The Journal of Urology最新文献

{"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}

{"title":"Active Surveillance versus Primary Intervention for Clinical T1a Kidney Tumors: Twelve-Year Experience of the DISSRM Prospective Comparative Study.","authors":"Khalid Y Alkhatib,Joseph G Cheaib,Maximilian Pallauf,Ridwan Alam,Hiten D Patel,Tina Wlajnitz,Nirmish Singla,Peter Chang,Andrew A Wagner,Christian P Pavlovich,James M McKiernan,Thomas J Guzzo,Mohamad E Allaf,Phillip M Pierorazio","doi":"10.1097/ju.0000000000004583","DOIUrl":"https://doi.org/10.1097/ju.0000000000004583","url":null,"abstract":"PURPOSEActive surveillance (AS) is an alternative to primary intervention (PI) in the management of small renal masses (SRMs; clinical stage T1a). However, AS remains underutilized due to a lack of strong, prospective data. We herein report mature outcomes after a twelve-year experience with the Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) Registry.MATERIALS AND METHODSMulti-institutional prospective comparative study from 2009 to 2022 of patients with SRM who chose to undergo AS or PI. Primary outcomes were cancer-specific survival (CSS) and overall survival (OS).RESULTSA total of 958 patients were enrolled; 581 chose AS, and 377 chose PI. Ultimately, 88 of 581 AS patients crossed over to delayed intervention (DI). The median follow-up time for the registry was 4.15 years (IQR 2.11-7.31) among patients who were still alive, with 406 patients followed for ≥5 years. Competing-risk CSS cumulative incidence function (CIF) accounting for other causes of mortality for AS at 4 years and beyond is 0.19% (95% CI; 0.3% - 1.4%), and for PI at 4 years and beyond is 0.68% (95% CI; 0.17% - 2.7%). Gray's test for statistical differences between CSS CI curves of PI vs AS showed no statistical difference (P=0.4). However, Kaplan-Meier analysis of OS showed to be higher in patients undergoing PI compared to AS at 4 years (95% vs 88%), 6 years (92% vs 81%), 8 years (90% vs 66%), and 10 years (85% vs 64%), this difference was statistically significant; log-rank P<0.001.CONCLUSIONSIn our study cohort, AS is not inferior to PI in patients with SRM suspicious for renal cell carcinoma. Difference in OS between AS and PI is most likely attributable to the increased risk of death from competing causes among AS patients. A priori definitions of progression, including growth rate, should be re-considered.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"21 1","pages":"101097JU0000000000004583"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866387","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":"Evolution of Active Surveillance of Prostate Cancer: Impact of MRI, MRI-guided Biopsy and Focal Therapy.","authors":"Shannon C Martin,Samantha Gonzalez,Lorna Kwan,Merdie Delfin,Anissa V Nguyen,Wayne Brisbane,Ely Felker,Anthony Sisk,Alan Priester,Shyam Natarajan,Leonard S Marks","doi":"10.1097/ju.0000000000004559","DOIUrl":"https://doi.org/10.1097/ju.0000000000004559","url":null,"abstract":"PURPOSEWe aimed to determine if, using baseline MRI-guided biopsy (MRGB), durability of active surveillance (AS) could be pre-determined, follow-up biopsies avoided, and if by incorporating focal therapy (FT), AS extended.MATERIALS AND METHODSA cohort of 869 men in the UCLA protocol study of AS (2010-2022) was analyzed. Inclusion criteria were baseline MRI-guided biopsy (MRGB) showing Grade Group (GG) ≤ 2 and >1 year enrollment. After 2016, FT was offered to men with GG2 and those progressing to GG3.RESULTSThe 869 men accrued 3500 patient-years of follow-up (median follow-up 4.1 years). At baseline, men were GG1 (505), GG2 (174), and 'GG0' (190), the latter describing those with prior diagnostic GG1 or 2, but negative baseline MRGB. Overall, progression to ≥ GG3 among the 664 with serial MRGB was 7% for GG0, 19% for GG1, and 34% for GG2. During follow-up, absence of progression (negative predictive value, NPV) was correctly identified by MRI in nearly 95% of men with baseline GG0; 90% of men with GG1; and 70% of men with GG2. FT was performed in 99/393 eligible men (25%); among them, five-year probability of RP/RT-free survival was 84% compared to 46% in the no-FT group (p<0.01).CONCLUSIONS AND RELEVANCEDurability of AS may be linked to baseline MRGB. In men starting AS with MRGB and low-risk prostate cancer, subsequent MRI exhibits high NPV, indicating routine follow-up biopsy is avoidable. In some men, FT may allow extension of AS and deferral of surgery or radiation.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"2 1","pages":"101097JU0000000000004559"},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861987","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":"Male Chronic Pelvic Pain: AUA Guideline: Part III Treatment of Chronic Scrotal Content Pain.","authors":"H Henry Lai,Michel A Pontari,Charles E Argoff,Larissa Bresler,Benjamin N Breyer,Roger Chou,J Quentin Clemens,Elise Jb De,R Christopher Doiron,Dane Johnson,Erin Kirkby,Susan M MacDonald,Jill H Osborne,Sijo J Parekattil,Beth Shelly","doi":"10.1097/ju.0000000000004566","DOIUrl":"https://doi.org/10.1097/ju.0000000000004566","url":null,"abstract":"PURPOSEThis Guideline covers the evaluation and treatment of men who present to a clinician with a complaint of chronic pelvic pain. This is Part III of a three-part series focusing on treatment of chronic scrotal content pain (CSCP). CSCP patients typically present with pain described in the testes with tenderness in the epididymis and/or spermatic cord. Patient education of the underlying etiology may promote discussion of treatment options, which often require a multidisciplinary approach that includes management of expectations through supportive counseling during treatment. For discussion of patient evaluation and treatment of chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS), refer to Parts I and II of this series.MATERIALS AND METHODSThe systematic review that informs the Guideline statements was based on searches in Ovid MEDLINE (1946 to June 6, 2023), the Cochrane Central Register of Controlled Trials (through May 2023), and the Cochrane Database of Systematic Reviews (through May 2023). An updated search was conducted in June 2024.RESULTSThe Chronic Pelvic Pain Panel developed evidence- and consensus-based statements to provide guidance for treatment of patients with CSCP, which may include lifestyle modification, pharmacologic management, and procedural intervention.CONCLUSIONSSpecific data on CSCP are lacking with most management options described as off-label use. While there are multiple evolving treatments for CSCP that have shown promising results, most currently lack sufficient data to recommend as treatment and require further investigation to establish a role in patient care.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"75 2 1","pages":"101097JU0000000000004566"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846390","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":"Male Chronic Pelvic Pain: AUA Guideline: Part II Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome.","authors":"H Henry Lai,Michel A Pontari,Charles E Argoff,Larissa Bresler,Benjamin N Breyer,Roger Chou,J Quentin Clemens,Elise Jb De,R Christopher Doiron,Dane Johnson,Erin Kirkby,Susan M MacDonald,Jill H Osborne,Sijo J Parekattil,Beth Shelly","doi":"10.1097/ju.0000000000004565","DOIUrl":"https://doi.org/10.1097/ju.0000000000004565","url":null,"abstract":"PURPOSEThis Guideline covers the evaluation and treatment of men who present to a clinician with a complaint of chronic pelvic pain. This is Part II of a three-part series focusing on treatment of chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS). A challenge for clinicians treating these patients is the necessity to address symptoms and etiologies outside of the usual urologic evaluation. Consequently, recommended treatment utilizes a multimodal/multidisciplinary approach that is highlighted through discussion of referral to other specialists and allied health professionals while continuing to manage urologic symptoms. For discussion of patient evaluation and treatment of chronic scrotal content pain (CSCP), refer to Parts I and III of this series.MATERIALS AND METHODSThe systematic review that informs the Guideline statements was based on searches in Ovid MEDLINE (1946 to June 6, 2023), the Cochrane Central Register of Controlled Trials (through May 2023), and the Cochrane Database of Systematic Reviews (through May 2023). An updated search was conducted in June 2024.RESULTSThe Chronic Pelvic Pain Panel developed evidence- and consensus-based statements to provide guidance for the treatment of patients with CP/CPPS, which may include lifestyle modification, behavioral therapy, pharmacologic and phytotherapeutic options, and procedural intervention.CONCLUSIONSWe usually think of pain in response to tissue injury that resolves with healing. We now know that pain can also derive from neurologic origins. Effective treatment of CP/CPPS will require better understanding of what is causing persistence of the pain in addition to further testing of therapies under investigation to establish a role in patient care.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"42 1","pages":"101097JU0000000000004565"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846391","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":"Male Chronic Pelvic Pain: AUA Guideline: Part I Evaluation and Management Approach.","authors":"H Henry Lai,Michel A Pontari,Charles E Argoff,Larissa Bresler,Benjamin N Breyer,Roger Chou,J Quentin Clemens,Elise Jb De,R Christopher Doiron,Dane Johnson,Erin Kirkby,Susan M MacDonald,Jill H Osborne,Sijo J Parekattil,Beth Shelly","doi":"10.1097/ju.0000000000004564","DOIUrl":"https://doi.org/10.1097/ju.0000000000004564","url":null,"abstract":"PURPOSEThis Guideline covers the evaluation and treatment of men who present to a clinician with a complaint of chronic pelvic pain. This is Part I of a three-part series focusing on the evaluation of such patients. The presentation of these men is widely variable. In addition to pelvic pain, they may also have pain in many body areas outside of the pelvis. The wide variety of clinical presentations and multidisciplinary diagnostic and treatment considerations makes management challenging. For discussion of treatment of chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS) and treatment of chronic scrotal content pain (CSCP), refer to Parts II and II of this series.MATERIALS AND METHODSThe systematic review that informs the Guideline statements was based on searches in Ovid MEDLINE (1946 to June 6, 2023), the Cochrane Central Register of Controlled Trials (through May 2023), and the Cochrane Database of Systematic Reviews (through May 2023). An updated search was conducted in June 2024.RESULTSThe Chronic Pelvic Pain Panel developed evidence- and consensus-based statements to provide guidance for the diagnosis and evaluation of male patients who experience chronic pelvic pain.CONCLUSIONSWhile the etiology of chronic pelvic pain is unknown, clinicians have a much better understanding of the pathophysiology from the last 25 years of research. Further progress in diagnosis and evaluation of men with suspected CP/CPPS and CSCP will require better understanding of what is causing persistence of the pain in addition to investigation of associated conditions.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"40 1","pages":"101097JU0000000000004564"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846389","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":"AI Biomarkers Predict Poor Efficacy of BCG Rechallenge in Previously BCG-Treated Non-muscle Invasive Bladder Cancer.","authors":"Yair Lotan,Roger Li,Sam S Chang","doi":"10.1097/ju.0000000000004541","DOIUrl":"https://doi.org/10.1097/ju.0000000000004541","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"8 1","pages":"101097JU0000000000004541"},"PeriodicalIF":0.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846370","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":"Letter: Updates to Microhematuria: AUA/SUFU Guideline (2025).","authors":"Karim Chamie,Andrew Chen,Alejandro Rodriguez,Wei Shen Tan","doi":"10.1097/ju.0000000000004553","DOIUrl":"https://doi.org/10.1097/ju.0000000000004553","url":null,"abstract":"","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"4 1","pages":"101097JU0000000000004553"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841055","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":"Accuracy of 18F-FDG PET in Early Metastatic Testicular Seminoma: Analysis from the SEMS Trial.","authors":"Brian Hu,Muhannad Alsyouf,Ala'a Farkouh,Clint Cary,Timothy Masterson,Lawrence Einhorn,Nabil Adra,Stephen A Boorjian,Christian Kollmannsberger,Anne Schuckman,Alan So,Peter C Black,Aditya Bagrodia,Eila Skinner,Mehrdad Alemozaffar,Timothy Brand,Scott Eggener,Phillip Pierorazio,Kelly Stratton,Lucia Nappi,Craig Nichols,Siamak Daneshmand","doi":"10.1097/ju.0000000000004561","DOIUrl":"https://doi.org/10.1097/ju.0000000000004561","url":null,"abstract":"PURPOSERecent clinical trials on primary RPLND for testicular seminoma highlight inaccuracies in conventional imaging for lymph node staging. Limited data exist on the accuracy of positron emission tomography (PET) in patients with chemotherapy-naïve testicular seminoma. We evaluated the accuracy of 18F-FDG PET for detection of metastatic disease within the SEMS trial (Surgery in Early Metastatic Seminoma).METHODSThe SEMS trial is a phase II prospective study evaluating efficacy of primary RPLND in patients with testicular seminoma with limited retroperitoneal lymphadenopathy. 18F-FDG PET scanning was performed as a radiographic correlate in addition to standard axial imaging prior to surgery. PET findings were based upon local interpretation and results were compared to surgical pathology.RESULTSOf the 55 patients enrolled in the trial, 26 (47%) underwent PET. Twenty (77%) scans were reported as positive with lymph nodes in the retroperitoneum, pelvis, or inguinal region. Of the positive PET scans, eighteen had pathologically positive lymph nodes (PPV 90%) at time of RPLND. Six PET scans were negative with five of these patients having surgically confirmed pN0 disease (NPV 83%). Sensitivity of PET for detecting lymph node metastatic seminoma was 95% and specificity was 71%. The average SUV of the PET positive lymph nodes and pathologically positive lymph node were 7.0 (range 2.6-18.8) and 6.8 (range 1.53-18.8), respectively. No PET positive lesions outside of the retroperitoneum or pelvis were found to represent metastatic seminoma on clinical follow-up.CONCLUSIONIn patients with testicular seminoma, 18F-FDG PET findings correlated with both pathologically positive and negative retroperitoneal lymph nodes in the majority of cases. Further research is needed to determine if PET can improve upon the already good predictive performance of conventional imaging and clinical expertise.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"23 1","pages":"101097JU0000000000004561"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818986","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 absolute volume of Gleason Pattern 4 on radical prostatectomy is more strongly associated with advanced stage and biochemical recurrence than Gleason grade groups.","authors":"Simone Scuderi, Amy L Tin, Jared Klug, Shaun Porwal, Leonardo Quarta, Margherita Ciabattini, Nazario Pio Tenace, Riccardo Leni, Roberta Lucianò, Armando Stabile, Giorgio Gandaglia, James A Eastham, Francesco Montorsi, Alberto Briganti, Andrew J Vickers","doi":"10.1097/ju.0000000000004484","DOIUrl":"https://doi.org/10.1097/ju.0000000000004484","url":null,"abstract":"ISUP Grade-Group (GG) is based on the relative proportion of Gleason patterns 3 and 4. We investigated whether absolute pattern 4 volume is more strongly associated with advanced stage and biochemical recurrence than GG in patients with pattern 4 but not 5.","PeriodicalId":501636,"journal":{"name":"The Journal of Urology","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143462529","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}