The Journal of Urology最新文献

{"title":"Association between Midline Extraction Incision and Increased Risk of Incisional Hernia Following Minimally-invasive Radical Nephrectomy: Results of an Observational Study from a High-Volume Center.","authors":"Zaeem Lone,Shelby Harper,David Shin,Erin Brooks,Erin Kim,Amy S Nowacki,Rebecca A Campbell,Eiftu Haile,Sara Maskal,Ryan Ellis,Ben Miller,Clayton Petro,Mohamed Eltemamy,Samuel C Haywood,Jihad Kaouk,Ryan Berglund,Robert Abouassaly,Venkatesh Krishnamurthi,Christopher J Weight,Steven C Campbell,Erick M Remer,Nima Almassi","doi":"10.1097/ju.0000000000004649","DOIUrl":"https://doi.org/10.1097/ju.0000000000004649","url":null,"abstract":"PURPOSETo determine whether specimen extraction incision and body morphometry analysis of skeletal muscle and fat mass is predictive of incisional hernia (IH) following minimally invasive nephrectomy (laparoscopic or robotic).MATERIAL AND METHODSWe conducted an observational study of a prospectively maintained database of patients undergoing minimally invasive nephrectomy from 2005-2022. For inclusion patients were required to have pre-operative and one-year and two-year post-operative abdominal cross-sectional imaging. Skeletal muscle and fat mass indices were calculated based on measurements obtained from preoperative imaging. The location of the specimen extraction incision was determined from operative reports. IH were diagnosed on review of post-operative imaging. Logistic regression analysis was performed to identify predictors of IH.RESULTS494 patients met inclusion criteria. The most commonly used extraction incisions were Gibson (250 patients, 51%), midline (98 patients, 20%), paramedian (58 patients, 12%), and Pfannenstiel (21 patients, 4.3%). At two-year post-operative follow-up, 59 patients (12%) had developed IH. The incidence of IH was highest among patients receiving midline incision (23%), compared to all other incision types (≤10% each). Baseline fat mass index (OR: 1.18, 95% CI: 1.06-1.32, p=0.002) and a midline extraction incision (OR: 4.60, 95% CI: 2.23-9.48, p<0.001) were independent predictors of IH.CONCLUSIONSA midline extraction incision is associated with a significantly higher risk of IH following minimally-invasive nephrectomy. Body morphometry analysis did not improve predictive models compared to models using body mass index. These data support a prospective trial to identify the optimal extraction incision for hernia-free survival and patient-reported quality of life.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"240 1","pages":"101097JU0000000000004649"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319866","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":"Defining Abnormal Prostate Specific Antigen Values for Prostate Cancer Screening in the Spinal Cord Injury Population.","authors":"Ryan W Fogg,Sarah C Krzastek,Nicole Vissichelli,Edem Defor,Roy Sabo,Mina Ghatas,Adam Sima,Natalie Swavely,Baruch M Grob,William Carter,Lance Goetz,Adam P Klausner","doi":"10.1097/ju.0000000000004644","DOIUrl":"https://doi.org/10.1097/ju.0000000000004644","url":null,"abstract":"INTRODUCTION AND OBJECTIVEMen with Spinal Cord Injury (SCI) experience frequent urinary tract inflammation and manipulation as well as chronic hypogonadism, all of which may artifactually alter PSA values. Thus, established PSA reference ranges and age-adjusted values may not be accurate in this population. This study's objective was to use national Veterans Affairs data to establish threshold values for PSA in the SCI population to guide decision making in prostate cancer screening.METHODSAll PSA values in the national Veterans Affairs system in men with SCI were collected between 1999-2019. Values collected prior to a diagnosis of SCI and after a diagnosis of prostate cancer were excluded. Determination of SCI was based on a list of ICD9 and ICD10 codes. Mixed-effect quantile regression was used to estimate percentile PSA values adjusted by age and time since spinal cord injury. These values were then compared to published values in the non-SCI population.RESULTSA total of 34,899 male veterans with SCI were included in the analysis with a total of 240,131 PSA values. Using the best-fit model, age-adjusted PSA values for the 25th, 50th, 75th, and 95th percentiles were created. The 95th age-adjusted percentile values for PSA in the SCI population were 40-49: 2.5 ng/mL, 50-59: 2.6 ng/mL, 60-69: 2.6 ng/mL, and 70-79: 2.8 ng/mL.CONCLUSIONSUsing a large, geographically diverse database, age-adjusted PSA values in the SCI population can be generated. While PSA values of the SCI population are comparable in younger men, as the SCI population ages, PSA fails to rise and stagnates at around 3 ng/mL.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"5 1","pages":"101097JU0000000000004644"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311415","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":"Predictors and patterns of non-urothelial recurrence after nephroureterectomy for upper tract urothelial carcinoma (UCAN Collaboration).","authors":"Andrew B Katims,Amy L Tin,Melissa Assel,Patrick Hensley,Roger Li,Vitaly Margulis,Surena Matin,Maximilian Pallauf,Roderick K Clark,Jay D Raman,Nirmish Singla,Philippe E Spiess,Jonathan Coleman","doi":"10.1097/ju.0000000000004646","DOIUrl":"https://doi.org/10.1097/ju.0000000000004646","url":null,"abstract":"PURPOSEAfter radical nephroureterectomy for upper tract urothelial carcinoma, 25% of patients experience distant metastasis within 5 years. Non-urothelial recurrence is associated with poor prognosis and survival, with ∼80% of patients dying within 2 years. We evaluated predictors, patterns, and timing of recurrences after radical nephroureterectomy and the association between recurrence location and cancer-specific survival.MATERIALS AND METHODSSeparate competing risk regression models with each site as the outcome and all other recurrence sites as the competing risk. A Cox proportional hazards model evaluated predictors and the association between cancer-specific survival and recurrence site, adjusting for time from surgery to recurrence. A separate model including multiple sites (yes/no) evaluated the association with cancer-specific survival, also adjusting for recurrence sites.RESULTS2177 patients with upper tract urothelial carcinoma underwent radical nephroureterectomy between 01/2000-02/2021 from 7 institutions, with 454 developing non-urothelial recurrence (survivor median follow-up, 34 (IQR 11, 70) months). Improved cancer-specific survival rates were seen in lung and lymph node metastasis compared to other sites (HR 0.60, 95% CI 0.37, 0.97, p = 0.038; HR 0.65, 95% CI 0.41, 1.02, p = 0.063, respectively). Recurrence to multiple concurrent non-urothelial sites was associated with worse cancer-specific survival rates (HR 1.68, 95% CI 1.30, 2.17, p<0.001). Significant recurrence associations included tumor size, high stage/grade, and tumor location. There was no statistically significant survival differences based on timing of recurrence.CONCLUSIONSRecurrences were common within 2 years. Lung/lymph node recurrences portended the most favorable cancer-specific survival rates. Understanding the timing and location of recurrence can tailor surveillance strategies.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"145 1","pages":"101097JU0000000000004646"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311419","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":"Evaluating Decisional Regret in Adults with Spina Bifida Regarding Childhood Surgeries for Neurogenic Bladder and Bowel.","authors":"Nikhil V Batra,Ashley W Johnston,Mark P Cain,Pankaj P Dangle,Martin Kaefer,Kirstan K Meldrum,Richard C Rink,Konrad M Szymanski,Benjamin M Whittam,Rosalia Misseri,Joshua D Roth","doi":"10.1097/ju.0000000000004643","DOIUrl":"https://doi.org/10.1097/ju.0000000000004643","url":null,"abstract":"PURPOSETo assess decisional regret (DR) amongst people with spina bifida (SB) regarding decisions caregivers made to manage their neurogenic bladder and bowel as children.MATERIALS AND METHODSConsecutive adults with SB were surveyed at clinic appointments. For history of childhood bladder reconstruction, we analyzed whether demographics, procedural type, complications, revisions, and functional outcomes impacted DR. For history of childhood Malone antegrade continence enema channel (MACE) creation, we additionally analyzed whether bowel management habits or symptoms impacted DR.RESULTSNinety-six adults (median age 26.3 years) had childhood surgery for neurogenic bladder and 71 had MACE for neurogenic bowel. Median DR scores were 0 (mean 11.9) for bladder reconstruction and 0 (mean 12.0) for MACE. For bladder surgery, 60% reported no regret. Of those with any regret, 89% reported low-moderate regret and 11% reported strong or very strong regret. DR was associated with having a bladder neck procedure (BNP) (OR 3.45, p=0.007) or bothersome urinary incontinence (OR 5.59, p=0.001). For MACE, 58% reported no regret. Of those with any regret, 97% reported low-moderate regret and 3% reported very strong regret. On univariate analysis, DR was associated time on toilet >1 hour (OR 3.7, p=0.023), bother waiting for stool evacuation (OR 3.2, p=0.029), and difficulty catheterizing (OR 3.3, p=0.024); none remained significant on multivariate analysis.CONCLUSIONSPeople with SB reported low levels of DR after childhood surgery for neurogenic bladder and bowel, suggesting general satisfaction with decisions made on their behalf by caregivers. More research is needed into factors that were associated with regret, including incontinence and BNPs.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"14 1","pages":"101097JU0000000000004643"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144311375","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: 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":"Adam C Reese","doi":"10.1097/ju.0000000000004606","DOIUrl":"https://doi.org/10.1097/ju.0000000000004606","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"31 1","pages":"101097JU0000000000004606"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122263","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: A Prospective Randomized Study on Low-Energy Extracorporeal Shockwave Therapy (LI-SWT) for Erectile Dysfunction After Radical Prostatectomy.","authors":"Peter Dietrich,Zachary Werner","doi":"10.1097/ju.0000000000004609","DOIUrl":"https://doi.org/10.1097/ju.0000000000004609","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"79 1","pages":"101097JU0000000000004609"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122217","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 \"A Prospective Randomized Study on Low-Energy Extracorporeal Shockwave Therapy (LI-SWT) for Erectile Dysfunction After Radical Prostatectomy\".","authors":"Jaxson Jeffery,Nahid Punjani","doi":"10.1097/ju.0000000000004608","DOIUrl":"https://doi.org/10.1097/ju.0000000000004608","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"33 1","pages":"101097JU0000000000004608"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122266","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: A Prospective Randomized Study on Low-Energy Extracorporeal Shockwave Therapy (LI-SWT) for Erectile Dysfunction After Radical Prostatectomy.","authors":"Roger Dmochowski","doi":"10.1097/ju.0000000000004607","DOIUrl":"https://doi.org/10.1097/ju.0000000000004607","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"137 1","pages":"101097JU0000000000004607"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122264","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":"MIDMID-TERM KIDNEY FUNCTION IN BOYS WITH POSTERIOR URETHRAL VALVES AND A SOLITARY FUNCTIONING KIDNEY.","authors":"Silvia Pecorelli,Mathilde Glenisson,Matthieu Peycelon,Etienne Suply,Marc-David Leclair,Nicolas Kalfa,Pauline Clermidi,Alexis Arnaud,Alice Faure,Quentin Ballouhey,Nadia Boudaoud,Yann Chaussy,Cyril Ferdynus,Thomas Blanc,Luke Harper","doi":"10.1097/ju.0000000000004612","DOIUrl":"https://doi.org/10.1097/ju.0000000000004612","url":null,"abstract":"PURPOSEIt has been suggested that patients with Posterior Urethral Valves (PUV) and a solitary functioning kidney (SFK) have poorer mid-term and long-term renal function than those with 2 functioning kidneys (2FK). We compared mid-term eGFR of PUV patients with and without solitary kidneys.MATERIAL AND METHODSWe used the CIRCUP randomized controlled trial database, which included only patients with prenatally suspected, postnatally confirmed PUV. Standardized follow-up included an early DMSA scan performed between 1 and 6 months of age. We retrospectively compared mid-term eGFR (>5 years of age) between those with or without findings of solitary functioning renal unit (<10% differential function of a renal unit). eGFR was calculated using the updated Schwartz formula. Comparison between groups was done using the Mann-Whitney U-test. The study respects our national ethics regulations.RESULTS68 PUV patients were included, 20 of whom had SFK. There were no differences in baseline characteristics between both groups, nor in timing of DMSA scan or latest follow-up.The median follow-up was 7 years (IQR: 6-8). The median eGFR in each group was: SFK 82.5 (55-109) vs. 2FK 94.5 (71-114).There was no significant difference in mid-term eGFR, nor in the proportion of boys with mid-term eGFR <90 or eGFR<60 between the two groups. However, nadir creatinine was significantly higher in boys with a mid-term eGFR < 90 as opposed to those with a mid-term eGFR >90 (p<0.01).CONCLUSIONSIn boys with PUV, having only one functioning kidney on a DMSA study is insufficient to determine decreased renal reserve.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"124 1","pages":"101097JU0000000000004612"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065917","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: Letter: a multi-institutional study of MR/US fusion guided nanoparticle directed focal therapy for prostate ablation.","authors":"Steven E Canfield,Ardeshir R Rastinehad","doi":"10.1097/ju.0000000000004580","DOIUrl":"https://doi.org/10.1097/ju.0000000000004580","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"18 1","pages":"101097JU0000000000004580"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143921089","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}