Cuaj-Canadian Urological Association Journal最新文献

{"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":"https://doi.org/10.5489/cuaj.8879","url":null,"abstract":"<p><strong>Introduction: </strong>In this study, 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, which 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 were 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 Y chromosome microdeletion testing were included in the study: 19 men with YCM and 97 controls without YCM. Overall, nine mTESE procedures were performed for patients with YCM and 38 mTESE procedures were done on 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), though a trend towards higher rates of findings 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). Out 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>Y chromosome microdeletion 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":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative outcomes of adrenal surgery: Does surgical specialty matter?","authors":"Basil Ahmad, Duva Karunakaran, Naji J Touma","doi":"10.5489/cuaj.7852","DOIUrl":"https://doi.org/10.5489/cuaj.7852","url":null,"abstract":"<p><strong>Introduction: </strong>Management of adrenal disease requires a multidisciplinary approach often involving varied specialists. Surgical management has often overlapped between general surgeons, usually with an interest in surgical endocrinology, or urologists with minimally invasive surgical skills. The objectives of this study were to define perioperative outcomes of contemporary Canadian adrenal surgery, and determine whether those outcomes are impacted by surgical subspecialty. As a secondary outcome, an assessment of the variability in the indications for adrenal surgery was carried out between the two surgical subspecialties.</p><p><strong>Methods: </strong>A retrospective chart review of all adrenalectomies performed at our center from August 2013 to August 2023 was conducted. The only exclusion criterion was when an adrenalectomy was performed secondary to the main procedure. Data was collected and grouped under four categories: patient characteristics, indications for an adrenalectomy, procedural statistics, and perioperative patient outcomes.</p><p><strong>Results: </strong>A total of 121 adrenalectomies were performed in a period of just over 10 years. Of these, 103 were included in the analysis. Thirty-seven were performed by general surgery, whereas 66 were performed by urology. There were no significant differences in patients' age and Charlson comorbidity score between the two surgical specialties. The indications for the adrenalectomy were similar between the specialties, and were as follows: 32 (31.1%) for pheochromocytoma, 24 (23.3%) for a cortical functional lesion, 19 (18.4%) for a metastatectomy, 16 (15.5%) for size or growth, and 10 (9.7%) for adrenocortical carcinoma. There were no differences in overall operating room time or type of procedure. Most (89.3%) of the procedures were performed laparoscopically. Patients that were operated on by general surgeons were more likely to be readmitted within 30 days than those operated on by urologists (five patients [13.5%] vs. one patient [1.5%], respectively, p=0.04), and more likely to require intensive care unit (ICU)/stepdown ICU admission (19 patients [51.4%] vs. 19 [28.8%], respectively, p=0.04). There was no difference in length of stay or postoperative complications. There was, however, one Clavien-Dindo 5 complication after a procedure performed by general surgery.</p><p><strong>Conclusions: </strong>Most adrenalectomies at this one Canadian center are performed by urology. Indications for adrenalectomy are similar between the specialties. Although postoperative complication rates are similar, rates of 30-day readmission and ICU/stepdown admission were decreased when urologists performed adrenalectomies. Adrenalectomies may be performed safely by either specialty, and factors such as local expertise and surgical volumes are likely important.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808532","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":"Addressing an urgent treatment gap in advanced prostate cancer.","authors":"Ricardo A Rendon","doi":"10.5489/cuaj.9053","DOIUrl":"10.5489/cuaj.9053","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"18 12","pages":"373"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787287","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":"Association des Urologues du Québec Congrès Annuel 2024 - Résumés Session scientifique IVendredi 8 novembre 2024 • Friday, November 8, 2024.","authors":"","doi":"10.5489/cuaj.9081","DOIUrl":"10.5489/cuaj.9081","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"18 12_Suppl_4","pages":"S231-S235"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787556","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":"The safety and efficacy of ambulatory urologic surgery A paradigm shift towards optimizing resource use in outpatient settings.","authors":"Dhiraj S Bal, David Chung, Harliv Dhillon, Maximilian Fidel, Jainik Shah, Alagarsamy Pandian, Jasmir G Nayak, Premal Patel","doi":"10.5489/cuaj.8806","DOIUrl":"10.5489/cuaj.8806","url":null,"abstract":"<p><strong>Introduction: </strong>Amid substantial surgical wait lists, novel methods are needed to improve the delivery of surgical care in Canada. One strategy involves shifting select surgeries from hospitals into community ambulatory centers, which expedite procedures and allow hospitals to prioritize critical and complex patients. We sought to evaluate surgical outcomes at a novel, Canadian urologic clinic and surgical center.</p><p><strong>Methods: </strong>A retrospective study was conducted at a novel, accredited surgical facility and outpatient ambulatory clinic from August 2022 to August 2023. Procedures ranged from scrotal and transurethral surgeries to inflatable penile prosthesis insertion. Traditional outpatient procedures, including vasectomy and cystoscopy, were excluded. All patients were discharged the same day and seen 4-6 weeks post-procedure. Variables of interest included surgery type, anesthesia administered, additional clinic appointments, unplanned family physician appointments, visits to the emergency department (ED), and hospital admissions.</p><p><strong>Results: </strong>In a 12-month period, 519 surgeries were performed. The mean patient age was 49.6±17.3 years, with most classified as American Society of Anesthesiologists (ASA) 1-2 (88.8%). Most (95.8%, n=497) patients did not require medical care outside the clinic before their scheduled followup; 2.5% (n=13) visited the ED presenting for wound concerns, postoperative pain, query infection, or catheter-related concerns. Only 1.7% (n=9) required an unscheduled appointment with their family physician, with concerns being inadequate postoperative pain management (n=4) or suspected infection (n=4). No patient required hospital admission.</p><p><strong>Conclusions: </strong>Many urologic surgeries classically performed in hospital operating rooms can be safely performed in a non-hospital, outpatient surgical facility with preservation of good outcomes. This strategy can potentially improve the efficiency of urologic healthcare delivery in select patients.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"393-397"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735605","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":"Establishing maximal wait times for urologic surgery in Canada in 2024.","authors":"Hassan Razvi, Troy Sitland, Fred Saad","doi":"10.5489/cuaj.9029","DOIUrl":"10.5489/cuaj.9029","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"18 12","pages":"376-378"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787522","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":"Upping the ante (with machine-learning) for patients with UTUC.","authors":"Kristen McAlpine","doi":"10.5489/cuaj.9052","DOIUrl":"10.5489/cuaj.9052","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"18 12","pages":"419"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787528","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":"2024 CUA-GUMOC Expert Report: Management of unresectable locally advanced and metastatic urothelial carcinoma.","authors":"Carlos E Stecca, Deepro Chowdhury, Normand Blais, Nimira Alimohamed, Lori Wood, Christina M Canil, Bernie Eigl, Girish S Kulkarni, Peter C Black, Wassim Kassouf, Peter Chung, Scott North, Di Maria Jiang, Srikala S Sridhar","doi":"10.5489/cuaj.8946","DOIUrl":"10.5489/cuaj.8946","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"18 12","pages":"379-390"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787015","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":"Communication breakdown or clashing models?","authors":"Michael Leveridge","doi":"10.5489/cuaj.9061","DOIUrl":"10.5489/cuaj.9061","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"18 12","pages":"367-368"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787500","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":"Ambulatory urologic surgery A paradigm shift towards optimizing resource use in outpatient settings.","authors":"Joseph Moryousef, Udi Blankstein","doi":"10.5489/cuaj.9050","DOIUrl":"10.5489/cuaj.9050","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"18 12","pages":"398"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787266","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}