Urology最新文献

{"title":"Long-term Trends in Bladder Management Strategies In Females Following Spinal Cord Injury.","authors":"Bridget L Findlay, Anthony Fadel, Miriam Dash, Jayson Kemble, Boyd R Viers, Katherine T Anderson","doi":"10.1016/j.urology.2025.06.026","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.026","url":null,"abstract":"<p><strong>Objective: </strong>To describe trends in bladder management strategies (BMS) for female patients following spinal cord injury (SCI).</p><p><strong>Methods: </strong>Data were collected from the National Spinal Cord Injury Model Systems (SCIMS) Database on 29,202 patients from 1972 to 2016. BMS included the following categories: Noninvasive (N), Urinary Diversion (UD), Urethral Catheter (UC), Intermittent Catheterization (CIC), and Suprapubic Tube (SP). Descriptive statistics were summarized and chi-squared analysis with Bonferroni correction was used to compare BMS among men and women.</p><p><strong>Results: </strong>The most common BMS for females at 40 years follow up was UC (33%), followed by CIC (30%) and N (22%). The proportion of UD increased from approximately 0% initially to 7% at 40 years. At any timepoint, females were significantly more likely to have UD (2.2% vs 1.2%) and UC (24.3% vs 12.4%) compared to males, but less likely to perform CIC (38.3% vs 32.8%) or use an SP (18.5% vs 9.1%) (all p<0.05). Patient-reported wheelchair use was prevalent among females with UD (94%) with 67% of them reporting new wheelchair use at time of conversion to UD.</p><p><strong>Conclusion: </strong>The use of urethral catheters in females after SCI is commonplace despite the known risks of this BMS. Urinary diversions increase over time which may be due to complications from previous BMS or functional decline, such as transition to wheelchair use. Further studies are needed to better understand the factors that govern choice of each BMS and the associated effect on quality of life.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318043","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":"Development and external validation of a local pelvic recurrence risk score after radical cystectomy: identifying the ideal candidate for adjuvant radiation clinical trials.","authors":"Matthew S Lee, Marco Moschini, Cameron J Britton, Mattia Longoni, Robert F Tarrell, Austin J Martin, Bryan J Traughber, Bradley J Stish, Jacob J Orme, Paras H Shah, Igor Frank, R Jeffrey Karnes, Stephen A Boorjian, Vidit Sharma","doi":"10.1016/j.urology.2025.06.030","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.030","url":null,"abstract":"<p><strong>Objective: </strong>To develop a risk stratification tool for locoregional recurrence (LR) after radical cystectomy (RC). LR confers a poor prognosis and current risk stratification tools are lacking, representing a critical knowledge gap in facilitating trial design for adjuvant local therapy.</p><p><strong>Methods: </strong>We reviewed our institutional Cystectomy Registry to ideurontify factors associated with LR. A risk score was created using the multivariable regression coefficients.</p><p><strong>Results: </strong>Among 1256 patients who underwent RC, 227 experienced LR, with median time to LR of 11 months, resulting in a 2- and 5-year LR risk of 17% and 22%, respectively. Median follow up was 4.4 years after LR. On multivariable analysis, pT-stage (HR=1.72), pN+ (HR=1.90), and number of lymph nodes removed (HR=0.98 per node) were independently associated with LR (all p<0.01). Positive ureteral/urethral margin (HR=1.52) and positive radial margin (HR=1.58) were associated with LR with p=0.08 and p=0.07, respectively. Our risk score stratified patients by risk of 5-year LR from 2% to 52% with c-index of 0.73. External validation in a European cystectomy cohort (N=614) demonstrated comparable performance to the development cohort with c-index of 0.75 at 3 years.</p><p><strong>Conclusions: </strong>We developed a risk score based on post-cystectomy pathologic variables which effectively stratified patients' risk of subsequent LR. The risk score had similar performance in the internal development and external validation cohorts, despite the cohorts being geographically distinct with different LR event rates. This risk score may therefore be considered in designing adjuvant therapy trials (e.g., radiation, immunotherapy) for high-risk patients after RC.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318042","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":"Addressing Lactation Challenges in Urology: A Call to Action.","authors":"Gwen M Grimsby","doi":"10.1016/j.urology.2025.06.024","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.024","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310498","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":"Exploring the Association Between Varicocele and Testosterone Deficiency in Men Over 50 Years of Age.","authors":"Daniel J Kim, Patrick E Teloken, John P Mulhall","doi":"10.1016/j.urology.2025.06.029","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.029","url":null,"abstract":"<p><strong>Objective: </strong>To define the impact of varicoceles (VX) on total testosterone (TT) levels in an aging male population.</p><p><strong>Methods: </strong>This retrospective analysis of a departmental database assessed patients ≥50 years of age, who had two testes, and recorded early morning TT levels. Patient demographics, comorbidity profiles, VX laterality, and VX grade were also analyzed.</p><p><strong>Results: </strong>Data was retrievable for 776 patients. Mean age was 66 ±12 years. 140 (18%) patients had at least one VX on examination (VX+). Of these 118 (84%) had unilateral VX while 22 (16%) had bilateral. Mean TT for the VX+ group (336 ng/dl ±168) was statistically significantly lower than for the VX- group (472ng/dL ±267) (p<0.01). Those with bilateral VX had lower TT (297 ng/dL) than those with unilateral VX (372 ng/dL) (p<0.05). While 16% of the total VX+ population had TT levels <300 ng/dl, these rates were 11% and 24% in men with unilateral and bilateral VX (p<0.01). In those with unilateral VX, there was a relationship between VX grade and testosterone deficiency, with the highest likelihood associated with Grade III (r=0.65, p<0.01). There was no association between Grade I and low T levels.</p><p><strong>Conclusions: </strong>In this population of men older than 50, the presence, laterality and grade of VX were associated with lower levels of TT.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310499","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":"Exploring the Impact of Mental Health on PSA Screening: Insights from a Population-Based Survey.","authors":"Andrea Piccolini, Zhiyu Qian, Stephan M Korn, Filippo Dagnino, Klara Pohl, Hanna Zurl, Yvonne Lei, Nora Y Osman, Giovanni Lughezzani, Nicolò M Buffi, Quoc-Dien Trinh, Alexander P Cole","doi":"10.1016/j.urology.2025.06.016","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.016","url":null,"abstract":"<p><strong>Objective: </strong>To explore the relationship between mental health status and prostate-specific antigen (PSA) screening, given that poor mental health may reduce engagement in preventive health behaviors.</p><p><strong>Methods: </strong>We analyzed data from the 2018 and 2020 Behavioral Risk Factor Surveillance System (BRFSS) surveys, including men aged 50-69 years without history of prostate cancer. The primary outcome was self-reported PSA screening in the past two years. Poor mental health was defined as at least 14 days of self-reported poor mental health or a depressive disorder diagnosis. Covariates included socio-demographic variables, chronic comorbidities, and healthcare access. Logistic regression assessed associations between mental health, PSA screening, and covariates.</p><p><strong>Results: </strong>A total of 114,972 men were included, representing a weighted population of 30.5 million. Of them, 81.9% and 18.1% had good and poor mental health, respectively. The overall PSA screening rate was 28.2%. Men with good mental health were more likely to undergo PSA screening (29.3% vs 23.2%; p<0.001). Poor mental health was associated with 10% lower odds of PSA screening (aOR: 0.90 [0.83-0.98]). Higher adherence was observed among older participants (aOR: 2.54), with higher education levels (aOR: 1.95), or married (aOR: 1.21). Having at least one personal doctor (aOR: 2.86) was a strong predictor of PSA screening.</p><p><strong>Conclusions: </strong>Men with poor mental health are less likely to undergo PSA screening. Addressing mental health barriers is essential to improve preventive care. Integrated care models with mental health support may reduce disparities and enhance prostate cancer outcomes in this population.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302948","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":"Prevalence, Risk Factors, and Coping Strategies for Burnout Among Pediatric Urologists.","authors":"Nicolette G Payne, Daniel Salevitz, Natalie Dvorak, Amanda North, Gwen M Grimsby","doi":"10.1016/j.urology.2025.06.025","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.025","url":null,"abstract":"<p><strong>Objective: </strong>To determine the current prevalence of burnout in pediatric urologists, to identify risk factors associated with higher levels of burnout, and to identify coping strategies among pediatric urologists.</p><p><strong>Methods: </strong>The Maslach Burnout Inventory (MBI) and an anonymous survey of demographic and practice characteristics were distributed electronically to pediatric urologists through the Society of Pediatric Urology. The MBI is a standardized, validated questionnaire comprised of three subscales: Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA). As per prior literature, higher scores in EE (>27) and/or DP (>10) were defined as high burnout. Independent variables of demographic and practice characteristics were compared between urologists with high versus low to moderate levels of burnout with t tests and Fisher's exact tests.</p><p><strong>Results: </strong>The survey response rate was 203/674 (30%). Mean age of respondents was 50 years, 66% were male, and the average number of years in practice was 15.6. The mean MBI scores were 22.6 for EE, 7.4 for DP, and 38.5 for PA. Overall, 43% of pediatric urologists met criteria for high burnout compared to 25.5% in the 2016 AUA census. Univariate analysis revealed three factors significantly associated with high burnout: younger age, female gender, and hours worked per week.</p><p><strong>Conclusions: </strong>The results of this study suggest an increased prevalence of burnout among pediatric urologists since the 2016 AUA census, particularly in younger and female urologists. Identification of these risk factors is important to mitigate burnout and maintain the already strained urology workforce.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302950","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":"Delayed Urinary Retention After Holmium Laser Enucleation of Prostate.","authors":"Maithili Gopalakrishnan, Anastasija Useva, Raj Kumar, Adam Novak, Scott Wiener","doi":"10.1016/j.urology.2025.06.018","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.018","url":null,"abstract":"<p><strong>Objective: </strong>To identify modifiable perioperative risk factors associated with delayed urinary retention (DUR) that occurs after a successful same-day trial of void (SDTOV) in patients undergoing holmium laser enucleation of prostate (HoLEP).</p><p><strong>Methods: </strong>Our institution prospectively maintains an IRB-approved single surgeon database of HoLEP procedures from which we identified patients with DUR after passing SDTOV. Exclusion criteria included the first 50 cases (due to surgeon's learning curve), patients with failed SDTOV, and clot retention. Using SPSS 26 statistical software, we analyzed various peri-operative factors in association with our primary outcome, DUR, using unpaired t-tests for continuous variables and chi-squared analysis for categorical variables. Multivariate logistic regression was used to assess several preoperative and operative variables in association with DUR (p<0.05 as significant).</p><p><strong>Results: </strong>500 HoLEPs were performed from Jan 2020-Aug 2024. 18 (5.17%) of the 348 patients included had DUR. We found no significant differences in age, BMI, ASA, comorbidities, preoperative prostate size, or medication use between patients who did and did not have DUR. On multivariate logistic regression, intraoperative urethral dilation (25.8% cases) and postoperative continuous bladder irrigation (CBI) (7.7% cases) were significantly associated with DUR (p<0.05).</p><p><strong>Conclusions: </strong>Intraoperative urethral dilation and postoperative CBI were significant predictors of non-clot DUR. Therefore, surgeries involving these contributors warrant additional postoperative patient counseling and consideration of discharge with catheter to decrease morbidity and cost from unplanned encounters for catheter replacement.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302947","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:\" Telehealth Use and Barriers in Non-Metropolitan Clinic Populations \".","authors":"Xiaoqing Hu","doi":"10.1016/j.urology.2025.06.022","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.022","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302949","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 \"Electronic Residency Application Service Application Fees in Surgical Subspecialties: A Barrier to a Diverse Healthcare Workforce?\"","authors":"Abdul-Jawad J Majeed, Dennis Head, Jay D Raman","doi":"10.1016/j.urology.2025.06.019","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.019","url":null,"abstract":"","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295031","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":"Disparities in Access to High Volume Centers for Muscle Invasive Bladder Cancer and its Association With Treatment Patterns and Outcomes.","authors":"Savannah Starr, Saam Kazemi, Precious Moman, Lin Lin, J J Zhang, Karim Chamie","doi":"10.1016/j.urology.2025.06.021","DOIUrl":"https://doi.org/10.1016/j.urology.2025.06.021","url":null,"abstract":"<p><strong>Objective: </strong>To investigate access to high volume centers (HVCs) for non-metastatic muscle-invasive bladder cancer (MIBC) and assesses implications of disparities on treatment outcomes. We hypothesized that socially disadvantaged patients would have limited access to HVCs, contributing to observed outcome disparities.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using the National Cancer Database (NCDB) from 2004 to 2020 of patients with non-metastatic MIBC. We categorized treatment facilities into high-volume centers (HVCs), intermediate-volume centers (IVCs), and low-volume centers (LVCs) based on annual case volumes. We analyzed demographic, socioeconomic, and insurance-related factors influencing access to HVCs through multivariable logistic regression. Treatment modalities, perioperative outcomes, and overall survival were compared across facility volume cohorts.</p><p><strong>Results: </strong>The majority of patients (57.2%) were treated at HVCs, with significant demographic disparities observed. Black patients (OR 0.68, p<0.001) and those from lower socioeconomic backgrounds were less likely to receive care at HVCs. Patients at HVCs experienced higher rates of radical cystectomy (OR 1.67, p<0.001) and neoadjuvant chemotherapy (OR 1.76 p<0.001) with better perioperative outcomes, including reduced readmissions (OR 0.78, p<0.001), less prolonged hospital stays (OR 0.76, p<0.001), and improved overall survival (5-year survival rates: HVCs 37.7% vs. LVCs 30.1%, p<0.001).</p><p><strong>Conclusion: </strong>Our findings reveal substantial disparities in access to HVCs for MIBC treatment, particularly affecting Black and economically disadvantaged patients. HVCs have significantly improved outcomes and survival, highlighting the need for systemic interventions to improve access to high quality cancer care.</p><p><strong>Data availability statement: </strong>The data used in this study are available from the National Cancer Database (https://www.facs.org/quality-programs/cancer/ncdb).</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295030","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}