Canadian Urological Association Journal最新文献

{"title":"The impact of the Ontario quality-based procedures funding model on radical prostatectomy outcomes","authors":"Nickan Motamedi, Andrew McClure, Nicholas Power, Stephen Pautler, Lilian Gien, Blayne Welk, Jacob McGee","doi":"10.5489/cuaj.8632","DOIUrl":"https://doi.org/10.5489/cuaj.8632","url":null,"abstract":"Introduction: In 2015, radical prostatectomy (RP) in Ontario transitioned to the quality-based procedures (QBP) funding model, which assigns disbursement from surgical quality indicator (QI) outcome performance. The objective of this study was to assess the QBP QI outcomes before and after implementation of the QBP funding model for RP, and to determine whether changes seen were attributable to the QBP model.\u0000Methods: We conducted a population-based, retrospective cohort study including all men who underwent RP for prostate cancer in Ontario from 2010–2019. We used administrative data from Ontario’s health databases to gather surgical and QI outcome data. Our primary outcomes were the five measurable QBP QIs outlined by the province. We performed a pre- and post-intervention comparison, in addition to an interrupted-time series (ITS) analysis.\u0000Results: Two of the five QIs improved after implementation of the QBP model (complication rate: 11.89% vs. 9.96%, p<0.001; proportion meeting length of stay target: 78.11% vs. 86.84%, p<0.001). ITS analysis revealed that there was no difference in trend in either outcome between pre- and post-implementation periods (p=0.913 and p=0.249, respectively). Two QIs were worse in the post-implementation period (unplanned visit rate: 23.45% vs. 25%, p=0.015; proportion meeting Wait 2 target: 94.39% vs. 92.88%, p<0.001). ITS revealed a significant trend changes post-implementation (p=0.260 and p=0.272, respectively). There was no difference in reoperation rate (2.84% vs. 2.45%, p=0.107).\u0000Conclusions: The QBP model for RP corresponds with mixed QI changes, but further analysis suggests that these changes were pre-existing trends and not attributable to the model.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141115054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive factors for prolonged operative time in ureteroscopic lithotripsy for ureteral stones","authors":"Taisuke Tobe, Takaaki Inoue, F. Yamamichi, Koki Tominaga, M. Fujita, Masato Fujisawa, H. Miyake","doi":"10.5489/cuaj.8713","DOIUrl":"https://doi.org/10.5489/cuaj.8713","url":null,"abstract":"Introduction: A prolonged operative time of lithotripsy with ureteroscopy for urolithiasis increases the risk of infectious complications; however, few reports have investigated the factors prolonging the operative time for ureteral stones. We investigated the factors associated with longer operative time in ureteroscopy for ureteral stones.\u0000Methods: This retrospective cohort study analyzed patients who underwent retrograde ureteroscopic lithotripsy for ureteral stones and achieved an endoscopic stone-free status between April 2019 and July 2022. Patients were classified into two groups based on an operative time of ≥90 minutes or <90 minutes. We compared the patient and stone characteristics and surgical outcomes, and investigated the factors associated with a prolonged operative time.\u0000Results: The cohort comprised 519 patients, with 58 patients in the group with an operative time of ≥90 minutes. Compared to the shorter operative time group, the longer operative time group had a significantly greater proportion of males, stone diameter, stone volume, and Hounsfield units of stone; additionally, the longer operative time group had higher prevalences of endoscopic findings of edema, polyps, and mucosa-stone adherence. Multivariable analysis showed that stone size >10 mm (odds ratio 4.05), polyps (odds ratio 2.40), and mucosal adherence (odds ratio 3.51) were significantly associated with an operative time exceeding 90 minutes. There were no significant differences between the two groups in the incidences of postoperative fever and systemic inflammatory response syndrome.\u0000Conclusions: Stone size, endoscopic findings of polyps, and mucosa-stone adherence were independent factors associated with a longer operative time.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141116622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence for predicting response to neoadjuvant chemotherapy for bladder cancer","authors":"C. V. Suartz, Lucas Motta Martinez, M. Cordeiro, Hunter Ausley Flores, Sarah Kodama, L. Cardili, J. M. Mota, Fernando Morbeck Almeida Coelho, José de Bessa Junior, Cristina Pires Camargo, Jeremy Yuen-Chun Teoh, S. Shariat, Paul Toren, W. C. Nahas, L. Ribeiro-Filho","doi":"10.5489/cuaj.8681","DOIUrl":"https://doi.org/10.5489/cuaj.8681","url":null,"abstract":"Introduction: Neoadjuvant cisplatin-based combination chemotherapy (NAC) followed by radical cystectomy is the standard of care for cisplatin-fit patients harboring muscle-invasive bladder cancer (MIBC). Prediction of response to NAC is essential for clinical decision-making regarding alternatives in case of non-response and bladder-sparing in case of complete response. This research aimed to assess the performance of machine learning in predicting therapeutic response following NAC treatment in patients with MIBC.\u0000Methods: A systematic review adhering to the PRISMA guidelines was conducted until July 2023. The study integrated articles relating to artificial intelligence and NAC response in MIBC from various databases. The quality of articles was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies 2 (QUADAS-2). A meta-analysis was subsequently performed on selected studies to determine the sensitivity and specificity of machine learning algorithms in predicting NAC response.\u0000Results: Of 655 articles identified, 12 studies comprising 1523 patients were included, and four studies were eligible for meta-analysis. The sensitivity and specificity of the studies were 0.62 (95% confidence interval [CI] 0.50–0.72) and 0.82 (95% CI 0.72–0.89), respectively, with a heterogeneity score (I2) of 38.5%. The machine learning algorithms used computed tomography, genetic, and anatomopathological data as input and exhibited promising potential for predicting NAC response.\u0000Conclusions: Machine-learning algorithms, especially those using computed tomography, genetic, and pathologic data, demonstrate significant potential for predicting NAC response in MIBC. Standardization of methodologic data analysis and response criteria are needed as validation studies.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141117712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variability in perioperative management of pheochromocytoma in Canada","authors":"Linda C. Qu, A. Istl, Elaine Tang, Richard C. Chaulk, Daryl Gray","doi":"10.5489/cuaj.8735","DOIUrl":"https://doi.org/10.5489/cuaj.8735","url":null,"abstract":"Introduction: Despite recent consensus guidelines, there is substantial variability in the management of pheochromocytomas. Our study aimed to characterize the current state of perioperative pheochromocytoma management by Canadian surgeons.\u0000Methods: A 23-item online survey was sent to Canadian surgeons who perform adrenalectomies for pheochromocytoma. We assessed personal and institutional practices, including preoperative and postoperative management.\u0000Results: National response rate was 51.8%. Surgeons from nine provinces responded; the majority were general surgeons (70.4%). Reviewing pheochromocytoma patients at a multidisciplinary tumor board was not routine practice (12%) and only 42.3% consistently referred patients for genetic testing. Preoperative α- and β-blockade at half of the respondent institutions were performed by endocrinology alone (53.8%), with the other half employing a multidisciplinary approach. Half of respondents admitted their pheochromocytoma patients to hospital prior to the day of surgery. Postoperatively, 11.5% of respondents routinely admitted their patients to the ICU for monitoring based on personal preference or institutional convention. Multivariate analyses found no significant relationships between demographics or preoperative factors and perioperative management.\u0000Conclusions: Perioperative surgeon management of patients undergoing adrenalectomy for pheochromocytoma was highly variable across Canada. Less than half of respondents routinely refer patients for genetic testing, despite recent practice guidelines. Surgeon preference and institutional convention are the main drivers behind preoperative admission and routine postoperative ICU admission, despite a lack of evidence to support this practice.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141115075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Could trainees’ finger placement at the surgeon’s console have any effect on the overall outcomes of robotic surgery specifically in radical prostatectomy?","authors":"Zachary M. Connelly, Matthew Moss, Tomas Paneque, Coleman McFerrin, Kevin Morgan, Mohamed Ahmed, Nazih Khater","doi":"10.5489/cuaj.8709","DOIUrl":"https://doi.org/10.5489/cuaj.8709","url":null,"abstract":"Introduction: Robotic surgery for localized prostate cancer offers a greater range of motion attributed to the EndoWrist instruments. Postoperative outcomes are linked to the quality of vesico-urethral anastomosis. Trainees frequently complain of suturing difficulty in a back-handed fashion. We aimed to analyze wrist motion using the DaVinci simulator. We hypothesized that using the thumb and index finger would allow superior surgical proficiency when compared to the middle finger.\u0000Methods: After institutional review board approval, we recruited 42 medical students in one academic medical center. Students were randomly assigned to start with their thumb and index finger (1&2) or thumb and middle finger (1&3). Three standardized modules were used with nine metrics calculated, including: score, total time, economy of motion, efficiency score, collisions, inaccurate puncture, wound approximation, out of view, and penalty subtotal. Statistical analysis of the metrics was calculated using SPSS.\u0000Results: Three metrics were found to have differences between the finger placement of 1&3 compared to 1&2. The number of collisions, wound approximation, and penalty score where 1&3 were used had a lower score in each. The number of collisions was 5.7 less in the 1&3 finger placement (p=0.046). This metric was found to have statistically significant differences between finger placement where 1&3 had a lower score compared to 1&2. The wound approximation score was 0.2 points lower when using the 1&3 placement (p=0.075). Lastly, the penalty assigned was 6.5 points lower when using 1&3 (p=0.069).\u0000Conclusions: Although finger placement did not affect the overall score of the completed simulation, instrument collisions and unnecessary wound complications may lead to adverse outcomes when using 1&2 despite offering a wider range of motion. This may be due to decreased comfort in hand position. Trainees may be able to improve the effectiveness of their vesico-urethral anastomosis during robotic-assisted radical prostatectomy.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141113352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic vs. in-irrigation tranexamic acid in percutaneous nephrolithotomy","authors":"D. Hinojosa-González, Bhaskar Somani, Daniel Olvera-Posada, Michal Segall, Juliana Villanueva-Congote, Brian H. Eisner","doi":"10.5489/cuaj.8721","DOIUrl":"https://doi.org/10.5489/cuaj.8721","url":null,"abstract":"Introduction: Percutaneous nephrolithotomy (PCNL) is the gold-standard treatment for large renal stones. One potentially significant complication of PCNL is blood loss, which can result in transfusion requirement and poorer stone-free outcomes. Tranexamic acid (TXA) has emerged as a promising intervention, administered systemically (TXA-S) or as part of irrigation fluid (TXA-I) in endourology. This study aimed to comprehensively analyze existing evidence regarding the applications of TXA in PCNL through a Bayesian network meta-analysis, offering insights into its efficacy and comparative effectiveness.\u0000Methods: In February 2022, a PRISMA-compliant systematic review (PROSPERO registration number CRD42021270593) was performed to identify randomized controlled clinical trials (RCT) on TXA as either systemic therapy or in irrigation fluid. Studies in other languages other than English and Spanish were not considered. A Bayesian network was built using results from identified studies to create models that were later run through Markov Chain Monte Carlo sampling through 200000 iterations.\u0000Results: Eight RCTs compared TXA-S vs. placebo, one TXA-I vs. placebo, and one TXA-I vs. TXA-S. TXA-I had lower risk of transfusion (relative risk [RR], 0.63 [0.47,0.84], SUCRA 0.950) than TXA-S (RR 0.79 [0.65,0.95], SUCRA 0.545). TXA-I had a lower risk of complications (RR 0.38 [0.21,0.67], SUCRA=0.957) compared to TXA-S (RR 0.55 [0.39, 0.78], SUCRA 0.539). TXA-I had a lower postoperative decrease in hemoglobin (MD -1.2 [1.3, 1.0], SUCRA 0.849) compared to TXA-S (MD-0.97 [-1.0, -0.93], SUCRA 0.646]).\u0000Conclusions: TXA, regardless of the route of administration, is an effective intervention in decreasing bleeding, postoperative complications, and risk of transfusion when compared with placebo. Further studies directly comparing TXA-S to TXA-I would be useful to determine the optimal route of delivery.","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141117984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient information resources: Bridging the communication gaps","authors":"Jason Izard, D. R. Siemens","doi":"10.5489/cuaj.8766","DOIUrl":"https://doi.org/10.5489/cuaj.8766","url":null,"abstract":"","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140380752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Second primary cancers following radiotherapy for prostate cancer: How many are actually due to the radiotherapy?","authors":"Scott C. Morgan, M. Corkum","doi":"10.5489/cuaj.8760","DOIUrl":"https://doi.org/10.5489/cuaj.8760","url":null,"abstract":"","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140380197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2024 Canadian Urological Association guideline: Female stress urinary incontinence","authors":"Kevin V. Carlson, Matthew Andrews, Alexandra Bascom, R. Baverstock, L. Campeau, Chantale Dumoulin, Joe Labossiere, Jennifer A. Locke, Geneviève Nadeau, B. Welk","doi":"10.5489/cuaj.8751","DOIUrl":"https://doi.org/10.5489/cuaj.8751","url":null,"abstract":"","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140379407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hawks and doves, differing content, scoring systems, and delivery platforms: No wonder there’s variability in grades","authors":"Andrew MacNeily","doi":"10.5489/cuaj.8747","DOIUrl":"https://doi.org/10.5489/cuaj.8747","url":null,"abstract":"","PeriodicalId":38001,"journal":{"name":"Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140379429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}