinical, exam, and total scores between the pre-COVID student groups after ensuring normality.

Results: Students in the virtual seminar group (mean ± standard deviation 88.69±6.50%) performed better than the in-person seminar student groups (86.32±6.33%) in terms of clinical performance gradings (p=0.02). There was no statistically significant difference in written exam scores between the in-person seminar and virtual seminar cohorts (77.34±10.94% vs. 78.75±11.37%, p=0.43). Cumulative scores were higher for virtual seminar student groups vs. in-person seminar cohort (86.70±5.40% vs. 84.52±5.44%, p=0.01).

Conclusions: Clinical clerks undergoing virtual education during a two-week urology elective had improved clinical and cumulative score performances when compared to the in-personal seminar cohort; virtual seminars did not statistically negatively impact exam scores.