Urology最新文献

{"title":"Utilization, Acute Complications, and Delays in Treatment Associated with Rectal Spacers for Prostate Cancer Radiotherapy.","authors":"Jack C Millot, Adithya Balasubramanian, Lauren Chew, Gal Wald, Camilo Arenas-Gallo, Edward Zhang, Jacob McCann, Leo D Dreyfuss, Stephen Rhodes, Patrick Lewicki, Angela Y Jia, Nicholas G Zaorsky, Jonathan E Shoag","doi":"10.1016/j.urology.2025.06.070","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.070","url":null,"abstract":"<p><strong>Objective: </strong>To investigate rectal hydrogel spacer use, placement complications, and associated radiation delays in the United States.</p><p><strong>Methods: </strong>The Merative^TM MarketScan Database was used to identify prostate cancer patients undergoing spacer placement or radiation alone between 2016 and 2021. Genitourinary and gastrointestinal complications and subsequent interventions that occurred after spacer placement but before radiation were captured. A 6-month window preceding spacer placement was employed to eliminate underlying diagnoses present before spacer placement. Delays in starting radiation after spacer placement were identified and categorized as more than one, two, or three months. A Cox proportional hazards model with a time-varying covariate of acute complications to assess the effect of complications on time-to-radiation RESULTS: We captured 3,732 spacer placements, of which 3,650 (97.8%) underwent radiation. The use of spacers among prostate cancer radiation patients increased from 0.5% in 2016 to 25.7% in 2021. Stereotactic body radiotherapy (SBRT) patients had the highest spacer use at 50.0% in 2021. Complications occurred in 6.4% (n=235) of patients before starting radiation. Of these, 5.2% (n=190) were genitourinary and 1.2% (n=43) were gastrointestinal complications. Catheterization, cystoscopy, rectal endoscopy, rectal abscess drainage were required for 21 (0.6%), 15 (0.4%), 12 (0.3%), 1 (0.03%), and 1 (0.03%) patients, respectively. Following a complication, patients had a significantly lower risk (Hazard Ratio 0.75, 95% CI 0.66 - 0.86, p<0.001) of starting radiation compared to before the complication.</p><p><strong>Conclusions: </strong>Rectal spacer use is prevalent amongst patients undergoing SBRT. While rare, spacer placement complications occur, which can delay the start of radiation therapy.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561305","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":"Revisiting the role of lymphovascular invasion in prostate cancer: a narrative review.","authors":"Jakub Karwacki, Laura Wojdyło, Karolina Klasen, Andrzej Dłubak, Adam Gurwin, Maciej Kaczorowski, Agnieszka Hałoń, Wojciech Krajewski, Tomasz Szydełko, Bartosz Małkiewicz","doi":"10.1016/j.urology.2025.06.063","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.063","url":null,"abstract":"<p><p>Lymphovascular invasion (LVI) is an adverse histopathological marker in prostate cancer (PCa), associated with increased risks of disease progression and biochemical recurrence (BCR). Despite its established value as an independent predictive factor, LVI remains underutilized in clinical decision-making. In particular, LVI identified in radical prostatectomy specimens does not currently influence management strategies, even though numerous studies highlight its critical role in patient outcomes. This review synthesizes recent literature on the clinical significance of LVI in PCa, emphasizing its relationship with BCR, lymph node invasion (LNI), and survival parameters. Future directions highlight the need for larger prospective studies, standardized definitions, and artificial intelligence-driven histopathological tools to enhance the detection and integration of LVI into clinical practice.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561304","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":"Urological Intervention during Hemipelvectomy for Advanced Pelvic Malignancy: Experience from a Comprehensive Cancer Center\".","authors":"Woodson W Smelser, Ian D English","doi":"10.1016/j.urology.2025.06.067","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.067","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555073","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 \"Sex and Age Variation for Nephrolithiasis Risk Factors on 24-hour Urine Metabolic Evaluation: A Real-world Single-center Retrospective Analysis\".","authors":"Muhammed A M Hammad, Mark I Sultan, Ramy F Youssef","doi":"10.1016/j.urology.2025.06.059","DOIUrl":"10.1016/j.urology.2025.06.059","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555071","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 \"Delayed Urinary Retention After Holmium Laser Enucleation of Prostate\".","authors":"Galen Cheng, Scott O Quarrier","doi":"10.1016/j.urology.2025.06.058","DOIUrl":"10.1016/j.urology.2025.06.058","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555070","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":"Treatment Deferral and Coping Mechanisms Associated with Nephrolithiasis-Related Financial Toxicity.","authors":"Jackson J Cabo, Rochelle Kofman, Christopher Ballantyne, Zelle Bannister, Mira T Keddis, Mitchell R Humphreys, Karen L Stern","doi":"10.1016/j.urology.2025.06.065","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.065","url":null,"abstract":"<p><strong>Objective: </strong>To assess how financial toxicity may impact risk of deferral of recommended therapy in nephrolithiasis patients.</p><p><strong>Methods: </strong>We performed a nationwide cross-sectional survey of adult volunteers with kidney stone disease registered with ResearchMatch. Comprehensive Score for Financial Toxicity (COST-FACIT) score <21 was used to identify patients with nephrolithiasis-related financial toxicity. Coping mechanisms, dietary, and medical interventions for stone disease were compared between high/low financial toxicity groups. Multivariable logistic regression assessed characteristics associated with deferral of recommended medical or surgical interventions in the preceding year.</p><p><strong>Results: </strong>Of 945 respondents with nephrolithiasis, 205 (21.6%) reported disease-related financial toxicity (COST≤20). Individuals with financial toxicity were more likely to defer recommended medical (28.3% vs. 3.8%;P<0.001) or surgical therapy (22.4% vs. 3.4%;P<0.001) for stones in the preceding year and were more likely to cite cost concerns as barriers to following nutritional recommendations (Table 1). On multivariable analysis, after controlling for income and emergency presentation for stones, higher COST-FACIT score (lower financial burden) was associated with lower odds of deferring recommend medicines or surgery for stone disease (OR 0.89, 95%CI 0.87-0.92;P<0.001).</p><p><strong>Conclusions: </strong>In this nationwide cross-sectional study, patients with kidney stones and associated financial toxicity were more likely to defer recommended surgical and medical therapy. Cost-concerns were commonly cited reasons for not following medical, surgical, or dietary recommendations, highlighting a need to integrate this information into discussion of preventative interventions.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555072","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":"Acute Changes in 24 Hour Lithogenic Urine Measures Intra- and Post-Partum.","authors":"Vikram Lyall, John R Asplin, Eileen Brandes, Zita Ficko, Elizabeth Johnson, Roger L Sur, Vernon Pais","doi":"10.1016/j.urology.2025.06.071","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.071","url":null,"abstract":"<p><strong>Objective: </strong>To measure lithogenic changes during pregnancy in patients on a standardized diet without a prior history of nephrolithiasis.</p><p><strong>Methods: </strong>IRB approval was obtained. The metabolic needs of pregnant participants were determined and standardized diet administered with Boost shakes and unlimited water. 24-hour urine collections were obtained during the third trimester, post-partum, and post-lactation. Subjects remained on the controlled diet for 24 hours prior to and during the collection. Standard statistical analysis was performed.</p><p><strong>Results: </strong>Of eighteen patients six had a de novo stone event during pregnancy. Of these, 83% were composed of calcium phosphate. Stone events with calcium phosphate presented later than calcium oxalate. Stone-formers had an intra-partum BMI greater than non-stone formers (33.1 vs 26.7, p<0.05). All participants had hypercalciuria, but stone-formers were found to have a nearly 2X greater urine calcium compared to non-stone formers on their controlled diet (392.1 vs 205.9, p<0.05). Post-partum, we observed a decrease in urine calcium, citrate, pH, and supersaturation of calcium oxalate and phosphate (p<0.05).</p><p><strong>Conclusions: </strong>This is the first study to identify lithogenic changes during pregnancy in de novo stone formers on a standardized diet. We show that stone-formers have primarily calcium phosphate stones. They also have an elevated BMI and are significantly more hypercalciuric without other demonstratable lithogenic differences compared to non-stone formers. Post-partum, we demonstrate reduction in intra-partum lithogenicity that may mitigate stone risk. These data suggest an underlying mechanism exists in stone formers that increases urine calcium above what would be expected in gestational hypercalciuria.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555069","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":"Protein Isolate Supplements and Urinary Stone Risk.","authors":"Daniel G Wong, Brad McNeely, Joel Vetter, Aleksandra Klim, Linda Black, Aaron Knutson, Kefu Du, Kristina Penniston, John Asplin, Alana Desai","doi":"10.1016/j.urology.2025.06.060","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.060","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the lithogenicity associated with consuming specific protein sources, we report a comparative crossover study evaluating the effects of whey, pea, soy, and rice protein isolates on urinary stone risk.</p><p><strong>Methods: </strong>Volunteers without history of stone disease were recruited for participation. Participants received a 5-day frozen meal plan which included three 20g protein shakes per day. Two 24-hour urine collections were completed on the last two days of each phase. The exact same diet was repeated for subsequent phases, exchanging only the protein isolate in the shake.</p><p><strong>Results: </strong>Nine participants - 8 male, 1 female - were enrolled with mean age of 24.8 ± 1.6 years and BMI of 22.3 ± 2.2 kg/m2. Urine calcium was significantly lower and pH was higher with pea and soy protein compared to whey protein consumption. Citrate excretion did not differ between any phases compared to whey protein. Urine oxalate was significantly higher in pea phase compared to whey. Supersaturation of calcium oxalate did not differ between any phases compared to whey.</p><p><strong>Conclusion: </strong>We examined the short-term urinary effect of 4 protein isolates commonly used to supplement high protein diets and found key urinary metabolite differences. These differences were due to varying amino acid profiles but may also be related to differing constituents in each powder, such as cations and unmeasured anions.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545048","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":"Effect of Sex Differences on Cancer Outcomes after Chemo-Radiation for Muscle-Invasive Bladder Cancer: A Retrospective Multicenter Cohort Study.","authors":"Iain MacIntyre, Ronald Kool, Gautier Marcq, Girish S Kulkarni, Rodney Breau, Ionut Busca, Michael Uy, Gagan Fervaha, Nimira Alimohamed, Ricardo Rendon, Peter Black, Wassim Kassouf, D Robert Siemens","doi":"10.1016/j.urology.2025.06.057","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.057","url":null,"abstract":"<p><strong>Objective: </strong>To examine whether the well demonstrated sex-based differences in bladder cancer management and outcomes are similarly observed for those treated with chemo-radiation for muscle invasive bladder cancer (MIBC).</p><p><strong>Methods: </strong>This retrospective, multi-center study reports on patients who underwent curative intent radiotherapy, with concurrent chemotherapy, for MIBC across 10 academic centers in Canada. The primary outcome was cancer specific survival (CSS) and secondary outcomes included complete response (CR) and overall survival (OS). Survival was estimated using the Kaplan-Meier method. Multivariable regression models were performed to assess an independent association of sex on outcomes.</p><p><strong>Results: </strong>There were 397 males and 145 females who underwent curative intent chemo-radiation for MIBC with a total median follow-up of 30 months. Baseline cancer characteristics and treatment specifics were similar between the sexes, although complete resection was more common in males and hydronephrosis was more common in females. There were no differences in CR rates between males and females (72.3% vs. 73.1%). The 3-year CSS was 78.4% vs. 70.4% for males and females respectively and median OS was 81 months vs. 52 months. Cumulative incidence of mortality was similar between the sexes with organ-confined disease but higher for females with non-organ-confined disease. In multivariable analysis, sex was independently associated with CSS (HR 1.46, 95% CI 0.95-2.24) but not OS.</p><p><strong>Conclusions: </strong>This multi-center study demonstrated worse CSS in females undergoing chemo-radiation. Future investigations should explore potential effects from differences in staging, as well as other biological- and treatment-related factors, including differential responses to chemo-sensitized radiation.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529691","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":"Does Variable Clamping Pressure Endanger Urologic Prosthetic Tubing?","authors":"Logan W Grimaud, Jeremy A Kurnot, Matthew Salvino, Andrew C Peterson, Aaron C Lentz","doi":"10.1016/j.urology.2025.06.062","DOIUrl":"10.1016/j.urology.2025.06.062","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of variable rubber-shod hemostat (RSH) clamp pressures on urologic prosthesis tubing (UPT) integrity.</p><p><strong>Methods: </strong>UPT segments were placed into four groups: control, RSH one-click, RSH three-click, or bare hemostat one-click. All experimental groups were clamped for 60 seconds at the point of intervention. Linear force was applied to the tubing until the UPT separated into 2 pieces. Force at the time of failure (FF), tear location, and incidence of leakage before tearing were recorded. Scanning electron microscope images were evaluated for UPT damage from each intervention.</p><p><strong>Results: </strong>The protocol was completed 10 times per group (40 total). Median FF was 99.4 N (79.9-106.5), 104.8 N (78.1-111.0), 97.2 N (74.6-106.5), and 98.1 N (87.9-107.4) for control, RSH one-click, RSH three-click, and bare hemostat one-click, respectively (P = .34). Tear location appeared random for all groups other than the bare hemostat one-click group, which tore at the point of intervention in 6 of 10 (60%) experiments (P = .000082). Only the bare hemostat one-click intervention caused leaking before a complete tear in 2 of 10 (20%) experiments. On scanning electron microscope imaging, only the bare hemostat damaged the surface of the UPT.</p><p><strong>Conclusion: </strong>RSH clamp pressures did not significantly compromise the durability of UPT; however, bare hemostats cause surface damage with a loss of material integrity.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529690","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}