IF 2.1 3区医学

Urology Pub Date : 2025-06-12 DOI: 10.1016/j.urology.2025.06.021

Savannah Starr, Saam Kazemi, Precious Moman, Lin Lin, J J Zhang, Karim Chamie

{"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":"10.1016/j.urology.2025.06.021","url":null,"abstract":"Objective: To investigate access to high-volume centers (HVCs) for nonmetastatic 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.Methods: We conducted a retrospective analysis using the National Cancer Database (NCDB) from 2004 to 2020 of patients with nonmetastatic MIBC. We categorized treatment facilities into HVCs, intermediate-volume centers, and low-volume centers 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.Results: The majority of patients (57.2%) were treated at HVCs, with significant demographic disparities observed. Black patients (OR 0.68, P < .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 < .001) and neoadjuvant chemotherapy (OR 1.76, P < .001) with better perioperative outcomes, including reduced readmissions (OR 0.78, P < .001), less prolonged hospital stays (OR 0.76, P < .001), and improved overall survival (5-year survival rates: HVCs 37.7% vs low-volume centers 30.1%, P < .001).Conclusion: 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.","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}

引用次数: 0

Understanding the Experience of Receptive Anal Intercourse in Patients With Chronic Pelvic Pain Syndrome. 了解慢性盆腔疼痛综合征患者接受性肛交的经验。

IF 2.1 3区医学

Urology Pub Date : 2025-06-12 DOI: 10.1016/j.urology.2025.06.015

Jonathan A Balcazar, Thomas W Gaither, Myles Anderson, Marcia M Russell, Mark S Litwin

{"title":"Understanding the Experience of Receptive Anal Intercourse in Patients With Chronic Pelvic Pain Syndrome.","authors":"Jonathan A Balcazar, Thomas W Gaither, Myles Anderson, Marcia M Russell, Mark S Litwin","doi":"10.1016/j.urology.2025.06.015","DOIUrl":"10.1016/j.urology.2025.06.015","url":null,"abstract":"Objective: To identify chronic pelvic pain syndrome (CPPS) correlates in receptive anal intercourse (RAI)-engaging individuals and their association with the NIH Chronic Prostatitis Symptom Index (NIH-CPSI) scores. CPPS, or category III prostatitis, causes pelvic pain, urinary symptoms, and sexual dysfunction. Its etiology remains unclear but may involve visceral crosstalk, where dysfunction in one pelvic organ affects another.Methods: We conducted an online cross-sectional survey (July 2022-January 2023) of individuals assigned male at birth who engaged in RAI in the past six months. Participants completed the NIH-CPSI and Anorectal Sexual Function Index to assess pain, urinary, and bowel symptoms. Mental health symptoms, childhood trauma, and urologic, gastrointestinal, and anorectal conditions were also assessed. NIH-CPSI severity groups: non-mild (<10), moderate (10-18), and severe (>18). Analyses included Kruskal-Wallis and chi-squared tests.Results: Among 408 participants, 117 (28.7%) had moderate/severe CPPS. Higher NIH-CPSI scores correlated with decreased pleasure (P = .001), increased pain (P <.001), and greater urinary/bowel symptoms. Lower RAI exposure (<50 times) correlated with higher NIH-CPSI scores (P = .01). Comorbid urologic, gastrointestinal, and anorectal conditions, childhood trauma, and mental health symptoms were associated with CPPS severity (P <.001).Conclusion: These findings highlight the interplay between CPPS severity, sexual function, and comorbid conditions in RAI-engaging individuals. Visceral crosstalk may contribute to anorectal symptom overlap, while mental health and childhood trauma align with the central sensitization models of chronic pain. The inverse relationship with CPPS severity suggests pelvic floor dysfunction or desensitization mechanisms; thus, multidimensional management is essential.","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":"144295035","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 Editorial Comment on "Benign Noninfectious Scrotal Dermatoses: An Overview". 对“良性非感染性阴囊皮肤病：综述”社论评论的回复。

IF 2.1 3区医学

Urology Pub Date : 2025-06-12 DOI: 10.1016/j.urology.2025.06.020

Katherine L Wang, James H Keeling, Miguel A Aristizabal, Thais P Pincelli, Elisha M Singer

引用次数: 0

Reply to Editorial Comment on "Incorporating Intra-Operative Education Into Ergonomics Training for Endourology Cases: A Pilot Study". 对“将术中教育纳入泌尿外科病例人机工程学培训：一项初步研究”社论评论的答复。

IF 2.1 3区医学

Urology Pub Date : 2025-06-11 DOI: 10.1016/j.urology.2025.06.001

Meghan F Davis, Rachael D Sussman

引用次数: 0

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". 致编辑的信：“24小时尿代谢评价中肾结石危险因素的性别和年龄变化：真实世界单中心回顾性分析”。