The Journal of Urology最新文献

{"title":"Magnetic Resonance Imaging at second surveillance biopsy after diagnosis in patients with Grade Group 1 prostate cancer in the Canary Prostate Active Surveillance Study.","authors":"Meera R Chappidi,Lisa F Newcomb,Yingye Zheng,Menghan Liu,Jeannette M Schenk,Kehao Zhu,Claire M de la Calle,James D Brooks,Peter R Carroll,Atreya Dash,Christopher P Filson,Martin E Gleave,Michael A Liss,Frances Martin,Jesse K McKenney,Todd M Morgan,Andrew A Wagner,Peter S Nelson,Daniel W Lin","doi":"10.1097/ju.0000000000004592","DOIUrl":"https://doi.org/10.1097/ju.0000000000004592","url":null,"abstract":"PURPOSENo clear guidelines exist regarding MRI use after confirmatory biopsy during active surveillance (AS). Our objective was to evaluate MRI performance after confirmatory biopsy in patients with vs. without prior MRI-informed biopsy.METHODSPatients in Canary PASS with Gleason grade group (GG) 1 disease undergoing MRI-informed Biopsy 2, defined as second surveillance biopsy after diagnosis, were separated into prior vs. no prior MRI-informed biopsy groups. Primary outcome was reclassification (≥GG2) at MRI-informed Biopsy 2. Reclassification rates and location (systematic cores, targeted cores, both) were compared between groups. Univariable and multivariable logistic regression identified predictors of reclassification.RESULTSPatients with (n=101) vs. without (n=103) prior MRI-informed biopsy had lower reclassification rates at Biopsy 2 (21% vs. 36%, p=0.017) and lower GG at reclassification (95% vs. 73% of reclassifications to GG2, p=0.039). In multivariable modeling, PI-RADS 4-5 at MRI-informed Biopsy 2 was associated with increased odds of reclassification (OR=2.04 95%CI [1.04-4.05]). The negative predictive value of MRI at Biopsy 2 was 87% (95%CI[78-96]) and 73% (95%CI[61-85]) in with vs. without prior MRI groups, respectively. Reclassification location was identified by targeted cores only in 36% vs. 19% of patients with vs. without prior MRI, respectively (p=0.4). Reclassification location was identified by systematic cores only in 36% vs. 58% of patients with vs. without prior MRI, respectively (p=0.4).CONCLUSIONSThese results support MRI use at Biopsy 2 and suggest negative surveillance MRI should not replace Biopsy 2. Both targeted and systematic cores should be taken at Biopsy 2 in patients with and without prior MRI on AS.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"36 1","pages":"101097JU0000000000004592"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897368","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 AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause.","authors":"Melissa R Kaufman,A Lenore Ackerman,Katherine A Amin,Marge Coffey,Elisheva Danan,Stephanie S Faubion,Anne Hardart,Irwin Goldstein,Giulia M Ippolito,Gina M Northington,Charles R Powell,Rachel S Rubin,O Lenaine Westney,Tracey S Wilson,Una J Lee","doi":"10.1097/ju.0000000000004589","DOIUrl":"https://doi.org/10.1097/ju.0000000000004589","url":null,"abstract":"PURPOSEGenitourinary syndrome of menopause (GSM) describes the symptoms and physical changes that result from declining estrogen and androgen concentrations in the genitourinary tract during the menopausal transition. There has not been a consensus reached about the number or type of symptoms needed to diagnose GSM, and the associated urinary symptoms are also linked with other common urologic conditions (e.g., overactive bladder) in older patients. This guideline provides information to clinicians regarding identification, diagnosis, counseling, and treatment for patients with GSM to optimize symptom control and quality of life while minimizing adverse events (AEs).METHODSThe systematic review utilized in the creation of this guideline is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ) and funded by the Patient Centered Outcomes Research Institute (PCORI). The EPC extracted and synthesized effectiveness and/or harms outcomes from 68 publications. An additional 66 publications evaluating 46 non-hormonal interventions, were described in an evidence map.RESULTSClinicians diagnose GSM based on symptoms, with or without related physical findings, and after ruling out other etiologies or co-occurring pathologies. There is a large body of evidence examining the use of hormonal and non-hormonal treatment options to manage the symptoms of GSM; however, the local low-dose vaginal estrogen has the most robust evidence base.CONCLUSIONThe strategies defined in this document were derived from evidence-based and consensus-based processes. Given that there is insufficient information to recommend one hormonal therapy over another, this guideline is not meant to support a stepwise progression through different hormonal approaches. The clinician should make treatment decisions in the context of shared decision-making considering patient goals and preferences, using the evidence of efficacy and AEs of each possible intervention as a guide.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"86 1","pages":"101097JU0000000000004589"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889330","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":"Pelvic lymph node dissection in prostate cancer - is it really necessary? A multicentric longitudinal study assessing oncological outcomes in prostate cancer patients undergoing pelvic lymph node dissection vs radical prostatectomy only.","authors":"Marc A Furrer,Niranjan J Sathianathen,Clancy J Mulholland,Nathan Papa,Andreas Katsios,Christopher Soliman,Nathan Lawrentschuk,Justin S Peters,Homi Zargar,Anthony J Costello,Christopher M Hovens,Peter Liodakis,Conrad Bishop,Ranjit Rao,Raymond Tong,Daniel Steiner,Declan G Murphy,Daniel Moon,Benjamin C Thomas,Philip Dundee,Jeremy Goad,Jose Antonio Rodriguez Calero,George N Thalmann,Niall Corcoran","doi":"10.1097/ju.0000000000004587","DOIUrl":"https://doi.org/10.1097/ju.0000000000004587","url":null,"abstract":"PURPOSEWith the availability of PSMA-PET scans, it is controversial whether pelvic lymph-node dissection (PLND) at time of radical prostatectomy (RP) is still the most reliable and accurate staging modality for lymph-node assessment. Furthermore, the oncological benefit of PLND remains unclear. Aim of this study was to assess whether omitting PLND in patients undergoing RP for prostate cancer is associated with the risk of tumor recurrence and progression to metastasis.MATERIAL AND METHODSIn this longitudinal multicentre cohort-study, we reviewed data of 2346 consecutive patients with prostate cancer who underwent RP with (n=1650) and without (n=696) extended-PLND between 01/1996 and 12/2021. Recurrence-free survival (RFS) and metastases-free survival (MFS) were analysed as a time-to-event outcome using Kaplan-Meier analyses with log-rank tests. To assess effect of PLND, we created multivariable Cox proportional hazards models adjusting for relevant clinical and demographic characteristics.RESULTS AND LIMITATIONSMedian follow-up was 44 months. There was no difference in RFS between men who had a PLND and those who did not [HR 1.07, 95%CI 0.87-1.32, p=0.52]. Patients with D'Amico high-risk-disease (PSA>20ug/l and/or ISUP-GG≥4) demonstrated a significantly prolonged MFS if they underwent PLND [HR 0.57, 0.36-0.91, p=0.02]. PLND also improved MFS in patients with intermediate-risk disease [HR 0.48, 95%CI 0.25-0.90, p=0.023]. Further significant prognostic variables for MFS on multivariable Cox proportional hazard regression were PSA, ISUP-GG, and pathological T-stage.CONCLUSIONSPLND improves MFS in D'Amico intermediate and high-risk prostate cancer patients and may therefore be considered in men undergoing RP.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"18 1","pages":"101097JU0000000000004587"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889271","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 Comment: Re: Utility of Preoperative Antimicrobial Prophylaxis in Hypospadias Repair: Results from NSQIP-Pediatric.","authors":"Douglas E Coplen","doi":"10.1097/ju.0000000000004575","DOIUrl":"https://doi.org/10.1097/ju.0000000000004575","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"9 1","pages":"101097JU0000000000004575"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889229","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 Comment on \"Effect of Chlorthalidone and Hydrochlorothiazide on Twelve-Hour Versus 24-Hour Calcium Excretion\".","authors":"Vernon M Pais","doi":"10.1097/ju.0000000000004573","DOIUrl":"https://doi.org/10.1097/ju.0000000000004573","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"19 1","pages":"101097JU0000000000004573"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889240","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":"Predicting Recurrence Following Surgical Resection for High-risk Localized Renal Cell Carcinoma: A Radiomics-Clinical Integration Approach.","authors":"Zine-Eddine Khene,Raj Bhanvadia,Isamu Tachibana,Prajwal Sharma,William Graber,Theophile Bertail,Raphael Fleury,Renaud De Crevoisier,Karim Bensalah,Yair Lotan,Vitaly Margulis","doi":"10.1097/ju.0000000000004588","DOIUrl":"https://doi.org/10.1097/ju.0000000000004588","url":null,"abstract":"PURPOSEAdjuvant immunotherapy for clear cell renal cell carcinoma (ccRCC) is controversial due to the absence of reliable biomarkers for identifying patients most likely to benefit. This study aimed to develop and validate a quantitative radiomic signature (RS) and a radiomics-clinical model to identify patients at increased risk of recurrence following surgery among those eligible for adjuvant immunotherapy.METHODSThis retrospective study included patients with ccRCC who are at intermediate-to-high or high risk of recurrence after nephrectomy. Inclusion criteria were patients with baseline characteristics matching the KEYNOTE-564 criteria. Radiomic texture-features were extracted from preoperative CT scans. Affinity-propagation clustering and random survival forest algorithms were applied to construct the RS. A radiomics-clinical-model was developed using multivariable Cox regression. The primary endpoint was disease-free survival (DFS). Model performance was assessed using time-dependent and integrated AUCs (iAUCs) and compared to conventional prognostic models via decision curve analysis (DCA).RESULTSA total of 309 patients were included, split into training (247) and test (62) sets. From each patient, 1,316 radiomic features were extracted. The RS achieved an iAUC of 0.78 in the training set and 0.72 in the test set. Multivariable analysis identified node status, vascular invasion, hemoglobin, and the RS as predictors of DFS (all p<0.05). These factors formed the radiomics-clinical-model, which achieved an iAUC of 0.81(95%CI,0.76-0.85) in the training set and 0.78(95%CI,0.69-0.88) in the test set. DCA demonstrated its superior clinical utility compared to conventional prognostic models.CONCLUSIONSIntegrating radiomics with clinical factors improves DFS prediction in intermediate-to-high or high risk ccRCC. This model offers a tool for individualized risk assessment, potentially optimizing patient selection for adjuvant therapy.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"42 1","pages":"101097JU0000000000004588"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889270","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 Prospective Randomized Study on Low-Energy Extracorporeal Shockwave Therapy for Erectile Dysfunction After Radical Prostatectomy.","authors":"Torben Brøchner Pedersen,Caroline Secher,Ali Moumneh,Nanna Hvid,Martin Lund,Grzegorz Fojecki,Lars Lund","doi":"10.1097/ju.0000000000004576","DOIUrl":"https://doi.org/10.1097/ju.0000000000004576","url":null,"abstract":"PURPOSETo evaluate the efficacy of low-energy extracorporeal shockwave therapy (LI-SWT) compared with a sham treatment in improving erectile function in men after radical prostatectomy. Erectile function was assessed using the Erection Hardness Score (EHS) and International Index of Erectile Function (IIEF) at baseline and 4, 12, and 24 weeks after treatment.MATERIALS AND METHODSA total of 75 participants were randomized to either LI-SWT or sham treatment. Data were analyzed using a zero-inflated negative binomial model for IIEF scores and appropriate nonparametric methods for the ordinal EHS data, including binary transformation for clinically relevant outcomes.RESULTSThe zero-inflated model for IIEF scores showed no significant difference between treatment groups with a ratio of 1.2 (95% CI: 0.1-2.4, P  =  .469). At 24 weeks post-treatment, the estimated median IIEF score was 4 in the LI-SWT group compared with 4 in the sham group. For EHS, no significant treatment effect was found, with median scores at 24 weeks of 2 in the LI-SWT group vs 2 in the sham group. The proportion of patients achieving sufficient erection hardness (EHS ≥3) at 24 weeks was 18% (95% CI: 9%-34%) in the LI-SWT group vs 26% (95% CI: 14%-43%) in the sham group (P = .552).CONCLUSIONSThis study did not demonstrate a statistically significant improvement in erectile function for men undergoing LI-SWT compared with sham treatment after radical prostatectomy.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"14 1","pages":"101097JU0000000000004576"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885498","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":"Utility of Preoperative Antimicrobial Prophylaxis in Hypospadias Repair: Results From NSQIP-Pediatrics.","authors":"Karen M Doersch,David A Diamond","doi":"10.1097/ju.0000000000004574","DOIUrl":"https://doi.org/10.1097/ju.0000000000004574","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"25 1","pages":"101097JU0000000000004574"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889242","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":"Acoustic Enhancer Microbubble Cavitation: A Randomized Clinical Trial Evaluating the Safety and Efficacy of a Novel Treatment for Urolithiasis.","authors":"Wesley A Mayer,Thomas Chi,Scott Wiener,Christopher H Cantrill,Julio G Davalos,Hemendra N Shah,Marshall L Stoller","doi":"10.1097/ju.0000000000004581","DOIUrl":"https://doi.org/10.1097/ju.0000000000004581","url":null,"abstract":"PURPOSEThe efficacy of ureteroscopy to treat urinary stones is often less than 60%. Acoustic Enhancer is an investigational device of microparticles with a tag designed with an affinity for calcium. We evaluated safety and efficacy of ureteroscopic laser lithotripsy with and without Acoustic Enhancer Microbubble Cavitation in a randomized clinical trial.MATERIALS AND METHODSPatients with urolithiasis were randomized to ureteroscopic laser lithotripsy with or without Acoustic Enhancer. The endpoints were the proportion of patients without residual fragments > 2mm on computed tomography 30 days post-procedure (fragment-free rate) and adverse events.RESULTSThere were 103 and 93 patients in the investigational and control groups, respectively. There was no statistical superiority between the 2 groups. The fragment-free rate was 41.4% and 47% in the investigational and control groups, respectively (p=0.46). Residual fragment size was similar, 5.55mm versus 5.70mm for the investigational and control groups, respectively (p = 0.71). Among investigational patients treated with higher average powers > 12W, the fragment free rate was 51% compared to 32% (n=47) for the low-power group (p=0.06). Adverse events were noted in 35% and 46.2% of patients in the investigational and the control groups, respectively (p=0.11). The total number of adverse events was less for the investigational arm (p<0.001).CONCLUSIONSAlthough laser lithotripsy with microbubble cavitation did not increase efficacy, it was associated with significantly fewer adverse events. . Efficacy of microbubble cavitation may depend on laser power utilized. The low efficacy and high rates of adverse events with ureteroscopy highlights the need for novel management approaches for urinary stones.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"36 1","pages":"101097JU0000000000004581"},"PeriodicalIF":0.0,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143885514","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 Prophylactic Antibiotics Decrease the Rate of Urinary Tract Infections after Robot-Assisted Radical Cystectomy? A Randomized Controlled Trial.","authors":"Ahmed A Hussein,Abdul Wasay Mahmood,Ali Ahmad,Holly Houenstein,Grace Harrington,Mohammad Khan,Dawod Abdelhaq,Zhe Jing,Kristopher Attwood,Nikolaos G Almyroudis,Qiang Li,Khurshid A Guru","doi":"10.1097/ju.0000000000004586","DOIUrl":"https://doi.org/10.1097/ju.0000000000004586","url":null,"abstract":"OBJECTIVETo investigate the role of prophylactic antibiotics after robot-assisted radical cystectomy (RARC) in the prevention of 90-day urinary tract infections (UTIs).METHODSPatients who underwent RARC with urinary diversion were randomized to standard of care (SOC) versus receiving prophylactic antibiotics (Nitrofurantoin 100 mg daily or trimethoprim/sulfamethoxazole 160/800 mg daily) for 30 days after discharge. The primary endpoint was 90-day UTIs (defined as positive urine culture with >105 cfu/ml associated with clinical symptoms, such as fever, chills, or flank pain). Secondary endpoints included adverse events, 90-day infectious complications, UTI-related readmissions, and cost.RESULTThe final cohort included 40 in the SOC and 37 patients in the study arm, with follow-up≥ 90 days. Median age was 69 years (IQR 65-76), 19 (25%) were females, and 28 (36%) received neoadjuvant chemotherapy. Ten patients (25%) developed UTIs in the SOC vs 0% in the study arm (p=0.001). There was no significant difference in complications or high-grade complications. 90-day infectious complications were 43% in the SOC arm vs 14% in the study arm (p=0.006), and 90-day infection-related readmissions were 30% in the SOC versus 5% in the study arm (p=0.007). The mean post-cystectomy cost was $9074 lower in the treatment arm compared to the SOC (p=0.007). The number needed to treat to prevent a single UTI was 4.0 (95% CI 2.5-7.0).CONCLUSIONProphylactic antibiotics for 30 days after RARC were associated with lower 90-day UTIs, infectious complications, UTI-related readmissions, and costs without an increase in adverse events.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"37 1","pages":"101097JU0000000000004586"},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880180","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}