Cuaj-Canadian Urological Association Journal最新文献

{"title":"The efficacy and safety of tranexamic acid use during radical cystectomy: A systematic review and meta-analysis.","authors":"Caio Vinicius Suartz, Henrique L Lepine, Caio Felipe Araujo Matalani, Mariana Pinho E Albuquerque Parente, Diogo Santana Moura, Leonardo Bandeira Cerqueira Zollinger, Roberto Iglesias Lopes, José Bessa Júnior, Maurício Dener Cordeiro, Leonardo O Reis, Jeremy Teoh Yuen Chun, José Maurício Motta, William Carlos Nahas, Paul Toren, Leopoldo Alves Ribeiro-Filho","doi":"10.5489/cuaj.9266","DOIUrl":"https://doi.org/10.5489/cuaj.9266","url":null,"abstract":"<p><strong>Introduction: </strong>Radical cystectomy (RC) is the standard treatment for muscle-invasive bladder cancer (MIBC), but it is associated with substantial perioperative blood loss and high transfusion rates. Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated efficacy in reducing surgical blood loss across various specialties; however, due to a paucity of randomized controlled trials in the RC setting, its role remains uncertain. We conducted a systematic review and meta-analyses to synthesize the current evidence and provide a critical assessment of TXA use during RC.</p><p><strong>Methods: </strong>Studies evaluating TXA during RC were identified through a comprehensive search of multiple databases up to November 2024. Primary outcomes included intraoperative and perioperative blood transfusion rates and estimated blood loss. The secondary outcome assessed was thromboembolic events RESULTS: Five studies comprising 1736 patients were included. TXA did not significantly reduce estimated blood loss (MD: -85.56 mL; 95% confidence interval [CI] -191.13-20.02, p>0.05) or intraoperative transfusion rates (odds ratio [OR] 0.73, 95% CI 0.40-1.33, p>0.05); however, TXA was associated with a lower likelihood of perioperative transfusions (OR 0.56, 95% CI 0.32-0.97, p<0.05). Notably, TXA increased the risk of thromboembolic events (OR 2.05, 95% CI 1.15-4.65, p<0.05). Heterogeneity varied across analyses, with robotic-assisted RC underrepresented in the included studies.</p><p><strong>Conclusions: </strong>This systematic review and meta-analysis revealed that, in patients undergoing RC, the use of TXA does not significantly reduce estimated blood loss or intraoperative transfusion rates. Moreover, TXA appears to be associated with an increased incidence of thromboembolic events, suggesting a potential pro-thrombotic effect. Based on these findings, its routine use in this context cannot be recommended, particularly when intended to reduce thromboembolic risk.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation exposure risk from ¹⁷⁷Lu-PSMA-617 in hematuric patients: What should urologists know?","authors":"Kathryn Neville, Naji J Touma","doi":"10.5489/cuaj.9403","DOIUrl":"https://doi.org/10.5489/cuaj.9403","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case series - Scrotal edema associated with zanubrutinib.","authors":"Phillip J Poppas, Manish Kuchakulla, John M Masterson, Aaron Gurayah, Brandon M Wahba, Alana Nguyen, James A Kashanian","doi":"10.5489/cuaj.9271","DOIUrl":"https://doi.org/10.5489/cuaj.9271","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case series - Beyond the stones: Thulium fiber laser-induced renal damage in children with proximal ureteral narrowing.","authors":"Hooman Ebrahimi, Samer Maher, Joana Dos Santos, Frank Papanikolaou, Armando Lorenzo, Mandy Rickard, Yonah Krakowsky, Michael Chua","doi":"10.5489/cuaj.9304","DOIUrl":"https://doi.org/10.5489/cuaj.9304","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrograde intrarenal surgery with flexible and navigable suction ureteral access sheaths vs. percutaneous nephrolithotomy for 2-3 cm kidney stones: Is less ınvasive better?","authors":"Recep Burak Degirmentepe, Yasir Muhammed Akca, Suleyman Alp, Haci Ibrahim Cimen, Deniz Gul, Mustafa Erkoc, Muammer Bozkurt, Tuncay Toprak, Fikret Halis","doi":"10.5489/cuaj.9279","DOIUrl":"https://doi.org/10.5489/cuaj.9279","url":null,"abstract":"<p><strong>Introduction: </strong>The management of renal stones measuring 2-3 cm remains a clinical challenge, with percutaneous nephrolithotomy (PCNL) traditionally favored over retrograde intrarenal surgery (RIRS) due to higher stone-free rates (SFR); however, advancements in flexible ureteroscopy and the introduction of flexible and navigable suction ureteral access sheaths (FANS-UAS) have expanded the role of RIRS for larger stones. This study compares the efficacy and safety of PCNL vs. FANS-UAS-assisted RIRS for medium-sized renal calculi.</p><p><strong>Methods: </strong>This retrospective study included 116 patients (50 RIRS, 66 PCNL) with 2-3 cm renal stones treated at a single institution. RIRS was performed using an 11/13 Fr FANS-UAS, while PCNL followed standard techniques. Outcomes assessed included operative time, hospitalization, hemoglobin drop, SFR (defined as no fragments ≥1 mm on three-month computed tomography), and complications (Clavien-Dindo).</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups (p>0.05). RIRS demonstrated significantly shorter operative times (63.1±11.3 vs. 97.3±15.1 minutes, p<0.001) and hospitalization (28.3±17.9 vs. 81±24.8 hours, p<0.001), with less hemoglobin drop (0.4±0.5 vs. 2.1±1.7 g/dL, p<0.001). SFRs were similar at three months (70% RIRS vs. 74.2% PCNL, p=0.677). PCNL had higher complication rates, including three grade III events (vs. none in RIRS), although not statistically significant (p=0.277).</p><p><strong>Conclusions: </strong>FANS-UAS-assisted RIRS offers comparable SFRs to PCNL for 2-3 cm stones, with advantages in operative efficiency, hospitalization, and perioperative safety. These findings suggest RIRS as a viable minimally invasive alternative, warranting further randomized trials to validate its role in this setting.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimated blood loss to urine output ratio during partial nephrectomy as a predictor of postoperative acute kidney injury in a hereditary renal cancer-enriched population.","authors":"Lauren Loebach, Ruben Blachman-Braun, Milan H Patel, Braden Millan, Maria Antony, Julie Solomon, Jaskirat Saini, Sandeep Gurram, W Marston Linehan, Mark W Ball","doi":"10.5489/cuaj.9290","DOIUrl":"https://doi.org/10.5489/cuaj.9290","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to assess whether the intraoperative estimated blood loss (EBL) to urine output (UOP) ratio (EBL/UOP) is a predictor of postoperative acute kidney injury (AKI) in a cohort of patients enriched with hereditary renal cancer syndromes undergoing partial nephrectomy (PN).</p><p><strong>Methods: </strong>We performed a retrospective chart review of patients who underwent PN at our institution from January 2006 to October 2024. We recorded and analyzed the clinical, demographic, and intraoperative characteristics of all patients.</p><p><strong>Results: </strong>A total of 1166 PNs (761 patients and 5903 renal tumors) were analyzed, of which 484 (41.5%) developed postoperative AKI. The average EBL/UOP was 1.06 (0.46-2.35) for patients without AKI and increased as AKI worsened, with a ratio of 5.00 (2.34-9.43) in patients with KDIGO AKI grade 3 (p<0.001). EBL/UOP was associated with AKI in all patients (odds ratio [OR] 1.079, p=0.002) and those with bilateral native kidneys (OR 1.083, p=0.003). After adjustment in patients with solitary kidney, no AKI association with EBL/UOP (OR 1.039, p=0.447) was found.</p><p><strong>Conclusions: </strong>EBL/UOP is a novel tool associated with the increased risk of developing post-PN AKI in select patients. In multiplex and repeat PNs, a higher ratio can assist the surgical team in identifying patients at risk of developing AKI. Prospective evaluation involving management strategies based on the EBL/UOP is needed to determine its true utility in clinical practice and generalization in the broader PN population.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The learning styles of graduating Canadian urology residents.","authors":"Nicolas Vanin Moreno, Jasmine Dhatt, Naji J Touma","doi":"10.5489/cuaj.9291","DOIUrl":"https://doi.org/10.5489/cuaj.9291","url":null,"abstract":"<p><strong>Introduction: </strong>The Kolb learning theory attributes differences in the way people learn with the way they perceive and process an experience, leading to uniquely different learning styles. Studied in other surgical disciplines, it has yet to be examined in a urology population. Identifying the learning style of urology residents may help in the development of teaching curricula that are best suited to knowledge and skill acquisition. The objective of this study was to characterize the learning styles of graduating Canadian urology residents attending the Queen's Urology Exam Skill Training (QUEST) examination.</p><p><strong>Methods: </strong>The Kolb Experiential Learning Profile (KELP) 4.0 questionnaire was administered to all graduating Canadian urological residents attending QUEST for the years 2021-24. Project participation was 100%. All participants received a report at the conclusion of the course. Participants' preferred learning phase (acting, thinking, reflecting, experiencing) and a specific learning style (deciding, analyzing, thinking, acting, initiating, balancing, reflecting, experiencing, imagining) were identified for all residents. Preferred learning phase and learning style were compared among years using the Chi-squared test (α=0.05). Preferred learning phase and learning style were compared amongst self-identified gender using the Fisher-Freeman-Halton exact test (α=0.05).</p><p><strong>Results: </strong>Graduates from 2021 (n=35), 2022 (n=29), 2023 (n=37), and 2024 (n=35) were included. In aggregate, the preferred learning phases among urology residents included thinking (38%, n=51), followed closely by acting (32%, n=44). A minority of urology residents preferred the reflecting (21%, n=28) and experiencing phase (10%, n=13). There were no significant differences year to year within an individual learning phase (p>0.05). In aggregate, the most common preferred learning styles included the deciding learning style (21%, n=29), followed by analyzing (15%, n=20), thinking (14%, n=19), acting (13%, n=18), and initiating (13%, n=18). Lesser common learning styles included balancing (11%, n=15), reflecting (7%, n=10), imagining (3%, n=4), and experiencing (2%, n=3). There were no significant differences year to year within an individual learning style (p>0.05). There were no significant differences between self-identified gender and preferred learning phase or style (p>0.05).</p><p><strong>Conclusions: </strong>Graduating Canadian urology residents vary in their preferred learning styles, but the majority seem to learn by acting and thinking. A non-trivial number of learners displayed learning styles under-represented in surgical specialties. This lays the groundwork for future studies correlating learning style to exam performance and identifying predictors of successful completion of residency.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authorship trends in the Campbell-Walsh-Wein Urology textbook: A sign of the times.","authors":"Irene W Su, Johanna Tamoka, Madelaine J Rangel, Gina M Badalato, Christopher Tenggardjaja, Doreen E Chung","doi":"10.5489/cuaj.9233","DOIUrl":"https://doi.org/10.5489/cuaj.9233","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to examine temporal trends in author demographics of the Campbell-Walsh-Wein Urology textbook.</p><p><strong>Methods: </strong>Name, institution, specialty, and faculty rank were extracted for all authors (9^th-12^th editions). A survey was emailed to determine gender. When self-reported data were unavailable, demographics and urologic subspecialty were determined based on name and online biographies. Demographics of academic and practicing urologists were taken from the American Urological Association Census. Chi-squared tests were used for statistical analyses.</p><p><strong>Results: </strong>Across the 9^th-12^th editions, there were 1119 total authors; 597/627 (95.2%) unique authors were emailed (18 deceased; 12 missing emails) and 161 (27.0%) responded. The final cohort included 536 unique contributors after excluding authors who were not attending urologists. The percentage of women authors increased over time, from 3.4% in the 9^th edition to 12.6% in the 12^th edition. The gender distribution of authors in the 11^th and 12^th editions was comparable to the gender distribution of both academic and practicing urologists for the respective years (p>0.05). A greater proportion of men had attained the rank of professor at the time of authorship (50.2% of men vs. 13.5% of women), and female gender was significantly associated with lower academic rank (p<0.001).</p><p><strong>Conclusions: </strong>Women urologists represent a smaller but increasing presence as authors of Campbell-Walsh-Wein Urology, mirroring the demographics of academic and practicing urologists. Women authors tended to hold lower academic ranks than their male counterparts. These findings suggest that efforts to promote diversity in authorship have been successful, but there is still room for growth in academic advancement.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological distress in prostate cancer: Validation of the K10 scale using a crossover randomized clinical trial.","authors":"Wyatt MacNevin, Ryan Lukic, Gabriela Ilie, Ricardo A Rendon, Ross Mason, Andrea Kokorovic, Greg Bailly, Nikhilesh Patil, David Bowes, Robert Rutledge","doi":"10.5489/cuaj.9294","DOIUrl":"https://doi.org/10.5489/cuaj.9294","url":null,"abstract":"<p><strong>Introduction: </strong>Men diagnosed with prostate cancer (PCa) experience substantial psychological distress. Despite this, the use of screening tools in this population is limited and understudied. This study evaluates the validity of the Kessler Psychological Distress Scale (K10) as a psychological distress screening tool in men undergoing curative PCa treatment.</p><p><strong>Methods: </strong>Participants in a PCa psychological distress prevention program (n=128) were assessed at baseline, six months, and 12 months using the K10. Exploratory (EFA) and confirmatory factor analysis (CFA) examined the scale's factor structure. Receiver operating characteristic (ROC) analyses evaluated sensitivity, specificity, and predictive values for depression and anxiety. Logistic regression assessed the impact of cutoffs on clinical psychological distress.</p><p><strong>Results: </strong>EFA identified a single-factor structure (factor loadings: 0.59-0.96, variance explained: 76%). CFA confirmed model-fit (CFI=0.905; SRMR=0.042). ROC analysis demonstrated excellent predictive ability (area under the curve [AUC] 0.98, 95% confidence interval [CI] 0.95-1.0 for depression; 0.92, 95% CI 0.86-0.98 for anxiety). Youden's index suggested K10 thresholds of ≥17.5 (depression) and ≥16.5 (anxiety), although these cutoffs lacked sensitivity. With standard K10≥20 cutoffs, significant differences were observed between intervention and control groups at six months (adjusted odds ratio [aOR] 3.59, 95% CI 1.12-11.51, p=0.031) and 12 months (aOR 4.41, 95% CI 1.35-4.41, p=0.014), consistent with prior findings.</p><p><strong>Conclusions: </strong>The K10 is valid and reliable for this population, demonstrating excellent internal consistency; however, lower cutoffs (K10≥16.5, K10≥17.5) may reduce sensitivity. The standard K10≥20 threshold remains preferable for detecting distress and evaluating intervention effects in men with PCa.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal pelvis urine density as a predictor of infectious complications after semi-rigid ureterorenoscopy for ureteral stone treatment.","authors":"Oguzhan Yildiz, Ufuk Caglar, Huseyin Burak Yazili, Muhammed Rasit Tutal, Arda Meric, Omer Sarilar, Faruk Ozgor","doi":"10.5489/cuaj.9273","DOIUrl":"https://doi.org/10.5489/cuaj.9273","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to investigate whether renal pelvis urine density (RPUD) serves as a reliable predictor of postoperative infectious complications in patients undergoing semi-rigid ureterorenoscopy (URS) for ureteral stone treatment.</p><p><strong>Methods: </strong>We retrospectively reviewed 1104 patients who underwent semi-rigid URS for ureteral stones. Patients were divided into two groups based on whether they developed postoperative infections within one month (n=64) or not (n=1040). Demographic variables (age, sex, body mass index), comorbidities, stone characteristics (location, size, density), and operative parameters (operation time, stent/catheter placement) were recorded. Renal pelvis urine density was measured in Hounsfield units on preoperative imaging.</p><p><strong>Results: </strong>Of the 1104 patients, 64 (5.8%) developed postoperative infections. The median RPUD was significantly higher in the infectious group (10 [5-17] HU) compared to the non-infectious group (4 [2-6] HU; p=0.001). On multivariate analysis, sex (odds ratio [OR] 4.001, 95% confidence interval [CI] 2.231-7.174, p=0.001), body mass index (OR 0.920, 95% CI 0.860-0.984, p=0.015), operation time (OR 0.963, 95% CI 0.932-0.996, p=0.028), and RPUD (OR 0.809, 95% CI 0.771-0.849, p=0.001) were independent predictors of postoperative infection. The area under the curve was 0.784 (p<0.001, 95% CI 0.711-0.857), demonstrating good discriminative ability. When a cutoff value of 6.35 was applied, the sensitivity and specificity were 71.9% and 76.9%, respectively, for predicting postoperative infections.</p><p><strong>Conclusions: </strong>Higher RPUD is significantly associated with an increased risk of infectious complications following semi-rigid URS for ureteral stones. Incorporating RPUD into preoperative assessments may help identify high-risk patients and optimize perioperative management to reduce infection-related morbidity.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}