IF 2.1 3区医学

Urology Pub Date : 2024-11-13 DOI: 10.1016/j.urology.2024.11.003

Joshua P Hayden, Jason Nelson, Edward Frankenberger, Alex J Vanni

{"title":"Risk of Hematuria-Related Complications Associated with Anticoagulant and Antiplatelet Medications: A Single-Institution Retrospective Cohort Study.","authors":"Joshua P Hayden, Jason Nelson, Edward Frankenberger, Alex J Vanni","doi":"10.1016/j.urology.2024.11.003","DOIUrl":"https://doi.org/10.1016/j.urology.2024.11.003","url":null,"abstract":"Objective: To evaluate enteral and parenteral anticoagulant and antiplatelet medications and their associated risks of hematuria-related complications.Materials and methods: This was a single-institution, retrospective cohort study. Primary outcomes were counts of ED visits, hospital admissions, and urologic procedures to manage gross hematuria that occurred while patients were exposed to anticoagulant/antiplatelet medications. Multivariable negative binomial regression was used to identify incidence density rates and rate ratios for hematuria-related complications associated with each anticoagulant/antiplatelet medication.Results: Among 119,528 patients in the study cohort, 10,601 were exposed to rivaroxaban and 108,927 were not exposed to rivaroxaban. Patients who were prescribed rivaroxaban were more likely to be male (55.5% vs. 52.0%, p <.001), of white race (95.9% vs. 92.8%, p <.001), and have higher BMIs (median BMI, 29.3 vs. 28.3, p <.001). Those not exposed to rivaroxaban had lower incidence density rates than those exposed to rivaroxaban for any hematuria-related complication (29.4 vs. 39.3). Exposure to enoxaparin compared to rivaroxaban was associated with higher rates of any hematuria-related complication (adjusted risk ratio (aRR) 2.74, 95% CI 2.43-3.10), emergency department visits related to hematuria (aRR 3.34, 95% CI 2.73-4.11), and hematuria-related hospitalizations (aRR 4.58, 95% CI, 3.70-5.70). All other oral anticoagulant and antiplatelet medications studied were associated with lower risk than rivaroxaban for hematuria-related complications.Conclusions: Among enteral and parenteral anticoagulant and antiplatelet medications studied, enoxaparin is associated with the highest rates of hematuria-related events. Further work is needed to elucidate the mechanisms by which distinct anticoagulant and antiplatelet medications contribute to hematuria.","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640020","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}

引用次数: 0

Editorial Comment on "PubMed-Indexed Research Productivity of Urology Applicants and Residents: Does Medical Student Research Productivity Predict Resident Research or Pursuit of an Academic Career?" 关于 "泌尿外科申请者和住院医师的 PubMed 指数研究生产力 "的编辑评论：医科学生的研究成果能否预测住院医师的研究或学术生涯的追求？

IF 2.1 3区医学

Urology Pub Date : 2024-11-12 DOI: 10.1016/j.urology.2024.11.010

Omer A Raheem, Ammar Al Homsi

引用次数: 0

Reply to Editorial Comment on "Comparative Outcomes of Day-Case Percutaneous Nephrolithotomy Versus Conventional Inpatient Surgery: A Systematic Review and Meta-Analysis". 对 "日间病例经皮肾镜取石术与传统住院手术的疗效比较：系统回顾和元分析"。

IF 2.1 3区医学

Urology Pub Date : 2024-11-12 DOI: 10.1016/j.urology.2024.11.012

Alejandro Calvillo-Ramirez, Juan Carlos Angulo-Lozano

引用次数: 0

Testosterone to Estradiol Ratios in Fertile and Subfertile Men: A Large Cohort Analysis. 可育和不育男性的睾酮与雌二醇比率：大型队列分析

IF 2.1 3区医学

Urology Pub Date : 2024-11-12 DOI: 10.1016/j.urology.2024.11.004

Evan J Panken, Solomon Hayon, Daniel R Greenberg, Sai Kaushik Sr Kumar, Robert E Brannigan, Joshua A Halpern

{"title":"Testosterone to Estradiol Ratios in Fertile and Subfertile Men: A Large Cohort Analysis.","authors":"Evan J Panken, Solomon Hayon, Daniel R Greenberg, Sai Kaushik Sr Kumar, Robert E Brannigan, Joshua A Halpern","doi":"10.1016/j.urology.2024.11.004","DOIUrl":"10.1016/j.urology.2024.11.004","url":null,"abstract":"Objective: To validate the established normal testosterone to estradiol ratio and characterize the distribution of testosterone to estradiol ratios in a large cohort of fertile and subfertile men.Materials and methods: Retrospective review of adult men (≥18 years of age) presenting for fertility evaluation between 2002 and 2021 who underwent evaluation by a reproductive urologist, had 2 separate semen analyses and had hormonal testing within 6 months of their index semen analysis. Men were dichotomized into fertile and subfertile groups based on total motile sperm count on 2 semen analyses. The subfertile cohort included men with a total motile sperm count <20 million on both semen analyses. The main outcome measures were serum testosterone, serum estradiol, and serum testosterone to estradiol ratio.Results: Among 816 men, 651 (79.8%) were classified as fertile and 165 (20.2%) as subfertile. Median testosterone (ng/dL) to estradiol (pg/mL) ratios were similar between the groups (14.48 vs 15.00, P = .5). The 20th percentile testosterone to estradiol ratio for the fertile group was 9.77.Conclusion: This is the largest study to date characterizing testosterone to estradiol ratios in men presenting for fertility evaluation. We validated the 10/1 ratio that was previously established as the 20th percentile for fertile men. We found no difference in testosterone to estradiol ratios between fertile and subfertile men defined by total motile sperm count, highlighting the need for further investigation to better define the cohort of men with infertility who could benefit from aromatase inhibitor therapy.","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629206","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}

引用次数: 0

Reply to "Virtual reality as an adjunct to traditional patient counseling in patients with newly-diagnosed localized prostate cancer". 对 "虚拟现实技术作为新诊断的局部前列腺癌患者传统咨询的辅助手段 "的答复

IF 2.1 3区医学

Urology Pub Date : 2024-11-12 DOI: 10.1016/j.urology.2024.11.008

Alan G Perry, Eric Qualkenbush, Raymond W Pak, Ram A Pathak

引用次数: 0

A Novel Machine Learning-Based Predictive Model of Clinically Significant Prostate Cancer and Online Risk Calculator. 基于机器学习的新型临床前列腺癌预测模型和在线风险计算器。

IF 2.1 3区医学

Urology Pub Date : 2024-11-11 DOI: 10.1016/j.urology.2024.11.001

Flavio Vasconcelos Ordones, Paulo Roberto Kawano, Lodewikus Vermeulen, Ali Hooshyari, David Scholtz, Peter John Gilling, Darren Foreman, Basil Kaufmann, Cedric Poyet, Michael Gorin, Abner Macola Pacheco Barbosa, Naila Camila da Rocha, Luis Gustavo Modelli de Andrade

{"title":"A Novel Machine Learning-Based Predictive Model of Clinically Significant Prostate Cancer and Online Risk Calculator.","authors":"Flavio Vasconcelos Ordones, Paulo Roberto Kawano, Lodewikus Vermeulen, Ali Hooshyari, David Scholtz, Peter John Gilling, Darren Foreman, Basil Kaufmann, Cedric Poyet, Michael Gorin, Abner Macola Pacheco Barbosa, Naila Camila da Rocha, Luis Gustavo Modelli de Andrade","doi":"10.1016/j.urology.2024.11.001","DOIUrl":"https://doi.org/10.1016/j.urology.2024.11.001","url":null,"abstract":"Objectives: To create a machine learning predictive model combining PI-RADS score, PSA density, and clinical variables to predict clinically significant prostate cancer (csPCa).Methods: We evaluated a cohort of patients who underwent prostate biopsy for suspected prostate cancer (PCa) in New Zealand, Australia, and Switzerland. We collected data on age, body mass index (BMI), PSA level, prostate volume, PSA density (PSAD), PI-RADS scores, previous biopsy, and corresponding histology results. The dataset was divided into derivation (training) and validation (test) sets using random splits. An independent dataset was obtained from the Harvard Dataverse for external validation. A cohort of 1272 patients was analyzed. We fitted a Lasso model, XGBoost, and LightGBM to the training set and assessed their accuracy.Results: All models demonstrated ROC AUC values ranging from 0.830 to 0.851. LightGBM was considered the superior model, with an ROC of 0.851 [95%CI: 0.804 - 0.897] in the test set and 0.818 [95% CI: 0.798 - 0.831] in the external dataset. The most important variable was PI-RADS, followed by PSA density, history of previous biopsy, age, and BMI.Conclusions: We developed a predictive model for detecting csPCa that exhibited a high ROC-AUC value for internal and external validations. This suggests that the integration of the clinical parameters outperformed each individual predictor. Additionally, the model demonstrated good calibration metrics, indicative of a more balanced model than the existing models.","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629181","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}

引用次数: 0

Vessel-sparing Non-transecting Anastomotic Reconstruction of the Posterior Urethra: Single Center Experience with Long-term Follow-up. 后尿道保全血管无交叉吻合重建术：单中心长期随访经验。

IF 2.1 3区医学

Urology Pub Date : 2024-11-08 DOI: 10.1016/j.urology.2024.10.059

Reynaldo G Gómez, Laura G Velarde, Rodrigo A Campos, Víctor Barrientos

{"title":"Vessel-sparing Non-transecting Anastomotic Reconstruction of the Posterior Urethra: Single Center Experience with Long-term Follow-up.","authors":"Reynaldo G Gómez, Laura G Velarde, Rodrigo A Campos, Víctor Barrientos","doi":"10.1016/j.urology.2024.10.059","DOIUrl":"10.1016/j.urology.2024.10.059","url":null,"abstract":"Objective: To discuss the long-term results of our vessel-sparing non-transecting approach (vspEPA) to perform anastomotic urethroplasty at the posterior urethra. We avoid transecting the bulbar arteries to preserve the antegrade vascularization of the urethra. We hypothesize that vspEPA is feasible, safe, and not inferior to the traditional transecting technique. Additionally, it may provide benefits if an artificial urinary sphincter (AUS) implantation be required in the future.Methods: The bulbar urethra was elevated from the corpus cavernosum, released distally, retracted laterally, and approached dorsally at the bulbo-membranous junction. This exposure allows removal of the scar and performs the anastomotic reconstruction as in the standard transecting technique, while avoiding division of the bulbar arteries.Results: One hundred twenty-seven patients, median age 58 years (interquartile range [IQR] 35-67), were reconstructed since 2008. Etiology of the stenosis was BPH surgery (n = 48), pelvic fracture urethral injury (PFUI) (n = 61), prostate cancer treatment (n = 14) and instrumentation (n = 4). With a median follow-up of 43 months (IQR 17-74) stenosis repair success was observed in 121 patients (95%). High-grade complications (Clavien ≥III) occurred in 6 (5%) of cases and overall stress incontinence was observed in 24 (19%) of patients. Fourteen patients subsequently received an AUS and notably none of them suffered cuff erosion after a median follow-up of 36 months.Conclusion: Sparing of the bulbar arteries during anastomotic reconstruction of the posterior urethra is feasible and safe. Although slightly more elaborated, it will not compromise the surgical results and may be instrumental to avoid AUS cuff-related erosion in the future.","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629143","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}

引用次数: 0

Male Factor Infertility and the Rural-Urban Continuum. 男性因素不育与城乡差别。

IF 2.1 3区医学

Urology Pub Date : 2024-11-08 DOI: 10.1016/j.urology.2024.10.080

Devon M Langston, Kiarad Fendereski, Joshua Halpern, Ijeoma N Iko, Kenneth Aston, Benjamin R Emery, Elisabeth Ferlic, Joemy M Ramsay, Joshua J Horns, James Hotaling

{"title":"Male Factor Infertility and the Rural-Urban Continuum.","authors":"Devon M Langston, Kiarad Fendereski, Joshua Halpern, Ijeoma N Iko, Kenneth Aston, Benjamin R Emery, Elisabeth Ferlic, Joemy M Ramsay, Joshua J Horns, James Hotaling","doi":"10.1016/j.urology.2024.10.080","DOIUrl":"10.1016/j.urology.2024.10.080","url":null,"abstract":"Objective: To examine the association between male factor infertility and the Rural-Urban continuum.Materials and methods: Single institution retrospective cohort study using the Utah Population Database, which combines demographic, medical, and residential data for patients residing in Utah and links to the Subfertility Health Assisted Reproduction and Environment database, which houses fertility data from 1998 to 2017. The data was divided by metropolitan (metro-) (large, medium, small) and non-metropolitan (non-metro-) (urban, rural) status, based on United States Department of Agriculture rural-urban continuum codes.Results: Non-metro urban/rural males were less likely to be a racial/ethnic minority (92.3% non-Hispanic white vs 86.2%) or use assisted reproductive technology (13.5% vs 18.5%). Multivariate regression controlling for race/ethnicity, age, semen analysis category (oligozoospermic vs normozoospermic), previous successful fertility outcome, and use of assisted reproductive technology, demonstrated complete rurality was associated with decreased likelihood of successful fertility outcome (Hazard Ratio [HR] 0.60, 95% CI 0.41-0.87, n = 49, P = 0.007). Non-metro urban individuals trended towards lower likelihood of successful fertility outcome ([HR] 0.90, 95% CI 0.82-0.98, P = 0.02). Complete rurality was associated with longer time for 50% cohort successful fertility outcome (>60 months vs approximately 34 months both metro), P = .007.Conclusion: Across the rural-urban continuum, residing in a metro area was associated with higher rates of racial/ethnically diversity, fertility treatment utilization, and successful fertility outcomes (live births). Given approximately 18% of the United States resides with a rural community (12% in Utah), these findings can provide more informed infertility care.","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629197","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}

引用次数: 0

Is There a Consensus on the Management of Primary Obstructive Megaureter? 是否已就原发性梗阻性巨输尿管的治疗达成共识？

IF 2.1 3区医学

Urology Pub Date : 2024-11-08 DOI: 10.1016/j.urology.2024.10.077

Romy Gander, Marino Asensio, Manuel Lopez

{"title":"Is There a Consensus on the Management of Primary Obstructive Megaureter?","authors":"Romy Gander, Marino Asensio, Manuel Lopez","doi":"10.1016/j.urology.2024.10.077","DOIUrl":"10.1016/j.urology.2024.10.077","url":null,"abstract":"Objective: To analyze the results of a survey regarding the opinion of experts in diagnosis and management of primary obstructive megaureter (POM) and to determine if their current therapeutic strategy matches with the British Association of Pediatric Urologist recommendations, published in 2014.Methods: From February 1 to June 30, 2023, an online-based survey was distributed through the eUROGEN network and some pediatric urology societies. The questionnaire was carried out using google forms and consisted of 14 questions. Additionally, a literature review of the most recent articles was performed.Results: One hundred three medical professionals completed the survey, 98 (96.1%) were pediatric urologists. 67.3% of respondents agreed with starting continuous antibiotic prophylaxis in all patients with POM. The diagnosis of obstruction is mostly made based on a combination of findings which include initial DRF <40%, drop of DRF of >5% on serial scans and worsening of dilation at follow-up ultrasound (63.7%). When specifically asked if initial DRF <40% as a solely finding without symptoms or massive dilatation was considered as an indication for early surgery, only 12 (11.9%) considered it so. Regarding ureteral reimplantation under the age of 1, 46 (45.1%) were confident in this procedure. Among temporizing interventions, high-pressure endoscopic balloon dilatation was the most popular.Conclusion: Current trends in the diagnosis and management of POM may challenge some of the British Association of Pediatric Urologist recommendations, especially in regards initial DRF <40% as a solely indication of surgery and the most popular temporizing procedures. It may be time to elaborate a new updated consensus and decide a common updated approach for all patients with POM.","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629192","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}

引用次数: 0

Analyzing Antibiotic Usage Trends in Genitourinary Infections and Procedures: Insights From the TriNetX Database. 分析泌尿生殖系统感染和手术中的抗生素使用趋势：来自 TriNetX 数据库的启示。

IF 2.1 3区医学

Urology Pub Date : 2024-11-08 DOI: 10.1016/j.urology.2024.10.071

Brian H Im, Aaron R Hochberg, Brandon Havranek, Courtney E Capella, Maria J D'Amico, Analyse H Giordano, Whitney Smith, Alana Murphy, Mihir S Shah, Costas D Lallas

{"title":"Analyzing Antibiotic Usage Trends in Genitourinary Infections and Procedures: Insights From the TriNetX Database.","authors":"Brian H Im, Aaron R Hochberg, Brandon Havranek, Courtney E Capella, Maria J D'Amico, Analyse H Giordano, Whitney Smith, Alana Murphy, Mihir S Shah, Costas D Lallas","doi":"10.1016/j.urology.2024.10.071","DOIUrl":"10.1016/j.urology.2024.10.071","url":null,"abstract":"Objective: To analyze antibiotic prescribing trends, particularly the decline in fluoroquinolone use for various genitourinary infection (GUI) and procedures and the growing preference for alternative treatments.Methods: The TriNetX database was queried for antibiotic utilization rates from 2016 to 2022. We analyzed cases of cystitis, pyelonephritis, prostatitis, and other GUIs, as well as periprocedure utilization for benign prostatic hyperplasia, urethral stricture disease, pelvic organ prolapse/stress urinary incontinence, and overactive bladder/interstitial cystitis (OAB/IC). We determined the top four to six antibiotics prescribed within 5 days of diagnosis or procedure. Statistical analysis included linear regression modeling.Results: From 2016 to 2022, fluoroquinolone use decreased in cystitis (P <.001), pyelonephritis (P <.001), and prostatitis (P <.01). These infections were increasingly treated with beta-lactams (P <.0001, P <.01, P <.01, respectively). Additionally, we found a decrease in fluoroquinolone utilization in procedures for benign prostatic hyperplasia (P <.001), urethral stricture (P <.01), pelvic organ prolapse/stress urinary incontinence (P <.001), and OAB/IC (P <.001). All cohorts except for OAB/IC showed a significant increase in beta-lactam use (P <.001, P <.01, P <.01, respectively).Conclusion: We noted a significant decline in fluoroquinolone use for GUI and procedures, accompanied by increased beta-lactam use, reflecting changes in prescribing practices. Judicious use is essential to promote antimicrobial stewardship and mitigate severe adverse effects.","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629184","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}

引用次数: 0

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