Urology Practice最新文献

{"title":"Reply by Authors.","authors":"Dhruv Puri, Yahir Santiago-Lastra","doi":"10.1097/UPJ.0000000000001051","DOIUrl":"10.1097/UPJ.0000000000001051","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"482"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537018","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":"Sam Melamed, Benjamin Waterman, Jonathan Bergman","doi":"10.1097/UPJ.0000000000001018","DOIUrl":"10.1097/UPJ.0000000000001018","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"530-531"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784911","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":"Caroline L Buckholtz, Timothy D Averch","doi":"10.1097/UPJ.0000000000001017","DOIUrl":"10.1097/UPJ.0000000000001017","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"530"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784866","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":"Comparative Effectiveness and Cost-Effectiveness of an Artificial Intelligence Workflow for Small Renal Mass Diagnosis on Computed Tomography.","authors":"Joseph M Rich, Thalia Bajakian, Tejal Gala, Mehrnegar Aminy, Edward Forsyth, Evan Raff, John Brunner, Inderbir Gill, Assad Oberai, Vinay Duddalwar, Sarmad Sadeghi","doi":"10.1097/UPJ.0000000000001031","DOIUrl":"10.1097/UPJ.0000000000001031","url":null,"abstract":"<p><strong>Introduction: </strong>Small renal masses are increasingly detected on imaging, but their accurate classification as benign, indolent, or aggressive remains challenging. Such classification can aid further diagnostic workup, improving patient outcomes and saving costs. Artificial intelligence (AI) models show promise in this area. Here, we evaluate the cost-effectiveness of 3 such models compared with standard of care (SOC).</p><p><strong>Methods: </strong>We developed a Markov microsimulation model to simulate clinical and economic outcomes in 10,000 patients aged 40 to 75 years with small renal masses over a 10-year horizon. We compared 4 strategies: SOC, MRI + AI, and 2 CT + AI models (with or without image embeddings). The model reported total costs, quality-adjusted life years gained, and incremental cost-effectiveness ratios, with 100 simulations per scenario.</p><p><strong>Results: </strong>CT + AI Model 1 (without embeddings) had the lowest cost ($9079.65) and highest quality-adjusted life years gained (8.8207), outperforming SOC ($10,601.23, 8.8000), MRI + AI ($10,178.30, 8.8108), and CT + AI Model 2 ($9177.93, 8.8205). CT + AI Model 2 (with embeddings) was dominant in 28% of simulations. The costs of CT + AI Model imaging could increase from $265 to $2358.58, while remaining cost-effective (incremental cost-effectiveness ratio ≤ willingness to pay) compared with the MRI + AI Model.</p><p><strong>Conclusions: </strong>CT-based AI models are cost-effective alternatives to SOC and MRI-based AI, offering better outcomes at lower cost. Their value stems from accurate risk stratification, enabling timely intervention and reducing overtreatment. These findings support the clinical and economic utility of AI in renal mass evaluation.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"483-492"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151497","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":"Jonathan Neil Rubenstein","doi":"10.1097/UPJ.0000000000001023","DOIUrl":"10.1097/UPJ.0000000000001023","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"482"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057354","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":"From Policy to Practice: Legislative Priorities From the 2026 Annual Urology Advocacy Summit.","authors":"Benjamin Pockros, Logan Galansky","doi":"10.1097/UPJ.0000000000001024","DOIUrl":"10.1097/UPJ.0000000000001024","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"468-472"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976028","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":"The Reality of Benign Prostatic Hyperplasia Surgery Price and Reimbursement Across Top United States Hospitals.","authors":"Gillian Murray, Victoria Edmonds, Bijan Borah, Dan Kelleher, Kevin M Wymer","doi":"10.1097/UPJ.0000000000001033","DOIUrl":"10.1097/UPJ.0000000000001033","url":null,"abstract":"<p><strong>Introduction: </strong>A growing number of surgical treatments are available for benign prostatic hyperplasia (BPH), each with distinct clinical profiles and resource demands. Wide variations in cost and reimbursement are understood to exist because of hospital-insurer negotiations, but are rarely quantified. The 2021 Medicare Price Transparency final rule now provides publicly available pricing data, allowing objective evaluation of real-world costs. We used these data to assess hospital charges and commercial reimbursement for common BPH procedures.</p><p><strong>Methods: </strong>Charges and commercial reimbursement were obtained from the Turquoise Health database, which compiles pricing reported under Medicare transparency regulations. We analyzed procedure type, hospital, payer class, and service location among US News Top 20 hospitals.</p><p><strong>Results: </strong>Charges varied by procedure; the highest median charge was associated with transurethral waterjet ablation ($15,742 [$11,281-$27,707]) and the lowest with prostatic urethral lift ($4489 [$1228-$46,289]). Private insurers were associated with higher charges. Significant interhospital variation was observed for prostatic urethral lift (<i>P</i> < .001) and transurethral waterjet ablation (<i>P</i> < .05). On multivariate analysis, hospital and payer predicted charges, while procedure type did not. Reimbursement also varied; the highest median reimbursement was associated with transurethral waterjet ablation ($12,476.49 [$8938.33-$29,208.64]) and the lowest with transurethral resection of the prostate ($4258.94 [$2889.88-$40,949.00]). Variation was driven by procedure type and care setting, but not institution.</p><p><strong>Conclusions: </strong>Substantial variation in BPH procedure pricing and reimbursement persists across top-ranked hospitals despite Medicare's price transparency regulations. Price variation seems more influenced by nonprocedural factors, highlighting inequities in institutional negotiations and the need for further evaluation of hospital pricing patterns.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"495-502"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13267861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206303","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":"Variability and Hospital-Level Predictors of Magnetic Resonance Imaging for Elevated Prostate Specific Antigen: Results of a Medicare and American Hospital Association Linkage.","authors":"Andrea Piccolini, Stephan Korn, Zhiyu Qian, Hanna Zurl, Klara K Pohl, Pietro Brin, Boyuan Xiao, Jianyi Zhang, Stuart Lipsitz, Timothy R Rebbeck, Kerry L Kilbridge, Adam S Kibel, Giovanni Lughezzani, Nicolò M Buffi, Quoc-Dien Trinh, Alexander P Cole","doi":"10.1097/UPJ.0000000000001020","DOIUrl":"10.1097/UPJ.0000000000001020","url":null,"abstract":"<p><strong>Introduction: </strong>Despite level 1 evidence supporting prostate MRI for suspected prostate cancer, its use remains limited in the United States. The impact of patient-level and hospital-level factors on MRI use after a new elevated PSA among Medicare beneficiaries is unclear. We evaluated these factors to explain variation in MRI utilization.</p><p><strong>Methods: </strong>We conducted a retrospective study of Medicare beneficiaries with newly elevated PSA (2019-2023), linked to hospital-level data from the American Hospital Association Annual Survey. The primary outcome was receipt of MRI for elevated PSA, modeled using a generalized linear mixed model with a binomial distribution and logit link function. Patient-level and hospital-level covariates were included, and their relative contributions assessed using Cox and Snell pseudo-R² statistics.</p><p><strong>Results: </strong>Of 304,161 patients across 2657 hospitals, the top quartile of hospitals achieved a mean prebiopsy MRI utilization rate of 8.5% (SD: 2.9) and the bottom quartile reported rates below 1.75%. Black patients were more likely to undergo MRI than White patients (OR: 1.15, 95% CI: 1.06-1.26; <i>P</i> < .001), as were those residing in metropolitan areas. Major teaching hospitals were associated with increased MRI use (OR: 1.19; 95% CI: 1.07-1.32; <i>P</i> = .001). Patient-level variables explained 37.2% of the variance in MRI utilization, while hospital-level factors accounted for less than 1%.</p><p><strong>Conclusions: </strong>Patient-level factors represent the primary drivers of variation in prebiopsy MRI use, with minimal contribution from hospital characteristics. Efforts to improve equity in prostate cancer care should prioritize reducing patient-level barriers and standardizing referral practices across institutions.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"503-513"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784892","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":"Perioperative and Renal Outcomes After Nephrectomy in Patients Receiving Glucagon-Like Peptide-1 Receptor Agonists: A Pilot Study.","authors":"Aidan S Weitzner, Soum D Lokeshwar, Craig Cronin, Phillip Korn, Nirmish Singla","doi":"10.1097/UPJ.0000000000001007","DOIUrl":"10.1097/UPJ.0000000000001007","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with elevated BMI undergoing nephrectomy are at increased risk of acute kidney injury (AKI) and perioperative complications. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) may confer renal-protective and anti-inflammatory effects while reducing perinephric adiposity. Thus, we aimed to determine whether GLP-1RA use is associated with fewer perioperative complications following nephrectomy.</p><p><strong>Methods: </strong>We conducted a retrospective, national claims analysis of patients undergoing nephrectomy from June 2021 to October 2025. Patients with BMI ≥ 27 kg/m² undergoing nephrectomy for renal neoplasms were included. Patients receiving GLP-1RA therapy within 180 days of surgery were 1:1 propensity matched by demographics (age, sex, race), comorbidities (body mass index, chronic kidney disease, hypertension, hyperlipidemia, diabetes mellitus, tobacco use), and metformin/sodium-glucose cotransporter-2 inhibitor use. Outcomes included 30-day and 90-day adverse events overall and stratified by partial and radical nephrectomy.</p><p><strong>Results: </strong>After 1:1 matching, 980 individuals on GLP-1RAs were well balanced with 980 controls from a pool of 36,382 eligible patients. At 30 days, GLP-1RA use was associated with lower rate of hospital readmission (odds ratio [OR] = 0.72; <i>P</i> = .011). At 90 days, GLP-1RA users had a reduced incidence of venous thromboembolism (OR = 0.62; <i>P</i> = .035) and readmission (OR = 0.62; <i>P</i> < .001). Those on GLP-1RA therapy had significantly lower odds of 90-day AKI (OR = 0.76; <i>P</i> = .031) and major adverse kidney events (MAKEs; OR = 0.56; <i>P</i> = .004). MAKE was significantly lower for partial (OR = 0.45; <i>P</i> = .0024) and radical (OR = 0.54; <i>P</i> = .0014) nephrectomy.</p><p><strong>Conclusions: </strong>Preoperative GLP-1RA use appeared to reduce rates of AKI, MAKE, and 30/90-day readmission among patients undergoing nephrectomy. These findings suggest GLP-1RAs may mitigate postoperative risk without increasing gastrointestinal, respiratory, or systemic morbidity.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"551-560"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522317","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":"Jonathan Rubenstein","doi":"10.1097/UPJ.0000000000001011","DOIUrl":"10.1097/UPJ.0000000000001011","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"529-530"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730307","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}