Urologic Oncology-seminars and Original Investigations最新文献

{"title":"BCG response and oncological outcomes in high risk nonmuscle invasive bladder cancer following previously treated upper tract urothelial carcinoma: A propensity-matched analysis","authors":"Benjamin J.H. Lim M.B.B.S. , Khi Yung Fong M.B.B.S. , Timothy Lu M.B.B.S. , Julene Ong M.B.B.S. , Siying Tan M.Sc. , Tsung Wen Chong M.B.B.S., F.A.M.S., Ph.D. , Christopher W.S. Cheng M.B.B.S., F.A.M.S. , Kae Jack Tay M.B.B.S., F.A.M.S. , John S.P. Yuen M.B.B.S., F.A.M.S., Ph.D. , Kenneth Chen M.B.B.S., F.A.M.S. , Johan Chan M.B.B.S., M.R.C.P. , Jason Y.S. Chan M.B.B.S., M.R.C.P. , Wei Chong Tan M.B.B.S., M.R.C.P. , R. Kanesvaran M.B.B.S., M.R.C.P. , Syed A. Hussain M.B.B.S., M.R.C.P., Ph.D. , Michael R. Abern M.D. , Yu Guang Tan M.B.B.S., F.A.M.S.","doi":"10.1016/j.urolonc.2025.03.026","DOIUrl":"10.1016/j.urolonc.2025.03.026","url":null,"abstract":"<div><h3>Introduction</h3><div>Metachronous bladder recurrences after prior treatment for primary upper tract urothelial carcinoma (UTUC) can occur in ∼3% to 50% of patients. Because UTUC demonstrated distinct molecular alterations, bladder recurrences in these patients may be molecularly and phenotypically different compared to primary bladder carcinoma. We aim to study the BCG efficacy in patients with primary high risk nonmuscle invasive bladder cancer (P-NMIBC) and metachronous bladder recurrences after previous nephroureterectomy for UTUC (M-NMIBC).</div></div><div><h3>Methods</h3><div>We reviewed an IRB-approved prospective uro-oncology database of patients who underwent resection followed by BCG therapy for high grade NMIBC from 2017 to 2021. Clinicopathological parameters, intravesical therapies and the oncological outcomes were analyzed. Patients in the P-NMIBC group were matched to patients in the M-NMIBC cohort (control) via propensity score matching (PSM) to adjust for potential clinicopathological confounders. Nearest-neighbor PSM targeting a 4:1 ratio of study to control subjects was performed using a caliper of 0.2, aiming for an absolute standardized mean difference of <0.1 across key covariates. Secondary outcomes were progression to distant metastasis and overall survival. Logistic and cox regression analyses were performed to elucidate independent variables associated with intravesical recurrences and disease progression.</div></div><div><h3>Results</h3><div>Of the 183 patients diagnosed with NMIBC, 35 patients were identified to have a history of UTUC with radical nephroureterectomy. EAU risk stratification revealed 50 (27.3%) intermediate risk, 107 (58.5%) high risk and 26 (14.2%) very high risk groups. P-NMIBC patients were more likely to have symptomatic presentation (79.7% vs. 23.9%), and a larger mean tumor size (25.7 mm vs. 15.4 mm) than M-NMIBC. The mean follow-up duration for the study was 34.0 months. In the unmatched analysis, M-NMIBC was associated with increased risk of HG intravesical recurrence post BCG compared to P-NMIBC (54.3% vs. 28.4%, <em>P</em> = 0.006, HR 2.14, 95% CI: 1.25–3.65) and increased risk of progression to MIBC (28.6% vs. 4.7%, <em>P</em> = 0.007, HR 4.19, 95% CI: 1.47–11.95). For the propensity-matched analysis, the control group consisted of 35 M-NMIBC matched to 123 P-NMIBC patients for similar demographics, EAU risk score and BCG doses. M-NMIBC again demonstrated a higher HG intravesical recurrence rate (54.3% vs. 22.8%, <em>P</em> = 0.001, HR 2.67, 95% CI: 1.50–4.77), progression to MIBC (28.6% vs. 5.7%, <em>P</em> = 0.022, HR 3.42, 95% CI: 1.20–9.75) and progression to distant metastasis (20.0% vs. 6.5%, <em>P</em> = 0.033, HR 3.02, 95% CI: 1.09–8.35). Overall survival in both groups were not significantly different in both unmatched and matched analysis.</div></div><div><h3>Conclusions</h3><div>Our study indicates that BCG treatment may be less effective for NMIBC patients with a histo","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 7","pages":"Pages 440.e1-440.e9"},"PeriodicalIF":2.4,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of short term surgical outcomes of radical prostatectomy in the decade following the introduction of minimum volume standards in the Netherlands","authors":"Caroline M. van der Starre ,&nbsp;Katja K.H. Aben ,&nbsp;Pim J. van Leeuwen ,&nbsp;Martijn B. Busstra ,&nbsp;Matthijs J.V. Scheltema ,&nbsp;Max H. Bruins ,&nbsp;Herman Roelink ,&nbsp;Henk G. van der Poel ,&nbsp;Igle J. de Jong ,&nbsp;Berdine L. Heesterman ,&nbsp;Diederik M. Somford","doi":"10.1016/j.urolonc.2025.03.020","DOIUrl":"10.1016/j.urolonc.2025.03.020","url":null,"abstract":"<div><h3>Introduction</h3><div>A minimum volume standard (MVS) of 20 radical prostatectomies (RPs) per institution per year was implemented in the Netherlands in 2014, and raised to 50 RPs in 2018 and 100 in 2019. This study aimed to evaluate the effects of implementing a MVS on the extent of care centralization and short term surgical outcomes.</div></div><div><h3>Methods</h3><div>All patients who underwent RP between 2014 and 2022 were identified in the nationwide Netherlands Cancer Registry. Short term surgical outcomes included positive surgical margins (PSMs), PSA persistence (failure to achieve a PSA value &lt;0.1 ng/mL within 6 months after RP) and complications (Clavien-Dindo grade ≥3) up to 30 days after RP. Multivariable logistic regression analyses were performed to evaluate surgical outcomes over time.</div></div><div><h3>Results</h3><div>Between 2014 and 2022, 24,576 RPs were performed and the number of hospitals performing RPs decreased substantially from 40 in 2014 to 14 in 2022, whereas the median number of RPs per hospital per year increased from 85 (IQR: 57–139) to 189 (IQR: 157–393). PSM-rate decreased from 51.6% to 45.7% for pT3-4 (OR = 0.95, 95% CI 0.93–0.98) and 23.6% to 17.6% for pT2 (OR = 0.93, 95% CI 0.91–0.96) prostate cancer. A decline was observed in PSA persistence from 14.0% to 7.7% (OR = 0.84, 95% CI 0.82–0.87). Also the grade ≥3 complication-rate slightly decreased from 3.9% to 3.0% (OR = 0.94, 95% CI 0.90–0.98).</div></div><div><h3>Conclusion</h3><div>Introduction of a MVS resulted in a substantial centralization of RP-care in the Netherlands. A gradual, but moderate, improvement was observed in complications, PSMs and PSA persistence after RP.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 7","pages":"Pages 445.e1-445.e10"},"PeriodicalIF":2.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paraneoplastic and symptomatic score (PRIMAL) for prediction of overall and cancer-specific survival after surgery in patients with renal cell carcinoma.","authors":"Giacomo Musso, Margaret F Meagher, Kit L Yuen, Benjamin Baker, Omer Baker, Aaron Ahdoot, Dhruv Puri, Mai Dabbas, Natalie Birouty, Cesare Saitta, Melis Guer, Dattatraya Patil, Hajime Tanaka, Masaki Kobayashi, Shohei Fukuda, Francesco Montorsi, Alberto Briganti, Andrea Salonia, Umberto Capitanio, Alessandro Larcher, Yasuhisa Fujii, Viraj Master, Ithaar H Derweesh","doi":"10.1016/j.urolonc.2025.03.022","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.03.022","url":null,"abstract":"<p><strong>Purpose: </strong>To develop the PRIMAL (Prognostic Risk stratification for Integrating Manifestations of symptoms and Abnormal Labs) score to predict prognosis in renal cell carcinoma (RCC) by integrating clinical presentation, paraneoplastic syndromes (PNS), and abnormal laboratory values at diagnosis.</p><p><strong>Materials and methods: </strong>5256 T1-T4, N0/1, M0/1 RCC surgical patients from 4 institutions were analyzed retrospectively. Preoperative variables included hematuria, visceral pain, nausea/vomiting, thrombocytopenia (<100 × 10⁹/L), hypoalbuminemia (<3.5 g/dL), anemia (<11.5 mg/dL for women, <12.5 mg/dL for men), elevated De Ritis Ratio (AST/ALT > 1.25), elevated neutrophil-to-lymphocyte-ratio (NLR > 2.27). Patients were stratified into 4 PRIMAL categories (Low = 0, Favorable-intermediate = 1-2, Unfavorable-intermediate = 1-2+anemia, High ≥ 3). Multivariable Cox regression and Kaplan-Meier analyses assessed association with overall survival (OS) and cancer-specific survival (CSS). C-indexes, Receiver operating characteristic curves and Area under curve assessed accuracy of the model towards OS and CSS individually and in combination with the Leibovich score.</p><p><strong>Results: </strong>2513 (48%) patients had low, 1532 (29%) favorable-intermediate, 909 (17%) unfavorable-intermediate, 302 (6%) high PRIMAL score. High score patients exhibited highest hazard ratios (HR) for all-cause mortality (ACM) (HR = 7.71, 95% CI = 5.98-9.93) and cancer-specific mortality (CSM) (HR = 8.54, 95% CI = 5.96-12.24). Five-year OS rates were 91%, 82%, 65% and 46%, while CSS rates were 95%, 90%, 76% and 60% for Low, Favorable-Intermediate, Unfavorable-Intermediate and High groups, respectively. PRIMAL achieved C-indexes of 0.70 for OS and 0.74 for CSS prediction. The combined CSS PRIMAL-Leibovich model yielded an AUC of 0.76 (P = 0.02), outperforming individual scores.</p><p><strong>Conclusion: </strong>PRIMAL is a valuable tool for RCC prognostication, enabling assessment of disease aggressiveness at diagnosis. Including PRIMAL score during initial evaluations enhances stratification, identifying patients with a higher risk disease and aids clinical decision-making.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of tumor diameter-to-prostate volume ratio for predicting the outcome of magnetic resonance imaging/transrectal ultrasound fusion-targeted biopsy","authors":"Yuki Kohada M.D. ,&nbsp;Shunsuke Miyamoto M.D., Ph.D. ,&nbsp;Tetsutaro Hayashi M.D., Ph.D. ,&nbsp;Ryo Tasaka M.D. ,&nbsp;Yukiko Honda M.D., Ph.D. ,&nbsp;Akira Ishikawa M.D., Ph.D. ,&nbsp;Kohei Kobatake M.D., Ph.D. ,&nbsp;Yohei Sekino M.D., Ph.D. ,&nbsp;Hiroyuki Kitano M.D., Ph.D. ,&nbsp;Keisuke Goto M.D., Ph.D. ,&nbsp;Kenichiro Ikeda M.D., Ph.D. ,&nbsp;Akihiro Goriki M.D., Ph.D. ,&nbsp;Keisuke Hieda M.D., Ph.D. ,&nbsp;Naoyuki Kitamura M.D., Ph.D. ,&nbsp;Kazuo Awai M.D., Ph.D. ,&nbsp;Nobuyuki Hinata M.D., Ph.D.","doi":"10.1016/j.urolonc.2025.03.021","DOIUrl":"10.1016/j.urolonc.2025.03.021","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the impact of the tumor diameter-to-prostate volume ratio (TD/PV) on predicting prostate cancer (PCa) and clinically significant (cs) -PCa in magnetic resonance imaging (MRI) /transrectal ultrasound (TRUS) fusion-targeted biopsy based on prostate imaging-reporting and data system (PI-RADS) findings in MRI.</div></div><div><h3>Materials and methods</h3><div>Patients who underwent MRI/TRUS fusion-targeted biopsy for PI-RADS version 2.1 categories 3–5 lesions between 2017 and 2023 were retrospectively reviewed. TD/PV was calculated by dividing the tumor diameter by the total prostate volume. csPCa was defined as a Gleason score of ≥ 3 + 4. Univariable and multivariable logistic regression analyses were used to develop predictive nomograms for PCa and csPCa. A receiver operating characteristic curve was constructed to evaluate the predictive ability of the factors using the area under the curve (AUC).</div></div><div><h3>Results</h3><div>A total of 565 patients were analyzed; the AUC of TD/PV was significantly superior to those of the prostate-specific antigen (PSA), tumor diameter, PSA density, and PI-RADS for predicting PCa (AUC: 0.840, <em>P</em> &lt; 0.05) and csPCa (AUC: 0.819, <em>P</em> &lt; 0.05). Multivariable analyses showed that TD/PV is a significant predictive factor for PCa and csPCa in MRI/TRUS fusion-targeted biopsy (<em>P</em> &lt; 0.05). The predictive nomograms combining TD/PV and PI-RADS category were constructed and their AUCs for predicting PCa and csPCa were 0.861 and 0.845, respectively.</div></div><div><h3>Conclusions</h3><div>In this retrospective analysis, prediction of PCa and csPCa on MRI/TRUS fusion-targeted biopsy was improved when TD/PV was combined with PI-RADS category.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 7","pages":"Pages 444.e11-444.e20"},"PeriodicalIF":2.4,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unlocking the secrets: Exploring the connection between HPV and bladder cancer in Pakistan.","authors":"Hafsa Yousaf, Aneela Javed, Nuzhat Sultana, Khalid Farouk, Muhammad Usman, Gul Rehman Khan, Miriam Kathleen Gomez, Sobia Asghar, Saira Justin","doi":"10.1016/j.urolonc.2025.03.014","DOIUrl":"10.1016/j.urolonc.2025.03.014","url":null,"abstract":"<p><strong>Background: </strong>Human Papillomavirus' (HPV) clear association with anogenital carcinomas raises concerns about its role in urologic carcinomas due to anatomical proximity. This etiological link is under-researched in Pakistan, creating a critical gap in the literature.</p><p><strong>Objectives: </strong>To decipher any probable pathological association of high-risk HPV genotypes in bladder cancer etiology.</p><p><strong>Methods: </strong>Bladder biopsies from 63 bladder cancer patients, confirmed by H&E and IHC staining were collected with histopathological and clinical data, after informed consent. DNA was extracted and processed for HPV detection using L1 consensus primers. HPV genotyping was performed using E6-E7 specific primers for HPV16 and 18, via conventional PCR.</p><p><strong>Result: </strong>About 15.9% (10/63) of bladder cancer cases were HPV-positive. 30% (3/10) of which were HPV16-positive, 60% (6/10) were HPV18-positive, while the remaining 1 sample (1/10) was neither positive for HPV16 nor 18 indicating a probable involvement of other high-risk genotypes. Histologically, most of the HPV-positive bladder cancers were low-grade invasive urothelial carcinoma, having a male-to-female incident ratio of 9:1 with an average age of 65 years. No significant association was found between HPV prevalence and tobacco consumption, physical activity, co-morbidities (diabetes and hypertension), and treatment effectiveness.</p><p><strong>Conclusion: </strong>The study provides the latest epidemiological data on the prevalence and genotype distribution of HPV in bladder cancer in Pakistan. Although the frequency of HPV was not so high, nonetheless an association with bladder cancer incidence was identified as an important risk factor. Consequently, HPV remains a serious issue in low- and middle-income countries (LMICs), significantly contributing to otherwise preventable cancers.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do differences in secondary treatment explain mortality impact of prostate cancer screening? – A randomized screening trial","authors":"Joona Lampela ,&nbsp;Kirsi Talala ,&nbsp;Teuvo L.J. Tammela ,&nbsp;Kimmo Taari ,&nbsp;Paula Kujala ,&nbsp;Anssi P. Auvinen ,&nbsp;Teemu J. Murtola","doi":"10.1016/j.urolonc.2025.02.023","DOIUrl":"10.1016/j.urolonc.2025.02.023","url":null,"abstract":"<div><h3>Background</h3><div>The European Randomized study of screening for prostate cancer (ERSPC) demonstrated a reduction in prostate cancer (PC) mortality via PSA-based screening. We evaluated whether treatments for castration resistant PC vary between the trial arms within the Finnish section (FinRSPC) of the ERSPC.</div></div><div><h3>Methods</h3><div>Clinical data were collected from medical records and national health care databases for all men diagnosed with PC and starting androgen deprivation therapy (ADT) during 1996–2015 at Tampere University Hospital. We evaluated frequencies and durations of treatments for castration resistant PC. Cox regression was used to assess time from ADT initiation to castration resistant PC treatment.</div></div><div><h3>Results</h3><div>In total, 62 (14.2%) and 116 (15.9%) received at least % cycle of treatment for castration resistant PC in the screening and control-arm, respectively. There were no statistically significant differences in distribution of treatments for castration resistant PC between the study arms at any treatment lines (<em>P</em>-values over 0.05 for first, second and third &amp; later lines of treatment). No difference was found in time to initiation of treatment for castration resistant PC after ADT. (HR: 1.00; 95% [CI], 0.78-1.39; <em>P</em> = 0.998).</div></div><div><h3>Conclusions</h3><div>Although limited by small sample size and a single-center scope, our findings suggest the mortality result of the FinRSPC is not attributable to differing treatment for castration-resistant PC between the trial arms</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 6","pages":"Pages 398.e7-398.e13"},"PeriodicalIF":2.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic heparin does not increase clinically significant bleeding following transurethral resection of a bladder tumor.","authors":"Eric Regele, Katherine Beran, Kunal Hanchate, Alex Hochwald, Michael A Edwards, Andrew J Zganjar, Timothy D Lyon","doi":"10.1016/j.urolonc.2025.03.017","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.03.017","url":null,"abstract":"<p><strong>Introduction: </strong>Transurethral resection of bladder tumor (TURBT) is a high bleeding risk procedure due to resection over a mucosal surface and is often performed in patients with risk factors for venous thromboembolism (VTE). Limited data exist to inform the risks and benefits of prophylactic heparin before TURBT. We sought to assess whether preoperative heparin was associated with clinically significant bleeding after TURBT.</p><p><strong>Methods: </strong>We retrospectively identified 583 consecutive patients who underwent TURBT between Jan 1, 2021 and April 30, 2023. In April 2022 we began routinely administering 5,000 units of subcutaneous heparin at anesthesia induction during TURBT. The primary outcome was clinically significant bleeding within 30 days of TURBT, defined as reoperation for clot evacuation/fulguration, clot retention, blood transfusion, and/or continuous bladder irrigation.</p><p><strong>Results: </strong>Among 583 patients, 220 (38%) received preoperative heparin and 363 (62%) did not. Twenty-five patients experienced a bleeding event, including 6 (2.7%) in the heparin group and 19 (5.2%) in the no heparin group (P = 0.25). After adjusting for sex and tumor size, heparin was not significantly associated with clinically significant bleeding (adjOR 0.51, 95% CI, 0.18-1.2, P = 0.16). Three patients (0.5%) experienced a 30-day VTE, including 1 (0.5%) in the heparin group and 2 (0.6%) in the group without heparin (P = 0.9).</p><p><strong>Conclusion: </strong>We did not observe a statistically significant difference in the rate of clinically significant bleeding within 30 days of TURBT between patients treated with and without preoperative heparin, suggesting that preoperative heparin can be considered among patients at high risk of postoperative VTE.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary leak after partial nephrectomy: Insights from a cohort with hereditary, multifocal, and reoperative cases.","authors":"Ruben Blachman-Braun, Milan Patel, Lauren Loebach, Braden Millan, Jaskirat Saini, Sandeep Gurram, W Marston Linehan, Mark W Ball","doi":"10.1016/j.urolonc.2025.03.013","DOIUrl":"https://doi.org/10.1016/j.urolonc.2025.03.013","url":null,"abstract":"<p><strong>Purpose: </strong>To identify risk factors, surgical considerations, and management strategies associated with urinary leak (UL) following partial nephrectomy (PN) in a cohort that includes a significant number of patients with hereditary renal cancer syndromes, multiple tumors, and a history of prior PNs.</p><p><strong>Material and methods: </strong>A retrospective chart review was conducted selecting patients who underwent PN at our institution from January 2006 to December 2023 was performed. Clinical, demographic, surgical characteristics, and management strategies were recorded and analyzed.</p><p><strong>Results: </strong>A total of 1,173 PNs were analyzed, of those 89(7.6%) had a UL. Patients had a median age at surgery of 50[38-59] years, 3[1-6] tumors removed per procedure with a total of 5,947 tumors were removed, 61.6% PN via the robotic approach, and the most common diagnosis was von Hippel-Lindau disease (47.4%). The frequency of UL was 5.1% for first-time PN, 10.4% for second, and 19.6% for third. An increased risk of UL was observed with higher EBL (OR = 1.016; P = 0.006) and decrease with robotic approach (OR = 0.376; P < 0.001). Overall, 44.9% of UL cases were successfully managed with conservative management (postop drain and Foley), while 98.9% were successfully managed with conservative management, ureteral stent placement, percutaneous drain, or nephrostomy tube.</p><p><strong>Conclusion: </strong>UL is directly associated with the complexity of the surgery. The advantages of robotic-assisted surgery in reducing UL risk indicate potential avenues for improved outcomes. Future efforts should explore the role of intraoperative and postoperative strategies to minimize this complication. Conservative management and drain or catheter placement resolve most of the ULs.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-year resource utilization of open vs. robot-assisted radical cystectomy: Results from optum's de-identified clinformatics® data mart database","authors":"Shaun Trecarten ,&nbsp;Caroline Schaefer ,&nbsp;Ahmed Elshabrawy ,&nbsp;Ahmad Abdelaziz ,&nbsp;Emad Dalla ,&nbsp;Furkan Dursun ,&nbsp;Trudy Krause ,&nbsp;Michael Liss ,&nbsp;Dharam Kaushik ,&nbsp;Robert Svatek ,&nbsp;Ahmed M. Mansour","doi":"10.1016/j.urolonc.2025.03.002","DOIUrl":"10.1016/j.urolonc.2025.03.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Despite increasing adoption of robotic radical cystectomy (RRC), its cost-effectiveness remains in question. Therefore, we aimed to compare 2-year resource utilization (RU) between RRC and open radical cystectomy (ORC).</div></div><div><h3>Methods</h3><div>Queried from Optum's de-identified Clinformatics® Data Mart Database, patients diagnosed with bladder cancer who underwent radical cystectomy were identified between 2014 and 2017. Patients with ≥2 years of continuous enrollment were stratified by open and robotic approach. RU was evaluated from incident hospitalization costs and total standardized costs over 2 years for each subsequent inpatient/outpatient visit. Multivariate generalized linear regression (MGLR) was used to determine the impact of surgical approach on subsequent RU.</div></div><div><h3>Results</h3><div>About 2,373 patients were identified. Of patients with continuous enrollment for ≥2 years (N = 1353), 798 (59%) underwent RRC and 555 (41%) underwent ORC. RRC was associated with lower RU than ORC, ($65,188.02 vs. $80,375.90, <em>P</em> &lt; 0.0001) and lower inpatient costs for incident hospitalization ($29,142 vs. $42,329, <em>P</em> &lt; 0.001). RRC, versus ORC, demonstrated shorter median length of hospital stay (5 vs. 7 days, <em>P</em> &lt; 0.0001), and was associated with lower rates of acute kidney failure (3% vs. 5%, <em>P</em> = 0.007), ileus (2% vs. 5%, <em>P</em> = 0.005) and blood transfusions (≤ 2% vs. 6%, <em>P</em> &lt; 0.001). MGLR demonstrated that robotic approach independently reduced total cost (β 0.84, CI 0.77–0.93, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>RRC is associated with reduced 2-year RU and incident hospitalization costs compared to ORC. Robotic technique was independently associated with lower total costs. While granular cost metric details are limited, the reduced RU with RRC represents a novel assessment of reduced postoperative morbidity.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 6","pages":"Pages 391.e21-391.e28"},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential response of low- and high-grade intermediate-risk non-muscle-invasive bladder cancer to bacillus Calmette-Guérin and gemcitabine-docetaxel therapy","authors":"Ahmed Eraky,&nbsp;Kaushik P. Kolanukuduru,&nbsp;Brenda Hug,&nbsp;Reuben Ben-David,&nbsp;Kyrollis Attalla,&nbsp;Nikhil Waingankar,&nbsp;Peter Wiklund,&nbsp;Reza Mehrazin,&nbsp;John P. Sfakianos","doi":"10.1016/j.urolonc.2025.03.009","DOIUrl":"10.1016/j.urolonc.2025.03.009","url":null,"abstract":"<div><h3>Background and Objective</h3><div>Sequential intravesical gemcitabine/docetaxel (Gem/Doce) is a potential alternative to bacillus Calmette-Guérin (BCG) for treating non-muscle-invasive bladder cancer (NMIBC). Intermediate-risk NMIBC group (IR-NMIBC) includes both low-grade (LG) and high-grade tumors (HG). This study investigates the response of HG and LG IR-NMIBC to Gem/Doce compared to BCG therapy.</div></div><div><h3>Methods</h3><div>We included patients with IR-NMIBC who received either BCG or Gem/Doce between 2013 and 2023. Maintenance regimens were administered to patients without recurrence after induction for 1 year. Follow-up cystoscopies were performed per American Urological Association (AUA) guidelines. Kaplan-Meier and Cox regression analyses were performed to evaluate recurrence-free survival (RFS) and progression-free survival (PFS).</div></div><div><h3>Results</h3><div>Among 505 NMIBC patients, 150 were IR-NMIBC: 115 with HG tumors (69 received BCG, 46 received Gem/Doce) and 35 with LG tumors (14 received BCG, 21 received Gem/Doce).With a median follow-up time of 31 months (Interquartile Range [IQR] 13–54), The overall 2-year any-grade RFS was 55%. For HG and LG groups, the 2-year any-grade RFS was 58% and 35% (<em>P</em> = 0.009), respectively. High-grade RFS at 2 years was 75% for HG and 94% for LG (<em>P</em> = 0.065). The 2-year PFS was similar between groups, at 96% for both HG and LG (<em>P</em> = 0.39). In HG patients, 2-year high-grade RFS was higher with BCG than Gem/Doce (81% vs. 59%, <em>P</em> = 0.008). In LG patients, 2-year any-grade and high-grade RFS were comparable between BCG and Gem/Doce (<em>P</em> = 0.067 and <em>P</em> = 0.37, respectively).</div></div><div><h3>Conclusions</h3><div>Our findings suggest that BCG may offer a superior benefit in terms of high-grade RFS for HG IR-NMIBC compared to Gem/Doce, while LG tumors respond similarly to both treatments. This emphasizes the role of risk stratification in treatment selection. Prospective studies are needed to validate these findings and refine treatment strategies.</div></div>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":"43 7","pages":"Pages 443.e1-443.e10"},"PeriodicalIF":2.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}