Urology最新文献

{"title":"EFFECTIVENESS OF MAPPING FOR COGNITIVE PROSTATE BIOPSY: A PROSPECTIVE, RANDOMIZED STUDY.","authors":"Murat Kars, Canan Cimsit, Yunus Emre Genc, Ece Bıcakcı, Muhammed Hasan Toper, Kamil Cam","doi":"10.1016/j.urology.2025.03.036","DOIUrl":"https://doi.org/10.1016/j.urology.2025.03.036","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of adding a simple prostate mapping diagram to multiparametric prostate magnetic resonance imaging (mpMRI) reports, a randomised, prospective study is designed. Despite cognitive prostate biopsy is the most preferred approach among targeted biopsy methods due to its low cost and easy application, its operator dependency requires standardization to improve diagnostic accuracy for prostate cancer (PCa).</p><p><strong>Methods: </strong>A total of 155 patients underwent mpMRI as the standard of care and were randomly assigned in a 1:1 ratio to two groups: prostate mapping diagram and standard group. In addition to the mpMRI reports, suspicious lesions (≥ PI-RADS 3) were drawn on a schematic diagram by a single specialized uro-radiologist in the prostate mapping group. A single experienced urologist sampled four cores from each target in addition to a twelve-core systematic biopsy in both groups. A Gleason score of 3+4 or higher was considered as clinically significant PCa (csPCa).</p><p><strong>Results: </strong>Overall cancer detection rate between the group 1 and 2 was statistically significant (57% and 35%, respectively, p=0.006). Particularly, csPCa rates among the groups were 47% (36/77) and 21% (16/78) for group 1 and group 2, respectively (p<0.001). The csPCa detection with only targeted biopsies was strikingly as high as 3-fold (17% vs 6%, p=0.048) in the mapping group.</p><p><strong>Conclusions: </strong>Our prospective study has shown that the addition of a simple mapping strategy to mpMRI reports significantly increased cancer rates by cognitive biopsy. We strongly recommend the use of a schematic mapping diagram in biopsy protocols.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701690","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":"Efficacy and safety of high-frequency irreversible electroporation in benign prostatic hyperplasia: a randomized controlled, open-labelled, multicenter clinical study.","authors":"Zhen Tong, Zhihong Yang, Baijun Dong, Benkang Shi, Qianyuan Zhuang, Yuanwei Li, Min Gong, Xiaoming Xu, Shengcai Zhou, Xulai Tao, Xinxing Du, Yanhao Dong, Haifeng Wang, Jian Huang, Wei Xue","doi":"10.1016/j.urology.2025.03.029","DOIUrl":"https://doi.org/10.1016/j.urology.2025.03.029","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of high-frequency irreversible electroporation for ablation of benign prostatic hyperplasia.</p><p><strong>Materials and methods: </strong>160 subjects were randomly assigned to the test group to receive ablation and the control group to receive 0.2 mg/day tamsulosin. The maximum urinary flow rate (Qmax), prostate volume and International Prostate Symptom Score (IPSS) and International Index of Erectile Function 5-item (IIEF-5) score were evaluated before treatment and 1, 3, and 12 months after treatment. Differences inter-group and changes intra-group over different follow-up periods were evaluated, and adverse events were recorded. At the same time, patients were divided into three groups according to tertile method of the baseline prostate volume, and the above indicators were also analyzed.</p><p><strong>Results: </strong>Qmax improvement in the test group and control group at 1, 3 and 12 months were 1.22±5.50 mL/s and 1.75±4.29 mL/s, 8.41±8.23 mL/s and 2.61±5.53 mL/s, 7.67±7.63 ml/s and 4.31±6.76 ml/s, respectively. IPSS improvement in the test group at 3 and 12 months were significantly higher than that in the control group, except for 1 month. Similarly, the reduction in prostate volume at 3 months was also observed. The incidences of adverse events were low in both groups. Subgroup analysis showed that there were no statistical differences in key indicators among subgroups.</p><p><strong>Conclusions: </strong>Qmax, prostate volume, IPSS were improved in the test group during 12-month follow-up, and the safety profile was favorable. H-FIRE ablation demonstrated significant efficacy and safety for all patients with large, medium and small prostate volumes.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693462","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":"Tailoring Cystoscopy Surveillance: Addressing the Needs of Frail Bladder Cancer Patients.","authors":"Kamil Malshy, Jathin Bandari, Zijing Cheng, Sindhuja Kadambi, Edward Messing","doi":"10.1016/j.urology.2025.03.022","DOIUrl":"https://doi.org/10.1016/j.urology.2025.03.022","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693521","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":"The (Re) evolution in the treatment of bladder cancer.","authors":"Juan Pablo Sade, Federico Ferraris, Jay Raman","doi":"10.1016/j.urology.2025.03.034","DOIUrl":"https://doi.org/10.1016/j.urology.2025.03.034","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693505","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":"Unilateral SLAM: A simple novel technique to correct complications of hypospadias.","authors":"Mohamed Fawzy, Ahmed T Hadidi","doi":"10.1016/j.urology.2025.03.015","DOIUrl":"https://doi.org/10.1016/j.urology.2025.03.015","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate Unilateral SLAM as a simple and effective option for repairing hypospadias complications.</p><p><strong>Materials and methods: </strong>Between December 2018 and December 2023, 66 patients were treated at our center, with a minimum follow-up of 12 months. Cases included meatal retraction (n=4), distal fistula (n=11), and glandular dehiscence (n=44). Additionally, the technique was utilized during the second stage repair of proximal hypospadias in 7 cases. The inclusion criteria included patients with recurrent hypospadias or complicated hypospadias in which the morphology of the meatus, though coronal position, yet its edge is contiuous to one side with the glans giving and L-Shape or crescentic shaped meatus. This was observed in cases with partial dehiscence, meatal retraction and distal fistulas after excision of the fistula. Patients with Lichen sclerosis and extensive tissue loss were excluded TECHNIQUE: This approach modifies the slit-like adjusted Mathieu (SLAM) technique, requiring only one suture line for the deficient side. The principle is to design a meatal based triangular flap with the wide base proximally. The wide base is flipped and rotated upwards towards the deficient side. There is one suture line that is subsequently covered by protective layers. (Figure 1) RESULTS: Overall complications during 6 years follow-up were 9.1%. Statistically significant associations with complications were observed for patient age at surgery (P=0.043) and glans width (P=0.010) but not with extra protective layer.</p><p><strong>Conclusion: </strong>Unilateral SLAM is a straightforward and effective technique with low complication rates, but its success depends on careful patient selection and surgical expertise.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693508","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":"Reply to Letter to the Editor on \"The Change of Detrusor Contractility at 5 Years After Transurethral Resection of the Prostate: A Single Center Prospective Observational Study\".","authors":"Naoya Masumori","doi":"10.1016/j.urology.2025.03.037","DOIUrl":"https://doi.org/10.1016/j.urology.2025.03.037","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693517","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":"Comment on \"Should Military Veterans Be Classified as High Risk for Prostate Cancer Screening? A Systematic Review and Meta-analysis\".","authors":"Rachana Mehta, Shubham Kumar, Ranjana Sah","doi":"10.1016/j.urology.2025.03.032","DOIUrl":"https://doi.org/10.1016/j.urology.2025.03.032","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693457","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":"Payment Bundles for Prostatectomy: A New Way to Improve Value for Prostate Cancer Care.","authors":"Yash B Shah, Vishnukamal Golla, Matthew E Nielsen, Ruchika Talwar","doi":"10.1016/j.urology.2025.03.033","DOIUrl":"https://doi.org/10.1016/j.urology.2025.03.033","url":null,"abstract":"<p><p>American healthcare expenditures exceed $4 trillion annually, with prostate cancer (PCa) accounting for $22 billion. Prostatectomy, a common treatment for PCa, incurs significant cost variability. Value-based care (VBC), emphasizing outcomes and efficiency over volume, has emerged as a potential solution. Bundled payment models, such as Medicare's Comprehensive Care for Joint Replacement (CJR), attempt to align financial incentives with quality but face challenges, including patient variability and misaligned incentives. Building on this, the Transforming Episode Accountability Model (TEAM) introduces longitudinal, episode-based bundles for five predefined surgeries. While urologic surgeries are currently excluded, the evolving landscape presents an opportunity to implement prostatectomy-specific bundles. Urology has piloted condition-specific bundles, such as Vanderbilt University's kidney stone bundle and the Large Urology Group Practice Association's (LUGPA) active surveillance (AS) bundle for PCa. These initiatives align incentives for comprehensive, guideline-based care but have yet to achieve widespread adoption. We propose a novel prostatectomy bundle that incentivizes urologists to optimize surgical outcomes, reduce complications, and enhance postoperative care. By incorporating disease-specific quality metrics and graded payments based on cancer severity, this model addresses critical barriers, including fair physician compensation and equity in access. Urology, uniquely positioned at the intersection of surgery and office-based care, can lead VBC innovation. TEAM's emphasis on care coordination, equity, and quality offers a promising foundation for refining bundles. With active physician involvement in VBC design, prostatectomy-specific bundles could advance cost, efficiency, and outcomes in PCa care.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693470","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":"Are women urologists caring for predominantly women patient populations? Exploring the role of patient-physician gender concordance in robotic and laparoscopic urological surgery.","authors":"Natalie Passarelli, Alexa Steckler, Benjamin Homer, Alexander Homer, Simone Thavaseelan, Elias Hyams","doi":"10.1016/j.urology.2025.03.031","DOIUrl":"https://doi.org/10.1016/j.urology.2025.03.031","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate gender proportions in women versus men urologists' patient populations as well as within subspecialties to further understand women urologists' practice patterns and workforce impact in the field of Urology.</p><p><strong>Methods: </strong>This retrospective study analyzed American Board of Urology (ABU) case logs of Robotic and Laparoscopic Surgeries (RLS) from 2012-2022. Cases were grouped by women and men urologists, and further sub-analyzed by physician subspecialty. Comparison of patient gender was performed using Fisher's Exact test and Chi-squared test.</p><p><strong>Results: </strong>Women urologists performed 7.2% of RLS cases, with the highest proportion of cases by women surgeons in Female Urology (36.9%) and Pediatric Urology (23.8%). Other subspecialties had 5% or less of the cases performed by women. Women urologist's patient population was 54.3% women patients, as compared to 23.5% of that of men providers (p<0.001).</p><p><strong>Conclusions: </strong>The higher percentage of women in the patient population of women urologists likely has a multifactorial explanation (e.g. patient preference, referral practice patterns, physician preference, gender bias). These practice patterns may limit opportunity for women urologists to exercise the full scope of their surgical training while also limiting the ability of male urologists to provide full-service care to women patients. Further research is needed to explore barriers to entry for women within urologic subspecialties that may affect types of patients seen to ensure equity for women urologists within the field and to optimize patient outcomes.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693454","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":"Real-World Economic Burden and Healthcare Resource Utilization of Radical Cystectomy and Trimodal Therapy for Bladder Cancer in the United States.","authors":"Stephen B Williams, Halit O Yapici, Puneet K Singhal, Ian Weimer, Farah Pathan, Hayden W Hyatt, Kunal Lodaya, Haojie Li","doi":"10.1016/j.urology.2025.03.028","DOIUrl":"https://doi.org/10.1016/j.urology.2025.03.028","url":null,"abstract":"<p><strong>Objectives: </strong>To leverage contemporary real-world data to offer a comprehensive and longitudinal assessment of cost and healthcare resource utilization in patients with bladder cancer who underwent radical cystectomy or trimodal therapy.</p><p><strong>Methods: </strong>Claims data between October 01, 2015, and April 24, 2023 were assessed to determine patient characteristics, costs, and healthcare resource utilization. Patients were followed from 90-days up to 5-years of follow-up. Costs and healthcare utilization were further broken down by place of service and specific cost drivers, and subgroups were assessed to explore aspects of treatment recommended guidelines.</p><p><strong>Results: </strong>Of 1,323 patients, 839 underwent radical cystectomy (median age 71 years; 26.2% female) and 484 received trimodal therapy (median age 75, 26.2% female). Median [IQR] per-patient costs were $70,671 [$55,878-$106,812] for the radical cystectomy cohort at 90-days follow-up and rose to $211,671 [$138,597-$346,389] by 5-years post-index. For trimodal therapy, total costs were $34,612 [$16,705-$64,263] at 90-days and increased to $274,462 [$186,337-$421,534] by 5-years. At 90-days, median overall visits (inpatient, outpatient, emergency room, or other) were 26 [16-39] for radical cystectomy and 19 [12-33] for trimodal therapy; overall visits were 163 [119-218] and 186 [144-238] by 5-years, respectively.</p><p><strong>Conclusions: </strong>This analysis reveals that radical cystectomy costs were primarily driven by inpatient services, particularly inpatient facility costs. For trimodal therapy, outpatient costs predominated, driven by drugs administered and outpatient radiology facilities. The considerable costs and utilization associated with these treatments underscore the need for value-based therapeutic approaches aimed at enhancing patient outcomes.</p><p><strong>Data availability statement: </strong>Data for this analysis was made available to the authors through a third-party license from CDM, a commercial data provider in the United States. As such, the authors cannot make these data publicly available due to data use agreement. Other researchers can access the data by purchasing a license through CDM.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693477","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}