The Journal of Urology最新文献

{"title":"A New Framework for Testosterone Deficiency: Integrating Organ-Specific and Circadian Thresholds.","authors":"Yu-Hsiang Lin,Jau-Yuan Chen,Chun-Te Wu","doi":"10.1097/ju.0000000000004692","DOIUrl":"https://doi.org/10.1097/ju.0000000000004692","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"1 1","pages":"101097JU0000000000004692"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701375","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":"Characterizing the impact of novel patient-centered pathology reports on men undergoing prostate biopsy: The PAPR randomized controlled trial.","authors":"R Kumar,K Lajkosz,J Hiemstra,A Finelli,R Hamilton,A Zlotta,A Berlin,J Papadakos,S Ghai,D Wiljer,S Alibhai,A Silberman,J Kreidstein,L Calicchia,N Perlis","doi":"10.1097/ju.0000000000004684","DOIUrl":"https://doi.org/10.1097/ju.0000000000004684","url":null,"abstract":"INTRODUCTION AND OBJECTIVESTo improve patient-centered communication, some institutions provide online portals for patients to immediately access medical results. However, early access to certain reports could harm patients. Standard pathology reports (SPRs), vital for clinical decision making, can be difficult for patients to understand and contextualize. Our group designed patient-centered pathology reports (PAPR) and tested them for patients undergoing prostate biopsy.METHODSBetween February 2023 to January 2024, 121 men were randomly assigned to receive either SPR or SPR + PAPR. Prior to follow-up encounters, participants completed a questionnaire examining their understanding of the reports and experience interacting with them and a validated anxiety questionnaire (STAIS-5). Following the visit, patients completed a validated shared decision-making questionnaire (SDM-Q-9).RESULTSTwenty-four patients were excluded with unanswered questionnaires leaving 97 patients with evaluable data. There was no difference in shared decision making between arms. Patients receiving SPR+PAPR agreed that their reports were patient friendly (74% vs. 20%, p<0.001), easy to understand (71% vs. 32%, p<0.001), improved experience (83% vs. 60%, p=0.029), empowered control (65% vs. 30%, p=0.001), reduced anxiety (81% vs. 31%, p<0.001), and helped communicating results to others (77% vs. 42%, p<0.001). The SPR+PAPR group more accurately understood their results (median 4 vs. 3 correct answers; p=0.003) and treatment options (63% vs. 13%, p<0.001). Anxiety increased less in the SPR+PAPR arm.CONCLUSIONSWhen comparing patient-centered to standard pathology reports, we did not see evidence of an impact on shared decision-making, but there were statistically significant differences in patient understanding and experience. Generalizability is limited by high resources needed to create PAPRs.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"95 1","pages":"101097JU0000000000004684"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652930","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":"Diagnostic Accuracy of [18F]-DCFPyL PSMA PET/CT in Intermediate-Risk Prostate Cancer Undergoing Radical Prostatectomy: Is Pelvic Lymph Node Dissection Still Necessary?","authors":"Ahmed Eraky,Neeraja Tilu,Reuben Ben-David,Brenda Hug,Henry Jodka,Yashaswini Agarwal,Hannah Sur,Ming Zhou,Manish Kumar Choudhary,Reza Mehrazin,Ashutosh Tewari","doi":"10.1097/ju.0000000000004659","DOIUrl":"https://doi.org/10.1097/ju.0000000000004659","url":null,"abstract":"PURPOSEPelvic lymph node dissection (PLND) remains standard for nodal staging in prostate cancer (PCa), yet its benefit in intermediate-risk PCa is controversial. Traditional imaging and nomograms often lack accuracy, resulting in unnecessary PLND. Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) is a promising alternative. We compared its diagnostic performance and clinical utility with established risk models in intermediate-risk PCa.MATERIALS AND METHODSWe analyzed intermediate-risk PCa patients who underwent [18F]-DCFPyL PSMA PET/CT and radical prostatectomy with bilateral PLND between January 2022 and December 2023. PSMA PET/CT results were classified as positive or negative for nodal involvement. Diagnostic performance was compared to multiparametric magnetic resonance imaging (mpMRI), the Briganti 2012, Briganti 2023 nomograms and the Memorial Sloan Kettering Cancer Center nomogram by sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, balanced accuracy, and area under the curve (AUC).RESULTSAmong 189 patients, 28 (15%) had PSMA-positive lymph nodes. Pathology confirmed metastases in 4 PSMA-positive patients (PPV: 14%, 95%CI: 7.1-22%) and 1 PSMA-negative patient (NPV: 99%, 95%CI: 98-100%). PSMA PET/CT demonstrated 80% sensitivity (95%CI: 40-100%), 87% specificity (95%CI: 82-91%), balanced accuracy of 83% (95%CI: 63-95%), and an AUC of 0.83 (95%CI: 0.64-1), outperforming other models. PSMA would have safely omitted PLND in 160 of 161 (99%) PSMA-negative cases, while mpMRI detected no positive nodes.CONCLUSIONSPSMA PET/CT, with high specificity and NPV, may safely guide PLND omission in PSMA-negative patients. Prospective validation is warranted.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"9 1","pages":"101097JU0000000000004659"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578746","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":"Performance characteristics of an analytic model predicting retroperitoneal lymph node dissection pathology following first-line chemotherapy for patients with metastatic non-seminomatous germ cell tumors.","authors":"Richard S Matulewicz,Melissa Assel,Andrew J Vickers,Viranda H Jayalath,Samuel A Gold,Samuel A Funt,Darren R Feldman,Joel Sheinfeld","doi":"10.1097/ju.0000000000004668","DOIUrl":"https://doi.org/10.1097/ju.0000000000004668","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"8 1","pages":"101097JU0000000000004668"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578745","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 Efficacy and Safety between Intradetrusor OnabotulinumtoxinA Injection and Combined Pharmacotherapy in Patients with Refractory Overactive Bladder: A Randomized Controlled Trial.","authors":"Meng-Hsuen Hsieh,Jiun-Chyi Hwang,Tsung-Hsien Su,Hui-Hsuan Lau","doi":"10.1097/ju.0000000000004660","DOIUrl":"https://doi.org/10.1097/ju.0000000000004660","url":null,"abstract":"PURPOSETo investigate whether intradetrusor onabotulinumtoxinA injection demonstrates superior efficacy and fewer side effects compared to combined pharmacotherapy in patients with refractory overactive bladder.MATERIAL AND METHODSIn this single-center, open-label, randomized trial, patients with urodynamically confirmed detrusor overactivity and persistent symptoms despite at least two months of single pharmacotherapy were randomized to receive onabotulinumtoxinA injection (100 U) or combined pharmacotherapy with solifenacin 5 mg and mirabegron 25 mg. Assessments at baseline and 12 weeks included voiding parameters, adverse events, and patient-reported outcomes using the Urogenital Distress Inventory, the Incontinence Impact Questionnaire, and the Overactive Bladder Symptom Score.RESULTSOf 74 patients enrolled, 66 completed the study (33 per group). Both treatments reduced urgency episodes to a median of 2.0 per 24 hours at 12 weeks. The mean difference between groups was -0.1 (95% CI: -1.5 to 1.4; p = 0.925), indicating no significant difference. Improvements in urinary frequency, nocturia, urge incontinence, and quality-of-life measures were observed in both groups, without significant differences. However, adverse effects such as dry mouth, constipation, and blurred vision were significantly more common with pharmacotherapy (all p < 0.05).CONCLUSIONBoth intradetrusor onabotulinumtoxinA and combined pharmacotherapy improved symptoms in women with refractory overactive bladder. OnabotulinumtoxinA demonstrated a more favorable safety profile and represents an appropriate option for patients sensitive to systemic anticholinergic effects or preferring non-daily interventions.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"11 1","pages":"101097JU0000000000004660"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533404","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":"Use of Rectal Diazepam to Prevent Bladder Spasms and Leakage of Medication During Intravesical Administration of Nadofaragene Firadenovec for BCG-Unresponsive Non-Muscle-Invasive Bladder Cancer.","authors":"Jacob A Moyer,Adri M Durant,Mimi V Nguyen,Lanyu Mi,Andrew J Zganjar,Timothy D Lyon,Paras H Shah,Stephen A Boorjian,Mark D Tyson","doi":"10.1097/ju.0000000000004658","DOIUrl":"https://doi.org/10.1097/ju.0000000000004658","url":null,"abstract":"PURPOSENadofaragene firadenovec-vncg is an FDA-approved therapy for bacille Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC). Bladder spasms and medication leakage during intravesical instillation are common and can affect treatment efficacy. We evaluated the effect of rectal diazepam pretreatment on bladder spasm incidence, retention of instilled medication, and 3-month recurrence rates.MATERIALS AND METHODSWe retrospectively analyzed data from patients treated with nadofaragene firadenovec for BCG-unresponsive NMIBC at Mayo Clinic from November 28, 2023, through September 30, 2024. Patients were stratified by pretreatment with rectal diazepam (10 mg) vs other strategies. Outcomes included bladder spasms, retention of instilled medication, and 3-month recurrence rates.RESULTSEighty-eight nadofaragene firadenovec instillations (45 patients) were evaluated. Rectal diazepam pretreatment was used for 25 instillations (28%) and associated with a 25% absolute risk reduction for nadofaragene firadenovec retention failure (4.0% vs 29% of instillations), as compared with other pretreatments (patient-level odds ratio, 0.22 [95% CI, 0.11-0.44]; P<.001). Additionally, we observed a 24% absolute reduction in bladder spasm incidence (32% vs 56% of instillations) in the rectal diazepam group (patient-level odds ratio, 0.32 [95% CI, 0.13-0.82]; P=.02). Patients without medication leakage had a lower recurrence rate at 3 months (18% vs 38%), although this difference was not statistically significant (P=.3). One patient had fatigue attributable to rectal diazepam.CONCLUSIONSRectal diazepam pretreatment may reduce bladder spasms and improve nadofaragene firadenovec retention during intravesical instillation, thereby enhancing efficacy. Rectal diazepam could improve patient comfort and treatment outcomes, thus warranting further investigation through larger, prospective studies.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"45 1","pages":"101097JU0000000000004658"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144488263","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":"What do we need for PRI-MUS 2.0?","authors":"Caelán Max Haney-Aubert,Maurin Mangold,Karl-Friedrich Kowalewski","doi":"10.1097/ju.0000000000004655","DOIUrl":"https://doi.org/10.1097/ju.0000000000004655","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"248 1","pages":"101097JU0000000000004655"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478670","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":"Can Genomic classifiers in biopsy cores with Grade Group 1 cancer predict higher-grade disease elsewhere in the prostate? Results from the prospective Miami Active Surveillance Trial (MAST).","authors":"Pedro F S Freitas,Archan Khandekar,Joao G Porto,Hui Yu,Adam D Williams,Yuval Avda,Ankur Malpani,Tarek Ajami,Dinno F Mendiola,Nachiketh Soodana-Prakash,Sanjaya Swain,Sandra Gaston,Oleksandr Kryvenko,Elai Davicioni,Mohammed Alshalalfa,Yangyang Hao,Brandon Mahal,Elena Cortizas,Zoe Szczotka,Timothy Guerard,Bruce Kava,Radka Stoyanova,Chad R Ritch,Bruno Nahar,Mark L Gonzalgo,Alan Pollack,Dipen J Parekh,Sanoj Punnen","doi":"10.1097/ju.0000000000004652","DOIUrl":"https://doi.org/10.1097/ju.0000000000004652","url":null,"abstract":"PURPOSETo investigate whether expression signatures from Grade Group 1 (GG1) biopsy cores can detect the presence of higher-grade cancer elsewhere in the prostate.METHODS AND MATERIALSWe enrolled 205 men with low to favorable intermediate-risk prostate cancer undergoing active surveillance on a prospective protocol. All participants underwent MRI and confirmatory biopsy at enrollment, followed by annual biopsies for three more years. Select cores were sent for Decipher genomic classifier (DGC) testing, and derived Genomic Prostate Score (dGPS) and Cell Cycle Progression (dCCP) signatures were obtained. We compared genomic scores from GG1 biopsy cores with versus without coexisting GG2 and GG3 or higher cancer (GG2+ and GG3+, respectively). We repeated this comparison using only the highest-volume GG1 core from each biopsy, which is the current standard of care.KEY FINDINGSGenomic profiling was successful in 141 of 205 patients (324 GG1 cores). There were no significant differences in DGC, dCCP, or dGPS scores between GG1 cores with versus without coexisting GG2+ cancer elsewhere. This remained true, when using the largest volume GG1 core from each biopsy. dGPS was higher among GG1 cores with coexisting GG3+ cancer compared to those without (0.24 vs 0.10, p=0.012); however, there was no difference between the groups on DGC or dCCP scores.CONCLUSIONSGenomic classifiers in GG1 cores did not predict coexisting GG2+ cancer, while dGPS signatures showed some promise in detecting GG3+ cancer elsewhere in the gland. None of the signatures showed a difference between groups when using the highest volume GG1 core, which is the standard practice for genomic classifiers.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"238 1","pages":"101097JU0000000000004652"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335314","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":"Global, Regional, and National Epidemiology of Pediatric Urolithiasis (1990-2021) and 2040 Forecast.","authors":"Jintao Hu,Jiarui Zhang,Junjie Wang,Yongmei Tan,Lingqu Zhou,Wan Chan,Degeng Kong,Cheng Liu,Kewei Xu","doi":"10.1097/ju.0000000000004645","DOIUrl":"https://doi.org/10.1097/ju.0000000000004645","url":null,"abstract":"PURPOSEPediatric urolithiasis is a common clinical condition that can cause kidney damage and long-term health complications. This study aims to assess the trends in incidence, prevalence, and disability-adjusted life years of pediatric urolithiasis from 1990 to 2021, and to predict the burden of the disease in 2040.MATERIALS AND METHODSDetailed information on Pediatric urolithiasis from 1990 to 2021 was collected from the Global Burden of Disease Database 2021. Based on Global Burden of Disease data, a systematic approach was used to analyze the burden and trends in the incidence, prevalence, and disability-adjusted life years of pediatric urolithiasis from 1990 to 2021, and to predict the disease burden in 2040.RESULTSIn 2021, there were 1,560,000 new cases, representing a 15% increase compared to 1990, with 920,000 cases in boys (58%) and 640,000 cases in girls (41%). Prevalence rose by 15%, while disability-adjusted life years decreased by 43% compared to 1990. However, from 2015 to 2021, both incidence and prevalence of pediatric urolithiasis significantly increased. Regions with lower Socio-Demographic Index exhibited higher incidence, prevalence, and disability-adjusted life years, exacerbating disparities in disease burden. By 2040, incidence is expected to exceed 1.53 million.CONCLUSIONSGlobal incidence and prevalence are expected to continue rising. Although disability-adjusted life years have decreased, health inequities remain prominent, particularly in low Socio-Demographic Index regions. To address the growing burden of pediatric urolithiasis, focusing on low Socio-Demographic Index areas is crucial, prioritizing access to prevention and treatment resources to improve global child urological health.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"15 1","pages":"101097JU0000000000004645"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319865","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":"Risks of Progression Following Early Androgen Deprivation Therapy for Biochemical Recurrence After Radical Prostatectomy.","authors":"Timothy J Daskivich,Shannon R Stock,Stirling Cummings,John M Masterson,William Aronson,Martha Terris,Zachary Klaassen,Christopher Kane,Christopher Amling,Matthew Cooperberg,Lourdes Guerrios Rivera,Stephen J Freedland","doi":"10.1097/ju.0000000000004648","DOIUrl":"https://doi.org/10.1097/ju.0000000000004648","url":null,"abstract":"BACKGROUNDCurrent prognostic assessment of men with biochemical recurrence(BCR) after radical prostatectomy(RP) relies on data from the pre-2000s era when androgen deprivation therapy(ADT) was delayed until metastasis. Most men now initiate ADT at low PSA values prior to metastases, especially for high-risk disease in which expanded ADT improves metastasis-free survival. We defined rates of cancer progression and mortality in men treated with early ADT for post-RP BCR.METHODSWe conducted an observational study of 1,108 men with nonmetastatic prostate cancer receiving ADT for BCR after RP from 1988-2019 from VA SEARCH. Fine and Gray competing risk models quantified risk of metastasis, CRPC, and PCSM across key predictors.RESULTSMedian follow up after ADT among men who did not die of prostate cancer was 5.8 years(IQR 3.0,9.9). Median PSA at ADT was 1.3ng/ml(IQR 0.4,4.9). Across all men, risks of metastasis, CRPC, and PCSM at 15 years after ADT were 28%, 27%, and 19%, respectively. In multivariable models, higher pre-ADT PSA, shorter pre-ADT PSA doubling time(PSADT), higher pathologic grade group(GG), and seminal vesicle invasion(SVI) were associated with higher risk of metastasis, CRPC, and PCSM. We created predictive nomograms and tables estimating 3,5,10, and 15-year risks of metastasis, CRPC, and PCSM by PSA at ADT, PSADT at ADT, pathologic GG, and SVI. Risks of PCSM at 15 years after ADT initiation ranged from 2%-60% across subgroups.CONCLUSIONSThese contemporary prognostic estimates are more applicable to men receiving early ADT for post-RP BCR and can help identify high-risk patients who are candidates for intensified hormonal therapy.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"24 1","pages":"101097JU0000000000004648"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319870","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}