Cuaj-Canadian Urological Association Journal最新文献

{"title":"Retiring trends: The role of artificial intelligence in mitigating the urologist shortage in Canada.","authors":"Asmaa Ismail, Osama Zaytoun, Ahmed Kotb","doi":"10.5489/cuaj.9065","DOIUrl":"https://doi.org/10.5489/cuaj.9065","url":null,"abstract":"<p><p>The aging urologist workforce in Canada is becoming an urgent issue, as a growing number of specialists are approaching retirement. This phenomenon is mirrored across the globe, particularly in the United States and other developed countries. A shortage of urologists threatens patient care, especially in rural and underserved areas, where access is already limited. This review explores the factors driving urologist retirement in Canada and discusses how emerging technologies like artificial intelligence could help manage workforce challenges.</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":"143675010","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":"Can preoperative vitamin D level be a predictive factor for continence after radical prostatectomy?","authors":"Emre Şam, Emrullah Söğütdelen, Fatih Akkaş, Kamil Gökhan Şeker, Deniz Noyan Özlü, Ekrem Güner","doi":"10.5489/cuaj.8999","DOIUrl":"https://doi.org/10.5489/cuaj.8999","url":null,"abstract":"<p><strong>Introduction: </strong>This study examined whether there is a relationship between vitamin D levels and post-prostatectomy incontinence (PPI).</p><p><strong>Methods: </strong>Patients who underwent robotic radical prostatectomy in a tertiary center constituted the population of this study. Patients whose serum vitamin D levels were measured three months before robotic radical prostatectomy were included. Continence status was recorded at one, three, six, and 12 months postoperatively. Urinary continence was defined as either no urine leak or using a pad to feel secure against potential minimal leakage. Patients were divided into groups according to continence status at the 12^th postoperative month (group 1: continent patients, group 2: PPI patients). Groups were compared in terms of patient characteristics, previously known PPI risk factors, and serum vitamin D levels.</p><p><strong>Results: </strong>The entire study cohort consisted of 318 patients. The rate of PPI was 14.5%. Since mean age, body mass index, and prostate volume were significantly higher in group 2 than in group 1, propensity score matching was applied. Before and after propensity score matching, serum vitamin D levels were higher in group 1 than in group 2 at the 12^th postoperative month but no statistically significant difference was observed; however, after propensity score matching, serum vitamin D levels were significantly higher in continent patients than in incontinent patients at one, three, and six months postoperatively.</p><p><strong>Conclusions: </strong>Serum vitamin D may be an essential marker in regaining continence in the early period after radical prostatectomy.</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":"143674986","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":"Understanding the hospital safety net: Hospital resource limitations impact prostate cancer treatment beyond socioeconomic disparities.","authors":"Raj R Bhanvadia, Rohit R Badia, Fady J Baky, Jennifer W Tse, Yair Lotan, Solomon L Woldu, Vitaly Margulis","doi":"10.5489/cuaj.9038","DOIUrl":"https://doi.org/10.5489/cuaj.9038","url":null,"abstract":"<p><strong>Introduction: </strong>Safety net hospitals (SNHs) care for a substantial population of vulnerable patients and are often resource-limited. These limitations may impact treatment decisions for high-risk prostate cancer (hPCa). We performed the first population-based analysis examining SNH status and treatment decisions for localized hPCa.</p><p><strong>Methods: </strong>National cancer database (NCDB) was queried from 2010-2016 for patients with non-metastatic hPCa. SNH status was defined as hospitals with the 95^th percentile of Medicaid and uninsured caseload. Non-curative intent treatment was defined as androgen deprivation monotherapy (ADT) or no treatment. Outcomes assessed were treatment choice and overall survival (OS) by SNH status.</p><p><strong>Results: </strong>A total of 95 747 patients with hPCa were included; 112 hospitals were identified as SNHs with mean Medicaid/uninsured caseload of 24.4% compared to 3.2% at non-SNHs (p<0.01). Patients at SNHs were independently associated with greater odds of non-curative intent treatment (odds ratio [OR] 2.2, p<0.01). Results were consistent across subgroups: private insurance (OR 2.2, p<0.01), age <65 (OR 2.3, p<0.01), and at academic centers (OR 1.9, p<0.01). There was no difference in OS among SNHs and non-SNHs when patients received curative treatment. Among patients who did not receive curative treatment, OS was greater at SNHs (hazard ratio 0.82, p=0.02).</p><p><strong>Conclusions: </strong>Patients at SNHs were more likely to receive non-curative treatment independent of known socioeconomic risk factors. Private insurance or treatment at academic centers did not mitigate these disparities. Increased resources may be needed at SNHs, especially in the context of healthcare expansion, which may further strain these facilities.</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":"143675015","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":"Repair of rectourethral fistulas with transperineal buccal mucosa: Our experience.","authors":"Yunus Çolakoğlu, Ali Ayten, Deniz Noyan Özlü, Emre Şam, Abdülmuttalip Şimşek","doi":"10.5489/cuaj.8962","DOIUrl":"https://doi.org/10.5489/cuaj.8962","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous closure of rectourethral fistulas (RUF), often seen after radical prostatectomy (RP), is rare, and most cases require surgical repair. In recent years, the perineal approach has become the most preferred technique. This study aimed to retrospectively present the surgical and functional results of transperineal buccal mucosal graft repair of RUFs developed after RP.</p><p><strong>Methods: </strong>Twenty-four patients who developed RUF secondary to RP between January 2016 and May 2023 were included in the study. Our study excluded patients who had previous unsuccessful fistula treatment and received radiotherapy (RT). Transperineal RUF repair was performed with buccal mucosa graft in all patients and patient data were evaluated retrospectively.</p><p><strong>Results: </strong>The mean surgery time was 15.3 (10-22) months after RP. The mean operation time was 110 minutes. The mean hospital stay was seven days. In 22 (91.6%) patients, the suprapubic catheter was removed in the third week. The mean followup period was 28 (4-76) months. The procedure was successful in all patients. No recurrence was observed in any patient during followup. The postoperative satisfaction of the patients was 100%.</p><p><strong>Conclusions: </strong>Repair of RUFs secondary to RP with transperineal buccal mucosa is a surgical technique with a low complication and high success rates. This technique can be a good alternative to interposition procedures in non-complex fistulas.</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":"143675007","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":"Advocating for patients with urinary retention and lower urinary tract obstruction regardless of etiology \"Establishing maximal wait times for urologic surgery in Canada in 2024\" (Can Urol Assoc J 2024;18:376-8).","authors":"Keith Rourke, Nathan Hoy, Walid Shahrour, Garson Chan, Blayne Welk, R Christopher Doiron, Daniel Liberman, Elizabeth Naud, Alex Kavanaugh, Melanie Aubé-Peterkin, Cora Fogaing, Annie Imbeault, Sarah Neu, Conrad Maciejewski, Greg Bailly, Matthew Andrews, Richard Baverstock","doi":"10.5489/cuaj.9138","DOIUrl":"10.5489/cuaj.9138","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"19 3","pages":"E125-E126"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558722","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":"Erratum - Title change for MIBC Guideline.","authors":"","doi":"10.5489/cuaj.9167","DOIUrl":"10.5489/cuaj.9167","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"19 3","pages":"E128"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558724","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 effects of pretreatment oral hydration on extracorporeal shockwave lithotripsy outcomes A randomized controlled trial.","authors":"Phornphen Prasanchaimontri, Patcharin Somboon","doi":"10.5489/cuaj.8877","DOIUrl":"10.5489/cuaj.8877","url":null,"abstract":"<p><strong>Introduction: </strong>We sought to investigate the effects of pretreatment oral hydration on the outcomes of extracorporeal shockwave lithotripsy (ESWL).</p><p><strong>Methods: </strong>Patients who underwent ESWL for a single, radio-opaque, renal or proximal ureteric calculus ≤2 cm in size were randomized into two groups. The oral hydration group (OHG) was administered 600 ml of water before ESWL, while the control group (CG) was not. The urine was held during ESWL to create a full bladder-induced hydronephrosis. Both groups received the same ESWL protocol at four-week intervals and a maximum of three sessions. The primary outcome was stone-free rate (SFR) at 12 weeks and the secondary outcomes were the total number of shockwaves and the number of ESWL sessions.</p><p><strong>Results: </strong>A total of 154 patients completed the study - 77 patients in each group; both groups were comparable in demographic data and stone characteristics. The SFR was 84.4% in the OHG and 68.8% in the CG group (p=0.036). Stone fragmentation in the OHG was significantly higher than in the CG at 75.3% vs. 58.4% (p=0.040). The OHG had more cases of artificial hydronephrosis (55.8% vs. 27.3%, p=0.001) and higher urine volume (375 [148] ml vs. 230 [110] ml, p<0.001). There were no statistically significant differences in the total number of shockwaves and the number of ESWL sessions. The auxiliary procedures in the OHG were less than in the CG (15.6% vs. 31.2%, p=0.049).</p><p><strong>Conclusions: </strong>Pretreatment oral hydration, together with holding urine during ESWL, has increased stone disintegration and SFR. This simple and safe technique improves the ESWL outcomes.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E98-E103"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631339","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":"Case - Ureteric entrapment following oblique lateral interbody fusion.","authors":"Arushi Wadhwa, Ailsa May Li Gan, Humberto Vigil","doi":"10.5489/cuaj.8948","DOIUrl":"10.5489/cuaj.8948","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E122-E124"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631051","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":"Subureteric injection for the treatment of vesicoureteral reflux in transplant kidneys.","authors":"M İrfan Dönmez, M Fırat Özervarlı, Erdem Özatman, İsmail Selvi, Tayfun Oktar, Orhan Ziylan, Tzevat Tefik, Öner Şanlı, Taner Koçak, Aydın Türkmen, Ayşe Serra Artan, İsmet Nane","doi":"10.5489/cuaj.8787","DOIUrl":"10.5489/cuaj.8787","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment of de novo vesicoureteral reflux (VUR) into the transplanted kidney constitutes a clinical challenge. Herein, we present our data on patients who underwent endoscopic subureteric injection for the treatment of VUR following renal transplantation (RT) in our center.</p><p><strong>Methods: </strong>The patients who underwent endoscopic subureteric injection for VUR into the transplanted kidney after RT in our department between 2008 and 2023 were reviewed retrospectively. Indication for subureteric injection, age, gender, laterality, number of injections, amount of material used, renal failure etiology, auxiliary procedures, and treatment success were noted. All interventions were performed by pediatric urologists who also perform RT.</p><p><strong>Results: </strong>During a median followup of 27.5 months (4-160), 22 patients (17 women, 77.2%) and 23 transplanted ureters (13 right, eight left, one bilateral) were treated with subureteric injections. In all patients, the indications for subureteric injection were recurrent febrile urinary tract infection (UTI), and the grades of VUR varied between 1-4. Patients received a median of 1.65 cc (0.7-2.7) dextranomer-hyaluronic acid copolymer. In total, 10 RTs (eight from living donors, two from cadaveric donors) were performed in another center, whereas 13 RTs were carried out in our center (eight from cadaveric donors and five from living donors). Among the patients who were transplanted in our center, the rate of subureteric injections due to de novo symptomatic VUR after RT was 2.2% (13/593 patients). After subureteric injections, five patients required a second injection due to the recurrence of VUR. Ureteroureterostomy (to the native ureter) was performed in two patients who had further UTIs after the second endoscopic treatment. Eventually, 19/21 patients (90.4%) benefited clinically from the endoscopic treatment and none of the patients underwent re-do ureteroneocystostomy. It is noteworthy that the etiology of renal failure was VUR nephropathy in seven (31.8%) patients.</p><p><strong>Conclusions: </strong>Subureteric injection provides a high clinical success for the treatment of de novo VUR after RT.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E92-E97"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631323","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":"Predicting cancer detection rates from multiparametric prostate MRI Beyond the PI-RADS classification system.","authors":"Agustin Perez-Londono, Francisco Ramos, Aaron Fleishman, Sumedh Kaul, Ruslan Korets, Michael Johnson, Aria F Olumi, Leo Tsai, Boris Gershman","doi":"10.5489/cuaj.8902","DOIUrl":"10.5489/cuaj.8902","url":null,"abstract":"<p><strong>Introduction: </strong>Although the Prostate Imaging-Reporting and Data System (PI-RADS) categorization represents the standard method for assessing the risk of prostate cancer using prostate magnetic resonance imaging (MRI), there exists wide variation in cancer detection rates (CDRs) in real-world practice. We therefore evaluated the association of clinical and radiographic features with CDRs and developed a predictive model to improve clinical management.</p><p><strong>Methods: </strong>We identified men aged 18-89 years with elevated prostate-specfic antigen (PSA) or on active surveillance for prostate cancer who underwent MRI-ultrasound (US) fusion biopsy or in-bore MRI-targeted biopsy. The associations of features with the per-lesion CDR (Gleason 6-10) and clinically significant (cs) CDR (Gleason 7-10) were examined using logistic regression, and results were operationalized into a predictive model.</p><p><strong>Results: </strong>Targeted biopsy was performed for 347 lesions in 281 patients. Overall, the CDR was 49.0% and the csCDR was 28.0%. On multivariable analysis, increasing PI-RADS category, smaller prostate size, and increasing PSA density were independently associated with higher CDR, while prior prostate biopsy was associated with lower CDR. A solitary PI-RADS 3-5 lesion was independently associated with higher csCDR, while 2+ prior prostate biopsies was associated with a lower csCDR. A predictive model provided a greater net benefit than a strategy of performing biopsy in all PI-RADS 3-5 lesions across a wide range of threshold probabilities.</p><p><strong>Conclusions: </strong>Several clinical and radiographic features are independently associated with the risk of prostate cancer in men undergoing MRI-targeted biopsy. A predictive model based on these features can improve clinical decisions regarding biopsy compared to the conventional strategy of performing biopsy for all PI-RADS 3-5 lesions.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E85-E91"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631319","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}