Cuaj-Canadian Urological Association Journal最新文献

{"title":"Complications and blood loss after invasive treatments for small renal masses A systematic review.","authors":"Maryam Kandi, Patrick O Richard, Philippe D Violette, Ashwini Sreekanta, Steven Hanna, Rachel Couban, Julian Daza, Russell Leong, Haseeb Faisal, Divyalakshmi Tamilselvan, Jeremy Steen, Wang-Choi Tang, Jaswinder Singh, Gordon Guyatt","doi":"10.5489/cuaj.8970","DOIUrl":"10.5489/cuaj.8970","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review and meta-analysis provides estimates of major complications and estimated blood loss (EBL) for open partial nephrectomy (OPN), conventional laparoscopic partial nephrectomy (LPN), and robot-assisted partial nephrectomy (RAPN). Additionally, it outlines the incidence of major complications associated with percutaneous thermal ablation (TA) in patients with small renal masses (SRMs).</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, and CINAHL from inception to the end of July 2023. We supplemented the electronic search with a hand search of the references in the included studies and suggestions from two content experts. We used random effect meta-analysis to obtain pooled estimates of major complications and EBL. We used the QUIPS tool for risk of bias assessment and applied a prognosis approach to rate the quality of evidence using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework.</p><p><strong>Results: </strong>We included 65 eligible studies that provided pooled estimates of major complications after OPN of 5.4% (95% confidence interval [CI] 2.9-9.9); after conventional LPN of 4.7% (95% CI 2.6-8.3); after RAPN of 2.9% (95% CI 2.2-3.7); and after TA of 2.5% (95% CI 1.7-3.6). Pooled estimates demonstrating mean EBL of 262 ml (95% CI 200-324) for OPN; 224 ml (95% CI 193-254) for conventional LPN; and 163 ml (95% CI 136-190) for RAPN.</p><p><strong>Conclusions: </strong>This review provides the best available estimates of major complications and mean EBL after partial nephrectomy in patients with SRMs.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"136-144"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"This is a busy slide: Fix your presentations this year.","authors":"Michael Leveridge","doi":"10.5489/cuaj.9199","DOIUrl":"10.5489/cuaj.9199","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"19 4","pages":"78-79"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted partial nephrectomy using the Hugo^TM robotic-assisted surgery platform Initial experience and insights.","authors":"Adam Bobrowski, William Wu, Chelsea Angeles, Simon Czajkowski, Jason Y Lee","doi":"10.5489/cuaj.8951","DOIUrl":"10.5489/cuaj.8951","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic-assisted surgery (RAS) is a vital modality in the armamentarium of minimally invasive surgeons. The Hugo™ RAS system (Medtronic^®) is one of the newest platforms on the market and has little surgical outcomes data. Herein, we describe our early experience performing robotic-assisted partial nephrectomy (RAPNx) with the Hugo™ RAS platform.</p><p><strong>Methods: </strong>We conducted a retrospective review of patients who underwent a RAPNx with the Hugo™ RAS platform between April and December 2023 at the University Health Network in Toronto, ON. One surgeon performed all procedures using a three-arm transperitoneal approach. Anesthetic, operative, and pathologic reports were assessed to collect pre-, intra- and postoperative variables.</p><p><strong>Results: </strong>Eleven patients were included. The mean age was 51 years, 45.0% were female, and 63.6% had a right-sided mass. Mean tumor size was 2.9 cm. Mean warm ischemia time was 18.9 minutes (standard deviation [SD] 7.12) and mean estimated blood loss was 179 ml (SD 63.6). Mean robot docking time was 232 seconds (SD 106.5), mean total console time was 93 minutes (SD 21.4), and mean total operative time was 165.6 minutes (SD 34.1). There were no intraoperative complications. On pathology review, most tumors were a clear-cell variant (72.7%) and staged pT1a (81.8%). All margins were negative. One patient sustained a port site infection.</p><p><strong>Conclusions: </strong>This is the first North American case series using the Hugo™ RAS platform for RAPNx. Our findings underscore that the platform is safe and effective for performing RAPNx with comparable outcomes to other robotic platforms.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"110-115"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Update on the state of urology in Canada Results of the 2024 Canadian Urological Association membership survey.","authors":"Hassan Razvi, Troy Sitland, Fred Saad","doi":"10.5489/cuaj.9185","DOIUrl":"10.5489/cuaj.9185","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"19 4","pages":"84-89"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sperm retrieval, fertilization rates, and clinical outcomes of infertile men with Y chromosome microdeletion A retrospective cohort study.","authors":"Jenna Baffa, Gilad Karavani, Bader Akroof, Mohamed S Kattan, Susan Lau, Keith Jarvi","doi":"10.5489/cuaj.8879","DOIUrl":"10.5489/cuaj.8879","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to explore whether a Y chromosome microdeletion (YCM) confers adverse effects on surgical sperm retrieval potential and intracytoplasmic sperm injection (ICSI) outcomes in men with azoospermia and severe oligospermia.</p><p><strong>Methods: </strong>This was a retrospective cohort study that included infertile men with azoospermia or severe oligospermia who were evaluated for karyotype analysis and YCM testing at a university-affiliated hospital between 2010 and 2022. Outcomes of microdissection testicular sperm extraction (mTESE) for surgical sperm retrieval were compared between men diagnosed with YCM and the control group, in which no YCM was found. Additionally, patients from each group who underwent in vitro fertilization (IVF)-ICSI cycle using ejaculated sperm or surgically retrieved mature spermatozoa were compared regarding their IVF-ICSI cycle outcomes, fertilization rates, cleavage, and blastocyst formation, and clinical pregnancy rates.</p><p><strong>Results: </strong>A total of 116 azoospermic and oligospermic men who underwent YCM testing were included in the study: 19 with YCM and 97 without. Overall, nine mTESE procedures were performed for patients with YCM and 38 for men from the control group. There were no significant differences between the YCM and control groups in mature sperm retrieval rates (11.1% vs. 26.3%, p=0.663), although a trend towards higher rates of elongated and round spermatids as the most mature germ cell was noted in the YCM group (66.7% vs. 28.9%, p=0.054). Of the 13 men with mature sperm - either ejaculated or surgically retrieved (mTESE) - that had known ICSI cycle outcomes, three men had proven YCMs and 10 controls had no identified YCMs. Basic characteristics were similar between the groups, except for testosterone levels, which were higher in the YCM group (23.0±13.1 vs. 9.4±6.4 nmol/L, p=0.027). Fertilization rates and cleavage rates were similar between the YCM and control groups (42.3% vs. 49.7% and 42.3% vs. 39.3%, p=0.491 and 0.774, respectively). Blastocyst formation rates, and pregnancy rates, while not statistically significant, showed a trend for favorable outcomes in the control group compared to the YCM group (24.1% vs. 7.7%, 72.7% vs. 20.0%, p=0.078 and 0.106, respectively).</p><p><strong>Conclusions: </strong>YCM does not affect sperm retrieval rates. Fertilization and cleavage rates are not impaired by microdeletions, while blastocyst formation rates and clinical pregnancy rates per embryo transfer follow a non-significant trend for unfavorable outcomes in the YCM group. Clinical and embryonic development results should be interpreted with caution, as these groups are relatively small.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"116-122"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cases - Renal cell carcinoma with remote testicular metastases.","authors":"Karim Sidhom, Michael Morra, Natasha Kuzyk, Saman Kalikias, Hanbo Zhang, Jasmir Nayak, Ardalan E Ahmad","doi":"10.5489/cuaj.9047","DOIUrl":"https://doi.org/10.5489/cuaj.9047","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674997","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":"Limitations of ultrasound compared with computed tomography for kidney stone surveillance.","authors":"Ryan Sun, Elijah Sommer, Calyani Ganesan, Alan C Pao, Joseph Liao, John Leppert, Helena Chang, Simon Conti, Timothy Chang","doi":"10.5489/cuaj.9043","DOIUrl":"https://doi.org/10.5489/cuaj.9043","url":null,"abstract":"<p><strong>Introduction: </strong>Renal ultrasound (US) offers less radiation exposure than computed tomography (CT) for kidney stone surveillance but has lower sensitivity and specificity for nephrolithiasis diagnosis. Additionally, US may overestimate stone size, leading to unnecessary surgical interventions. Evidence on US performance for kidney stone surveillance is variable, making its clinical utility unclear. We aimed to assess US accuracy against CT and identify factors influencing US performance.</p><p><strong>Methods: </strong>We performed a retrospective review of patients with known nephrolithiasis seen in urology clinic at Stanford who underwent both renal US and CT within 90 days for surveillance from January to December 2022. Patients with spontaneous stone passage or interventions were excluded. Stone characteristics were recorded, and statistical analysis compared the diagnostic accuracy of US and CT.</p><p><strong>Results: </strong>A total of 107 patients and 128 stones were included, with a mean time difference of 25.7 days between US and CT. US sensitivity was 77%, with a positive predictive value (PPV) of 75% for stone detection. The PPV was only 59% for stones >4 mm by CT. Mean stone size was 8.7 mm on US vs. 5.5 mm on CT (p=0.02), with more pronounced overestimation in smaller stones and higher body mass index (BMI) (p<0.05). No significant differences in US performance were found by stone location, laterality, or time between scans. Differences in stone detection (p=0.01) and size (p=0.03) were associated with the individual performing the ultrasound.</p><p><strong>Conclusions: </strong>US performance is limited compared to CT and is influenced by stone size, BMI, and sonographer. Overestimation by US may lead to unnecessary interventions in up to 40% of patients with stones >4 mm.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675002","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":"Open, laparoscopic, and robotic radical nephroureterectomy for upper tract urothelial carcinoma: Comparing outcomes and the tetrafecta as a composite marker of surgery quality.","authors":"Maxwell Sandberg, Parth Udayan Thakker, Rory Ritts, Megan Escott, Mary Namugosa, Adam Cohen, Stephen Tranchina, Kimberly Waggener, Madeline Snipes, XiXi Yi, Justin Refugia, Gregory Russell, Timothy O'Rourke, Ashok Kumar Hemal","doi":"10.5489/cuaj.9039","DOIUrl":"https://doi.org/10.5489/cuaj.9039","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this study was to compare surgical outcomes and costs between robotic radical nephroureterectomy (RNU), laparoscopic radical nephroureterectomy (LNU), and open radical nephroureterectomy (ONU), and to assess the relevance of the tetrafecta as a composite outcome on survival parameters after nephroureterectomy (NU).</p><p><strong>Methods: </strong>Operative and oncologic followup data was retrospectively collected on patients who underwent NU from 2006-2022 at our institution. The tetrafecta was defined as a true bladder cuff, lymph node dissection, negative surgical margins, and no postoperative complications. Cox proportional hazards regression was used to assess the impact of surgical approach on survival outcomes.</p><p><strong>Results: </strong>A total of 248 patients were included in the analysis (145 RNU, 61 LNU, and 42 ONU). The complication rate differed by approach and was lowest in RNU (p<0.01). Cancer-specific survival (CSS) differed between ONU and RNU patients, with ONU patients 2.51 times as likely to die from their cancer. Retroperitoneal recurrence-free survival (RPFS) differed between ONU and RNU patients, with ONU patients 7.22 times more likely to experience a retroperitoneal recurrence (p=0.0013). Variable surgical costs were lower in LNU compared to ONU (p=0.028) and direct inpatient hospital cost was lowest with RNU (p<0.01). Eighty-one patients met criteria for the tetrafecta. RNU patients were more likely to achieve the tetrafecta compared to LNU (p<0.01) and ONU (p<0.01) patients. No differences in survival parameters existed between patients who did and did not achieve the tetrafecta.</p><p><strong>Conclusions: </strong>Most oncologic outcomes after NU do not differ by approach on long-term followup; however, CSS and RPFS appear to differ between RNU and ONU. ONU has traditionally been considered the approach with the lowest cost; however, our analysis demonstrates both RNU and LNU require lower costs than ONU, depending on the cost parameter analyzed. Among all approaches, the tetrafecta is best achieved with RNU.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675005","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 - Recurrent ureteral inguinal herniation: A rare presentation of post-kidney transplant anuria and acute kidney injury.","authors":"Wyatt MacNevin, Liam Power, Laura Harkness, Juan Santiago Rubio, Nicholas R Paterson, Thomas B McGregor","doi":"10.5489/cuaj.9090","DOIUrl":"https://doi.org/10.5489/cuaj.9090","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674992","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":"Assessing Canadian medical students' confidence in undergraduate urologic training and preferences for teaching methods.","authors":"Othmane Zekraoui, Sepehr Niakani, Mahmoud Moustafa, Mohamad Baker Berjaoui, Abbas Guennoun, Dean Elterman, Bilal Chughtai, David-Dan Nguyen, David Bouhadana, Naeem Bhojani","doi":"10.5489/cuaj.9018","DOIUrl":"https://doi.org/10.5489/cuaj.9018","url":null,"abstract":"<p><strong>Introduction: </strong>Given the aging population, urologic conditions are increasingly prevalent in primary care, necessitating well-prepared medical graduates to recognize and manage essential complaints. This study assessed medical students' confidence in managing common urologic conditions, identified preferred teaching methods, and examined the role of the Canadian Undergraduate Urological Curriculum (CanUUC) in their education.</p><p><strong>Methods: </strong>A survey was distributed to third- and fourth-year Canadian medical students, assessing their self-confidence in history taking, diagnosis, management planning, and physical examination for 12 urologic conditions. The survey also explored preferred teaching methods and awareness of the CanUUC. Statistical analysis included ANOVA and t-tests to determine significant differences in confidence across various factors.</p><p><strong>Results: </strong>A total of 117 medical students and 10 first-year urology residents responded. Students felt equally confident about taking histories (3.51±1.19), proposing diagnoses (3.38±1.19), and performing physical examinations (3.58±1.16) while demonstrating lower confidence (p<0.001) for management planning (3.16±1.25). Confidence was highest for urinary tract infections and lowest for male infertility. Furthermore, students who completed urology rotations reported higher confidence in history taking (3.67±0.69, p=0.003) and management planning (3.35±0.66, p=0.003). Direct clinical exposure, simulations, and case-based discussions were the preferred learning methods. Only seven (6%) students were aware of CanUUC, with five (4.3%) using it.</p><p><strong>Conclusions: </strong>Medical students have moderate confidence in handling urologic conditions, with higher comfort among those who completed urology rotations. Implementing targeted curriculum enhancements and integrating resources like the CanUUC could address these educational gaps and lead to improved patient outcomes.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674979","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}