Urology Practice最新文献

{"title":"Use of Doublet or Triplet Therapy in Metastatic Hormone-Sensitive Prostate Cancer Across Community-Based Urology Settings in the United States.","authors":"Benjamin Lowentritt, Sreevalsa Appukkuttan, Nicholas Lazarou, Lorraine O'Donnell, James Eller, Katie Grant, Israel Arango-Hisijara, Bashir Kalayeh, Lauren Curry, Audrey Himes, Jay Jhaveri, Joelle Hamilton","doi":"10.1097/UPJ.0000000000000841","DOIUrl":"10.1097/UPJ.0000000000000841","url":null,"abstract":"<p><strong>Introduction: </strong>This study examines patient clinical profiles and real-world utilization patterns of darolutamide doublet (DT; androgen deprivation therapy alone) and triplet therapy (TT; androgen deprivation therapy and docetaxel) for the treatment of metastatic hormone-sensitive prostate cancer (mHSPC).</p><p><strong>Methods: </strong>This was a retrospective, observational study using the Precision Point Specialty Analytics (Specialty Networks) patient population health management platform to identify adult men with mHSPC who received darolutamide DT or TT between July 1, 2019, and March 31, 2023.</p><p><strong>Results: </strong>Of 420 patients, 249 received DT and 171 received TT. Most patients included in the analysis were non-Hispanic White (DT: 67.1%; TT: 63.2%) and had Medicare insurance (DT: 77.5%; TT: 54.4%). Comorbid conditions were common, with hypertension (32.4%) and diabetes (15.0%) being the most prevalent. The mean PSA value on the index date was 20.9 ng/mL (SD 87.2 ng/mL) in the DT cohort and 66.4 ng/mL (SD 286.4 ng/mL) in the TT cohort. Most patients presented with high-grade cancer at diagnosis, with 50.6% of patients in the DT cohort and 74.2% of patients in the TT cohort having a high (≥8) Gleason score at diagnosis. The median duration of darolutamide treatment was 48 weeks in the DT cohort and 46 weeks in the TT cohort.</p><p><strong>Conclusions: </strong>This study demonstrated that darolutamide DT and TT are used ubiquitously across community urology practices in the United States for the treatment of mHSPC.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"533-540"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunities for Quality Improvement in Postoperative Prostate-Specific Antigen Testing After Radical Prostatectomy.","authors":"Alice Semerjian, Emily Fisher, Kevin Ginsburg, Tudor Borza, Sabir Meah, Corinne Labardee, Stephanie Daignault-Newton, Dennis Boynton, Todd Morgan, Daniel Triner, Conrad M Tobert, Brian R Lane","doi":"10.1097/UPJ.0000000000000843","DOIUrl":"10.1097/UPJ.0000000000000843","url":null,"abstract":"<p><strong>Introduction: </strong>After radical prostatectomy (RP), PSA testing is performed to identify persistent or recurrent prostate cancer. We explored the timing and results of initial PSA testing after RP.</p><p><strong>Methods: </strong>Patients undergoing RP within the Michigan Urological Surgery Improvement Collaborative from March 2012 to December 2023 were included. Timing and detectable value of initial and confirmatory PSA testing were measured.</p><p><strong>Results: </strong>Of 21,991 patients, 81.9% had an initial PSA < 90 days of surgery, 9.9% had initial PSA within 91 to 120 days, 6.2% had initial PSA > 120 days, and 2.0% had no available postoperative PSA. Two thousand two hundred ninety-two of 18,021 patients (17.6%) with PSA < 90 days had an initial value > 0.1 ng/mL, of whom 20% had no confirmatory PSA within 6 months. Four hundred fifty-two patients (2.1%) had PSA < 3 weeks of RP, of which 77% were > 0.1 ng/mL, and repeat PSA testing remained > 0.1 ng/mL in only 21%. Two thousand eight hundred twenty-nine patients (12.9%) tested PSA 3 to 5 weeks after RP, with 15% > 0.1 ng/mL and 52% remained > 0.1 ng/mL. By contrast, only 10% of PSA values obtained > 5 weeks were > 0.1 ng/mL, and 80% remained > 0.1 ng/mL on repeat testing.</p><p><strong>Conclusions: </strong>Initial PSA testing < 5 weeks after RP provides unclear results, with false-positive detectable results that often become undetectable when repeated. Alternatively, repeat PSA testing confirmed detectable PSA in 80% of patients whose initial PSA was 35 to 90 days after RP. Opportunities for education and quality improvement include (1) initial PSA testing is best performed > 5 weeks and < 90 days after surgery and (2) timely confirmatory PSA testing is required when the initial PSA is detectable.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"586-593"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152318","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":"A Split Renal Function-Based Approach for Predicting New Baseline Glomerular Filtration Rate After Radical Nephroureterectomy.","authors":"Kieran Lewis, Jayant Siva, Angelica Bartholomew, Anne Wong, Carlos Munoz Lopez, Akira Kazama, Nityam Rathi, Eran N Maina, Rebecca A Campbell, Nicholas Heller, Jason M Scovell, Robert Abouassaly, Nima Almassi, Samuel C Haywood, Christopher J Weight, Steven C Campbell","doi":"10.1097/UPJ.0000000000000826","DOIUrl":"10.1097/UPJ.0000000000000826","url":null,"abstract":"<p><strong>Introduction: </strong>Accurate prediction of new baseline glomerular filtration rate (NBGFR) after radical nephroureterectomy (RNU) is important for managing upper tract urothelial carcinoma (UTUC) because it can inform timing of systemic chemotherapy. Current prediction models do not account for split renal function (SRF) and show modest accuracy. This study evaluates the accuracy of an SRF-based model, PVA⁺, which incorporates both parenchymal volume analysis (PVA) and degree of parenchymal enhancement.</p><p><strong>Methods: </strong>We reviewed patients with UTUC (n = 712) managed with RNU (2013-2023) and included patients with (1) contrast-enhanced CT < 1 year preoperatively, (2) glomerular filtration rate (GFR) < 3 months preoperatively, and (3) NBGFR 1 to 12 months postoperatively. Predicted NBGFR was 1.25 × (GFR_PreRNU) × (SRF_{Contralateral}), with 1.25 representing the average renal functional compensation after nephrectomy. For PVA⁺, differential parenchymal volumes and degree of enhancement were estimated using semiautomated software. SRF-based models (based on PVA⁺, PVA alone, or nuclear renal scans) and a non-SRF-based algorithm were compared using a 20% accuracy threshold.</p><p><strong>Results: </strong>Among patients analyzed (n = 352), the median preoperative GFR was 63 mL/min/1.73 m², 101 (29%) had moderate/severe hydronephrosis, and 42 (12%) had infiltrative renal masses (IRMs). For prediction of NBGFR after RNU, PVA⁺ demonstrated superior accuracy (84%) compared with PVA alone (accuracy = 79%, <i>P</i> < .05), nuclear renal scans-based approach (accuracy = 73%, <i>P</i> < .01), and non-SRF-based algorithm (accuracy = 65%, <i>P</i> < .01). Among patients with hydronephrosis, notable improvements were observed for PVA⁺ compared with PVA alone (accuracies 88%/61%, respectively, <i>P</i> ≤ .01). For IRMs, PVA⁺ seemed to be equivalent to other approaches for predicting NBGFR after RNU.</p><p><strong>Conclusions: </strong>PVA⁺ incorporates both differential renal function (degree of enhancement) and parenchymal volumes and outperforms other SRF-based and non-SRF-based approaches for predicting NBGFR after RNU. These findings alleviate concerns that the prevalence of hydronephrosis and IRMs in this population reduces accuracy of SRF-based approaches. PVA⁺ can inform counseling about the timing of systemic chemotherapy in patients with high-risk UTUC.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"557-567"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054324","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":"Reply by Authors.","authors":"Cato C Bresser, Harm H E van Melick, Regina The, Paul B van der Nat, Mirjam M Garvelink","doi":"10.1097/UPJ.0000000000000849","DOIUrl":"https://doi.org/10.1097/UPJ.0000000000000849","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":"12 5","pages":"577"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973400","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":"Health Care Spending Associated With Preventative Pharmacologic Therapy for Urolithiasis.","authors":"Wilson Sui, John M Hollingsworth, Mary K Oerline, Ryan S Hsi, Joseph J Crivelli, Sara L Best, Vahakn B Shahinian","doi":"10.1097/UPJ.0000000000000829","DOIUrl":"10.1097/UPJ.0000000000000829","url":null,"abstract":"<p><strong>Introduction: </strong>Urolithiasis is among the most expensive urologic conditions from a payer standpoint. Preventative pharmacologic therapy (PPT) can reduce symptomatic recurrences; however, the potential savings from fewer recurrences may be offset by medication costs. This study aimed to evaluate the cost of PPT from the payer perspective.</p><p><strong>Methods: </strong>The Medicare-Litholink database was queried for beneficiaries with urolithiasis who had at least 1 urinary chemistry abnormality. Payments made on their behalf, along with out-of-pocket costs, were measured. Payments were compared among 3 groups using 2-part generalized linear models: patients prescribed guideline-concordant PPT who adhered to therapy, those prescribed PPT but did not adhere, and untreated patients.</p><p><strong>Results: </strong>Among 16,329 patients who met inclusion criteria, 30.8% were prescribed PPT. Alkali therapy represented 42.7% of all spending among adherent patients, whereas thiazides and uric acid-reducing therapies combined contributed only 3.3%. Out-of-pocket spending on alkali represented 88% of total prescription costs for adherent patients. For patients with hypocitraturia or low pH, adherence to therapy resulted in the lowest mean cost for symptomatic stone events but the highest overall costs due to medication expenses. Conversely, in hypercalciuria and hyperuricosuria, nonadherent patients were the most expensive overall even after multivariable adjustment.</p><p><strong>Conclusions: </strong>Among patients with hypocitraturia and low pH, adherence was the most expensive, driven by medication costs. Conversely, among patients with hypercalciuria and hyperuricosuria, nonadherence was costliest. Although PPT can lead to reduced costs due to averted stone events, medication adherence is critical to ensuring these savings are fully realized.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"594-602"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Patient Decision Aid for cT1 Renal Masses: A User-Centered Mixed-Methods Study.","authors":"Cato C Bresser, Harm H E van Melick, Regina The, Paul B van der Nat, Mirjam M Garvelink","doi":"10.1097/UPJ.0000000000000830","DOIUrl":"10.1097/UPJ.0000000000000830","url":null,"abstract":"<p><strong>Introduction: </strong>It is important to actively involve patients with cT1 renal masses in treatment decision-making. Patient decision aids (PtDAs) support patients and health care professionals (HCPs) in shared decision-making. The aim of this study was to develop a Dutch PtDA for cT1 renal masses and to test its acceptability and usability.</p><p><strong>Methods: </strong>This was a user-centered mixed-methods design. Cocreation process with HCPs from several hospitals and a patient representative, with input from (a) a needs assessment study (semistructured interviews and questionnaires) and (b) acceptability and usability testing (think-aloud sessions and semistructured interviews), guided by the International Patient Decision Aids Standards (IPDAS) criteria. Compatibility with the IPDAS criteria was evaluated (c).</p><p><strong>Results: </strong>In total, 12 patients with cT1 renal masses and 56 HCPs participated. The PtDA consists of 3 components: (1) a decision aid handout demonstrating an overview of treatment options; (2) an online decision aid with information on renal cell carcinoma, treatment options, and values-clarification exercises; and (3) a personal decision aid summary. Both patients and HCPs highly appreciated the PtDA and were able to navigate through it. The PtDA fulfills all 12 IPDAS criteria.</p><p><strong>Conclusions: </strong>We systematically developed a PtDA for cT1 renal masses. The PtDA was found acceptable and usable by patients and HCPs. The PtDA is currently being implemented in routine care.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"568-577"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural-Urban Differences and Socioeconomic Disparities in Long-Term Urinary Adverse Events Following Prostate Cancer Treatment.","authors":"Marvin N Carlisle, Kevin D Li, Stephanie L Jarosek, Anna R Faris, Hiren V Patel, Samuel L Washington, Benjamin N Breyer","doi":"10.1097/UPJ.0000000000000837","DOIUrl":"10.1097/UPJ.0000000000000837","url":null,"abstract":"<p><strong>Introduction: </strong>Long-term urinary adverse events (UAEs) after prostate cancer (PCa) treatment significantly affect survivor quality of life. Previous research suggests disparities in PCa outcomes across geographic and sociodemographic lines, but a comprehensive analysis of treatment-related UAEs is lacking.</p><p><strong>Methods: </strong>Using SEER (Surveillance, Epidemiology, and End Results)-Medicare data (1999-2019), we conducted a retrospective cohort study of men aged 66 or older with nonmetastatic PCa treated within 12 months of diagnosis. Rural vs urban residence was determined using Rural-Urban Continuum Codes. UAE risk was assessed using multivariable Cox models and competing risks regression, adjusting for demographics, education, income, comorbidities, and treatment type.</p><p><strong>Results: </strong>Among 166,581 patients, rural residents (16% of cohort) showed lower 15-year cumulative UAE incidence compared with urban residents (17% vs 20%; <i>P</i> < .001), despite having lower median per capita income ($18,595 vs $26,343; <i>P</i> < .001) and less education (19% vs 12% without high school education; <i>P</i> < .001). Rural residence was associated with lower UAE rates (adjusted HR [aHR] 0.90, 95% CI, 0.86-0.94). Higher risk was observed among Hispanic (aHR 1.18, 95% CI 1.11-1.25) and non-Hispanic Black patients (aHR 1.11, 95% CI 1.05-1.16), those with lower education (aHR 1.31, 95% CI 1.23-1.39 for lowest vs highest quartile), and patients aged 80 years or older (aHR 1.54, 95% CI 1.47-1.61).</p><p><strong>Conclusions: </strong>Rural residence was unexpectedly associated with lower UAE rates after PCa treatment. However, significant disparities persisted across racial and socioeconomic lines, with higher risks among minority and less educated patients, suggesting complex relationships between geography, demographics, and treatment outcomes.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"497-506"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152373","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":"National Institutes of Health Funding Reform: Potential Implications for Urologic Researchers.","authors":"Benjamin Pockros, Patrick Lewicki, Ganesh S Palapattu, Todd M Morgan","doi":"10.1097/UPJ.0000000000000836","DOIUrl":"10.1097/UPJ.0000000000000836","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"479-481"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200380","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":"Editorial Commentary.","authors":"Luis G Medina, Aditya Bagrodia","doi":"10.1097/UPJ.0000000000000834","DOIUrl":"https://doi.org/10.1097/UPJ.0000000000000834","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":"12 5","pages":"621"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973403","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":"Do Social Determinants of Health Affect Adherence to the 2014 American Urological Association Cryptorchidism Guideline? A Multi-Institutional Evaluation.","authors":"Julie R Solomon, Piroz Bahar, Andrew Bisenius, Miles Duncan, Drew K Price, Alethea G Paradis, Joel Vetter, Jacob D Hansen, Linder Wendt, Patrick Ten Eyck, Kate H Kraft, Erica Traxel, Jonathan S Ellison, Douglas W Storm","doi":"10.1097/UPJ.0000000000000819","DOIUrl":"10.1097/UPJ.0000000000000819","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence shows that the 2014 AUA Cryptorchidism Guidelines have not influenced the use of ultrasonography before urologic evaluation or referral timing. We evaluated whether local indicators of health care access are associated with these quality-of-care indicators.</p><p><strong>Methods: </strong>Boys referred in 2013, 2015, and 2019 for cryptorchidism at 4 institutions were retrospectively analyzed. Local indicators of health care access were assessed by cross-referencing patient zip codes to the Rural Health Information and Health Resources and Service Administration websites. Using univariate generalized linear mixed models, we evaluated the association of geocoded factors to the likelihood of preevaluation sonography and mean age at referral.</p><p><strong>Results: </strong>A total of 3243 patients were evaluated. Boys from rural and designated health shortage areas were more likely to undergo sonography (odds ratio [OR], 1.38, 95% CI, 1.06-1.81 and OR, 20.5, 95% CI, 4.83-87.2, respectively) yet more likely to be referred at a younger age (OR, 0.87, 95% CI, 0.78-0.97 and OR, 0.70, 95% CI, 0.53-0.93). Conversely, boys with private insurance (OR 0.48, 95% CI, 0.27-0.86) and those residing near a referral center (OR, 0.53, 95% CI, 0.42-0.66) or from wealthier counties (OR, 0.42, 95% CI, 0.30-0.59) were less likely to undergo sonography.</p><p><strong>Conclusions: </strong>Boys with cryptorchidism living in rural, poorer, and medically underserved areas were more likely to receive a preevaluation ultrasound yet were more likely to be referred to a pediatric urologist at a younger age than their counterparts. Drivers of guideline-adherent care may differ depending on the care component and local health care access availability.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"507-516"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052976","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}