Urology最新文献

{"title":"Implementing and Optimizing Universal Germline Genetic Testing for Patients With Prostate Cancer in Clinical Practice","authors":"Neal Shore ,&nbsp;Andrew J. Armstrong ,&nbsp;Pedro Barata ,&nbsp;Lindsey Byrne ,&nbsp;Jason Hafron ,&nbsp;Sarah Young ,&nbsp;Channing Paller ,&nbsp;David R. Wise ,&nbsp;Karen Ventii ,&nbsp;Ali Samadi ,&nbsp;Paul Arangua ,&nbsp;Priya N. Werahera ,&nbsp;Justin Lorentz","doi":"10.1016/j.urology.2025.01.070","DOIUrl":"10.1016/j.urology.2025.01.070","url":null,"abstract":"<div><h3>Objective</h3><div>To advocate for universal germline genetic testing (UGGT) in prostate cancer and provide practical recommendations for its implementation.</div></div><div><h3>Methods</h3><div>Although guidelines for germline genetic testing in prostate cancer have progressed, usage remains limited and inconsistent due to barriers including access, cost, and variable guideline adherence. These issues prevent some patients with germline pathogenic/likely pathogenic variants from benefiting from risk assessment, precision therapies (eg, PARP inhibitors, PD-1 inhibitors), and potential clinical trials. Despite these benefits, studies indicate that germline genetic testing use remains low, especially in prostate cancer care. The PROCLAIM trial (Shore et al, 2023) highlighted that nearly half of patients with pathogenic variants are missed under National Comprehensive Cancer Network guidelines, particularly impacting non-white patients and those with incomplete family history data. Additional racial and socioeconomic disparities further hinder access and variant interpretation accuracy. Given these challenges, UGGT for all prostate cancer patients has been proposed to improve care equity and decision-making. In March 2024, prostate cancer experts convened to discuss strategies for UGGT implementation.</div></div><div><h3>Results</h3><div>The outcome of that meeting includes recommendations for integrating UGGT into oncology and urology practices and have been outlined in this paper.</div></div><div><h3>Conclusion</h3><div>To maximize the benefits while mitigating the potential risks of UGGT, it is essential to address implementation details, including careful gene panel selection, variants of uncertain significance reporting and management, appropriate genetics follow-up, and seamless integration of test reports into electronic medical records for accessibility by patients and providers.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"199 ","pages":"Pages 1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256699","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":"Letter to the Editor on “Early Adjuvant Chemotherapy Improves Survival in Muscle Invasive Bladder Cancer: A Systematic Review and Meta-analysis”","authors":"Shubham Kumar ,&nbsp;Nosaibah Razaqi ,&nbsp;Rachana Mehta ,&nbsp;Ranjana Sah","doi":"10.1016/j.urology.2025.01.010","DOIUrl":"10.1016/j.urology.2025.01.010","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":"199 ","pages":"Pages 259-260"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075642","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":"Pregnancy, Fertility Implications, and Parental Leave Policies: Where Does Urology Stand?","authors":"Joanna Orzel ,&nbsp;Charla Holdren ,&nbsp;Gwen Grimsby ,&nbsp;Sophia Delpe Goodridge ,&nbsp;Gillian Stearns","doi":"10.1016/j.urology.2025.01.037","DOIUrl":"10.1016/j.urology.2025.01.037","url":null,"abstract":"<div><h3>Objective</h3><div>To review the existing literature on the status of parenting in urology in the academic urology setting. The field of urology has an ever-growing proportion of women, both in training and in practice. Female residents spend most of their peak fertile years in training and female surgeons at any age experience increased pregnancy complication rates. There is a need to shed light on the unique needs of female urologists who want to have both: a fulfilling surgical career and becoming a parent.</div></div><div><h3>Methods</h3><div>A literature search was conducted on PubMed using combinations of the terms “pregnancy,” “urology,” “fertility,” “infertility,” “pregnancy complications,” and “parental leave” with one author who reviewed and read the papers.</div></div><div><h3>Results</h3><div>Topics explored included timing of pregnancy, pregnancy complications, parental leave policies, returning to work and lactation policies, and implications of parenting in urology.</div></div><div><h3>Conclusion</h3><div>Progress has been made in the field of urology when it comes to creating spaces that allow for women to pursue both their career and family goals. There is still work that needs to be done to fully support the growing number of female urologists as both parents and physicians.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"199 ","pages":"Pages 242-247"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075782","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":"Propensity Score Matched Analysis of Thulium Fiber vs Pulsed Thulium:Yttrium Aluminum Garnet Laser Lithotripsy in Flexible Ureteroscopy for Kidney Stone Disease Using a Flexible and Navigable Suction Ureteral Access Sheath: Results From a Prospective, Multicenter Study of the EAU Section of Endourology","authors":"Daniele Castellani ,&nbsp;Khi Yung Fong ,&nbsp;Olivier Traxer ,&nbsp;Vigen Malkhasyan ,&nbsp;Nariman Gadzhiev ,&nbsp;Deepak Ragoori ,&nbsp;Wissam Kamal ,&nbsp;Ioannis Goumas Kartalas ,&nbsp;Steffi Kar Kei Yuen ,&nbsp;Bhaskar Kumar Somani ,&nbsp;Mehmet Ilker Gökce ,&nbsp;Vineet Gauhar","doi":"10.1016/j.urology.2025.01.065","DOIUrl":"10.1016/j.urology.2025.01.065","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate outcomes after flexible ureteroscopy (F-URS) for renal stone(s) using a flexible and navigable suction ureteral access sheath (FANS-UAS) comparing Thulium fiber (TFL) vs pulsed Thulium:Yttrium aluminum garnet (p-Thulium:YAG) laser.</div></div><div><h3>Methods</h3><div>Data from adults who had F-URS in 5 centers were prospectively collected (April 2023-January 2024). All patients had a preoperative and within 30<!--> <!-->days CT scan. Stone-free: grade A: zero fragments; grade B: single fragment ≤2<!--> <!-->mm; grade C: single fragment 2.1-4<!--> <!-->mm; grade D: single/multiple fragments &gt;4 mm. One-to-one propensity score-matching for age, gender, prestenting, stone volume, stone location, and Hounsfield units was performed. Within 6<!--> <!-->months after surgery, an intravenous urography or CT urography scan was performed in all patients.</div></div><div><h3>Results</h3><div>Of 179 included patients, TFL was employed in 115 patients. After matching, 64 patients from each group with comparable baseline characteristics were included. Median lasing time was significantly longer in the TFL group (15.5 [10,23] minutes vs 13 [10,15] minutes, <em>P</em> <!-->=<!--> <!-->.02), while total surgical time did not differ. There was no case of blood transfusion and sepsis. Overall stone-free rate (SFR) was significantly different between the groups with a higher proportion of patients in p-Thu:YAG laser group undergoing reintervention for residual fragments (17.2% vs 3.1%). There was no case of new-onset hydronephrosis, ureteropelvic junction/ureteral stenosis, impaired urinary drainage, or altered pelvicalyceal anatomy at a median follow-up of 13<!--> <!-->weeks.</div></div><div><h3>Conclusion</h3><div>F-URS using FANS-UAS showed negligible serious adverse events and good SFR using both lasers. p-Thu:YAG laser showed shorter lasing time, marginal better grade A+B SFR but higher reintervention rate for residual fragments.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"199 ","pages":"Pages 47-53"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256738","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 Editorial Comment on “The Outcomes of Onco-Testis Sperm Extraction at the Time of Radical Orchiectomy”","authors":"Jose M. Flores","doi":"10.1016/j.urology.2025.01.071","DOIUrl":"10.1016/j.urology.2025.01.071","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":"199 ","pages":"Page 96"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366013","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":"Editorial Comment on “A Comparison Between Intravesical Gemcitabine Plus Docetaxel and Intravesical Bacillus Calmette-Guérin in the Treatment of Nonmuscle Invasive Naive Urinary Bladder Cancer: A Systematic Review and Meta-analysis of Oncological Outcomes”","authors":"Patrick D. Michael,&nbsp;Rebecca A. Campbell","doi":"10.1016/j.urology.2025.02.001","DOIUrl":"10.1016/j.urology.2025.02.001","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":"199 ","pages":"Pages 179-180"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410883","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":"Benign Prostatic Hyperplasia Knowledge Deficits Among Male Urology Patients","authors":"Suruchi Ramanujan ,&nbsp;Peace Orji ,&nbsp;Austin Chiu ,&nbsp;Sailakshmi Senthil Kumar ,&nbsp;William Jevnikar ,&nbsp;Bailey Cox ,&nbsp;Drogo Montague ,&nbsp;Nima Almassi ,&nbsp;Byron Lee ,&nbsp;James Bena ,&nbsp;Shannon Morrison ,&nbsp;Ali Cyrus Chehroudi ,&nbsp;Petar Bajic ,&nbsp;Smita De","doi":"10.1016/j.urology.2025.01.023","DOIUrl":"10.1016/j.urology.2025.01.023","url":null,"abstract":"<div><h3>Objective</h3><div>To measure patient knowledge about Benign prostatic hyperplasia (BPH) and identify factors associated with knowledge deficiencies among those newly presenting to our urology clinic.</div></div><div><h3>Methods</h3><div>Adult men presenting as new patients to our institution’s urology clinic, regardless of chief complaint, were invited to complete a 26-item multiple choice questionnaire to assess basic knowledge about BPH, related symptomatology, and treatment options prior to their initial consultation. Responses were correlated to demographic variables using Analysis of Variance (ANOVA) and multivariable linear modeling.</div></div><div><h3>Results</h3><div>206 patients completed the questionnaire and had a mean age of 60.8 years. The majority were white (85.6%) and 28.9% were medicare/medicaid insured. The mean correct response rate was 62% (standard deviation of 22.9%) with the worst performing domain being BPH complications. Having a graduate or professional degree (<em>P</em> &lt;.001) and self-referral were associated with significantly higher scores (<em>P</em> = .027).</div></div><div><h3>Conclusion</h3><div>There remain significant knowledge gaps about BPH among men seeking urologic care. Education tools for both patients and primary care physicians may help improve health literacy as well as health outcomes for patients with BPH.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"199 ","pages":"Pages 141-146"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012598","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":"Assessment of Outcomes and Anatomical Changes in the Upper Urinary Tract Following Flexible Ureteroscopy With a Flexible and Navigable Suction Ureteral Access Sheath: 3-Month Results From a Multicenter Study","authors":"Khi Yung Fong ,&nbsp;Steffi Kar Kei Yuen ,&nbsp;Bhaskar Kumar Somani ,&nbsp;Vigen Malkhasyan ,&nbsp;Yiloren Tanidir ,&nbsp;Satyendra Persaud ,&nbsp;Albert El Hajj ,&nbsp;Chu-Ann Chai ,&nbsp;Tzevat Tefik ,&nbsp;Karl Tan ,&nbsp;Mohamed Elshazly ,&nbsp;Deepak Ragoori ,&nbsp;Mehmet Ilker Gokce ,&nbsp;Boyke Soebhali ,&nbsp;Saeed Bin Hamri ,&nbsp;Nariman Gadzhiev ,&nbsp;Ben Turney ,&nbsp;Olivier Traxer ,&nbsp;Daniele Castellani ,&nbsp;Vineet Gauhar","doi":"10.1016/j.urology.2025.01.029","DOIUrl":"10.1016/j.urology.2025.01.029","url":null,"abstract":"<div><h3>Objective</h3><div>To study the long-term outcomes of the flexible and navigable suction ureteral access sheath (FANS) in flexible ureteroscopy (FURS). FANS has well-established efficiency and 30-day perioperative safety; however, its influence on pelvicalyceal and ureteric anatomy remains to be investigated.</div></div><div><h3>Methods</h3><div>This was a prospective study of patients with normal renal anatomy who underwent FURS with FANS for renal stones from April 2023 to August 2024 in 16 centers worldwide. Thirty-day postoperative stone-free rate and delayed complications after 3 months were analyzed with a non-contrast CT scan and contrasted CT urogram respectively. The primary aim was to report if FANS could potentially cause pelviureteric junction, pelvicalyceal or ureteric complications.</div></div><div><h3>Results</h3><div>Three hundred-ten patients were analyzed. Median age was 51; median stone volume was 1584 mm³. Disposable scopes were used in 58.1%. Predominant laser energies were Thulium fiber laser (56.1%) followed by Thulium-YAG laser (20.6%). Median laser time was 14 minutes, median ureteroscopy time was 30 minutes, and median total operation time was 45 minutes. Ureteric injury occurred in 11 patients (3.5%), of which 10 were Traxer-Thomas Grade 1. On 30-day NCCT, 63.5% of patients had zero residual fragments; overall stone-free status was seen in 95.1%. Thirty-day reintervention rate was 4.2% (13 cases). Three-month CT urogram showed ureteric stenosis in only 1 patient (0.3%) who was managed by dilatation and stenting. No other anatomical anomalies were recorded.</div></div><div><h3>Conclusion</h3><div>The extremely low rates of 3-month adverse outcomes, high immediate SFR, and low 30-day reintervention rates further strengthen the evidence for safety and effectiveness of FANS.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"199 ","pages":"Pages 35-41"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012617","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":"Website Transparency and Information Dissemination Among Urology Residency Programs","authors":"Jate Bernard ,&nbsp;Joon Kyung Kim ,&nbsp;Benjamin Morrison ,&nbsp;Katelyn Spencer ,&nbsp;Alison Rasper ,&nbsp;Jason Bylund ,&nbsp;Campbell Grant ,&nbsp;Benjamin Dropkin","doi":"10.1016/j.urology.2025.01.044","DOIUrl":"10.1016/j.urology.2025.01.044","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the transparency and quality of information dissemination among urology residency program websites and provide a checklist. Due to the COVID-19 pandemic, urology residency programs have had to adjust their typical practices, including the adoption of virtual recruiting. Such efforts have included improving program websites, which are often the starting point for potential applicants to obtain information about programs.</div></div><div><h3>Methods</h3><div>The websites of 136 nonmilitary, accredited US urology residency programs were evaluated for presence of various measures grouped into distinct categories including program priorities, program curriculum, program profiles, program quality of life, medical student opportunities, interview process, selection/exclusion criteria, and social media.</div></div><div><h3>Results</h3><div>The most frequently reported category was program profiles with 81% of websites providing details about residents, faculty, and alumni. The least frequently reported category was selection/exclusion criteria (26%). Program mission/objective statements, training site locations, and current resident and faculty profiles were subcategories reported on greater than 90% of websites. Regarding virtual opportunities, 21% of websites provided online open house information, and 32% provided direct links to social media, even though 88% of programs had an active X/Twitter account. On average, program websites provided information on 52% of reportable subcategories.</div></div><div><h3>Conclusion</h3><div>The importance of transparency and quality of information dissemination is greater than ever with the increasing utilization of virtual formats in the residency application process. Our results indicate several areas of improvement that urology residency programs can address to provide improved transparency for applicants.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"199 ","pages":"Pages 214-220"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068239","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":"Trends in Urology Residency Applications: Results From the American Urological Association Medical Student Survey From 2022 to 2024","authors":"Michael Creswell ,&nbsp;Kirsten Greene ,&nbsp;Lee Richstone ,&nbsp;Simone Thavaseelan ,&nbsp;Erica Traxel ,&nbsp;Aaron Tverye ,&nbsp;Casey Kowalik ,&nbsp;Gina Badalato ,&nbsp;Thomas Jarrett ,&nbsp;Kate Kraft ,&nbsp;Mathew Sorensen ,&nbsp;Moben Mirza","doi":"10.1016/j.urology.2025.01.075","DOIUrl":"10.1016/j.urology.2025.01.075","url":null,"abstract":"<div><h3>Objective</h3><div>To provide a comprehensive overview of the American Urological Association Medical Student Surveys and includes data 2022, 2023, and 2024.</div></div><div><h3>Methods</h3><div>Data collected through surveys distributed prior to match day and were distributed to all medical students who submitted a rank list for urology residency. Questions consisted of various topics, including applicant demographics, application metrics, and experiences with preference signals and virtual interviews.</div></div><div><h3>Results</h3><div>440 (79%), 428 (84%), and 387 (77%) applicants participated in surveys for the years 2022, 2023, and 2024, respectively. Applicants continue to participate in research at a high level. Additionally, United States Medical Licensing Exam Step 2 Clinical Knowledge scores gained prominence following the transition of United States Medical Licensing Exam Step 1 to pass/fail. Preference signals were well-received, and large volume signaling may have prompted applicants to apply to fewer programs. Virtual interviews were favored for cost-effectiveness and perceived equity benefits; however, applicants expressed a preference for in-person interactions.</div></div><div><h3>Conclusion</h3><div>There have been dynamic shifts in urology residency applications from the applicant perspective from 2022 to 2024. This may be influenced by changing evaluation metrics as well as the adoption of preference signals and virtual interviews. The findings highlight the need for ongoing feedback and transparency to ensure equitable practices for both applicants and residency programs during this evolution.</div></div>","PeriodicalId":23415,"journal":{"name":"Urology","volume":"199 ","pages":"Pages 203-209"},"PeriodicalIF":2.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366038","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}