Cuaj-Canadian Urological Association Journal最新文献

{"title":"Predictors of failed same-day discharge in patients undergoing robot-assisted radical prostatectomy in a Canadian universal healthcare system.","authors":"Michael Uy, Abdullah Alrumaih, Matthew Fuda, Raees Cassim, Braden Millan, Bobby Shayegan","doi":"10.5489/cuaj.8777","DOIUrl":"https://doi.org/10.5489/cuaj.8777","url":null,"abstract":"<p><strong>Introduction: </strong>Same-day discharge (SDD) after robot-assisted radical prostatectomy (RARP) has been shown to be feasible and safe. In order to improve uptake of this ambulatory model in Canada, we aimed to update our experience of SDD after RARP and identify reasons for SDD pathway non-initiation and failure in a universal healthcare system.</p><p><strong>Methods: </strong>A review of our prospectively collected database of patients undergoing RARP at a Canadian tertiary academic center from May 2021 to May 2023 was conducted. Binary logistic regression analysis determined predictors SDD pathway non-initiation and failure.</p><p><strong>Results: </strong>We identified 387 patients, of which 198 were initiated on the SDD pathway. Of those initiated, 104 (51.7 %) were successfully discharged home on the same day. Patients who travelled distances greater than 100 km, or who had non-CPAP compliant obstructive sleep apnea were significantly less likely to be initiated on the SDD pathway (both p<0.05). Patients that were scheduled to be the second case or later, had an estimated blood loss ≥300 mL, or had a postoperative abdominal drain, were predictive of failing SDD after initiation (all p<0.05). There were similar rates of readmissions, unscheduled office visits, and emergency department presentations, when compared to the traditional in-patient model (all p>0.05).</p><p><strong>Conclusions: </strong>SDD after RARP in a Canadian healthcare system remains feasible and safe for selected patients. Predictors of failed SDD identified in this study inform the development of future ambulatory protocols and highlight areas of need in infrastructure to increase uptake of these outpatient pathways.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428204","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":"Money talks.","authors":"Jennifer Bjazevic","doi":"10.5489/cuaj.8854","DOIUrl":"10.5489/cuaj.8854","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11230686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560260","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":"On conference posters.","authors":"Michael Leveridge","doi":"10.5489/cuaj.8863","DOIUrl":"10.5489/cuaj.8863","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11230690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560261","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":"Examining the utility of routine perioperative hemoglobin monitoring in patients undergoing radical nephrectomy.","authors":"Charlie J Gillis, Ali Sherazi, Ricardo A Rendon, Gabriela Ilie, Ross Mason","doi":"10.5489/cuaj.8603","DOIUrl":"10.5489/cuaj.8603","url":null,"abstract":"<p><strong>Introduction: </strong>Patients undergoing radical nephrectomy (RN) are often admitted with protocolized bloodwork for several days following their operation, yet the clinical value of serial hemoglobin (Hgb) measurements has not been established. This can lead to unnecessary costs and can prolong patient stay, despite the absence of an intervention based on these lab values. This study sought to examine perioperative Hgb values and identify those patients at high risk of bleeding requiring intervention, as well as those patients who are unlikely to require further monitoring.</p><p><strong>Methods: </strong>Patient and perioperative factors were retrospectively examined for a cohort of 259 radical nephrectomy patients from 2015-2021 in Atlantic Canada. Postoperative Hgb values and transfusion rates were recorded. A multivariate logistic regression analysis was performed to identify variables associated with requiring a blood transfusion.</p><p><strong>Results: </strong>Overall, 31 (12%) patients required a blood transfusion in the postoperative period. Median estimated blood loss (EBL) was 150 (interquartile range [IQR] 100-300) ml, with a median Hgb change of 15 (IQR 9-22) g/L from preoperative to postoperative day 1 (POD1). In patients with a Hgb loss of ≤15 g/L (n=131), transfusion was only required in four patients (3.1%). Among those with a POD1 Hgb >100 g/L (n=199), only four (2%) required transfusion. These patients were identified as having complications based on hemodynamic instability. On multivariate regression analysis, factors found to be associated with higher transfusion risk were age and intraoperative EBL, while higher preoperative Hgb was found to be associated with a lower transfusion risk.</p><p><strong>Conclusions: </strong>In patients who have a reassuring POD1 Hgb value, with a drop of <15 g/L or an absolute value of >100 g/L, consideration can be made towards discontinuing routine Hgb testing in the absence of a clinical indication. Age, blood loss, and preoperative Hgb are factors that may affect a patient's overall risk of transfusion.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11230693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934021","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":"Understanding the sleep-pain relationship in patients with interstitial cystitis/bladder pain syndrome.","authors":"Alexandra A Kelly, Krista Jones, Olivia Pineau, J Curtis Nickel, Jessica Rose, Robert Moldwin, Christopher Doiron, Claus Riedl, Mauro Cervigni, Jean Wyndaele, A Tripp","doi":"10.5489/cuaj.8686","DOIUrl":"10.5489/cuaj.8686","url":null,"abstract":"<p><strong>Introduction: </strong>Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pelvic pain condition with critical symptoms of urinary urgency and frequency, persistent bladder-related pain, and reduced quality of life. Poor-quality sleep can lead to significant disturbances in daily life and increased pain in IC/BPS patients. Resilience, depressive symptoms, and pain catastrophizing have univariate associations with sleep and pain in IC/BPS, suggesting they may be mechanisms in this sleep and pain relationship.</p><p><strong>Methods: </strong>This online study recruited patients self-reporting a diagnosis of IC/BPS through support groups, social media posts (Facebook, Reddit, and Instagram), and urology clinic advertisements. Participants completed questionnaires on demographics, urologic symptoms, pain, pain catastrophizing, depressive symptoms, and resilience. Only those participants who met the RAND Interstitial Cystitis Epidemiology (RICE) criteria for IC/BPS diagnosis were included. A multiple mediation model was first examined, followed by a serial mediation model.</p><p><strong>Results: </strong>Seventy-four participants (M_age= 47.0, standard deviation [SD ] 16.7, range 18-83 years) met inclusion criteria. A multiple mediation model showed greater sleep disturbance was associated with greater pain severity through depressive symptoms and pain catastrophizing, but not resilience (b=0.79, bootSE =0.26, bootCI [0.33, 1.35]). A serial mediation showed that the sleep-to-pain relationship had a significant indirect effect through pain catastrophizing and depressive symptoms (b=0.78, bootSE =0.26, bootCI [0.35, 1.32]).</p><p><strong>Conclusions: </strong>Findings suggest depressive symptoms and pain catastrophizing may be important psychosocial mechanisms in the sleep-to-pain relationship. These results help guide future sleep and pain research in IC/BPS and aid in developing and refining treatments.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11230695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934025","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":"An in-depth analysis on the effects of body composition in patients receiving neoadjuvant chemotherapy for urothelial cell carcinoma.","authors":"Landan MacDonald, Ricardo A Rendon, Myuran Thana, Lori Wood, Robyn MacFarlane, David Bell, Jon Duplisea, Ross Mason","doi":"10.5489/cuaj.8542","DOIUrl":"10.5489/cuaj.8542","url":null,"abstract":"<p><strong>Introduction: </strong>Neoadjuvant chemotherapy (NAC) is the standard of care for patients undergoing radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC); however, NAC can be associated with significant side effects and morbidity in some patients. NAC may contribute to sarcopenia, obesity, and the combination of the two. Our study examined the effects of NAC on body composition and the association between body composition and adverse events.</p><p><strong>Methods: </strong>We created a retrospective database of patients with non-metastatic MIBC receiving NAC prior to RC. The change in skeletal muscle index (SMI) and fat mass index (FMI) was calculated using computed tomography (CT) scans done within three months prior to NAC and after the first two cycles. The association between body composition (sarcopenia, obesity, and sarcopenic obesity) and preoperative adverse events was investigated using a multivariable logistic regression. Changes in body composition were calculated using a paired Student's t-test.</p><p><strong>Results: </strong>A total of 70 patients were included in our study. There was a mean decrease in SMI of 2.2±3.2 cm²/m². Adiposity and FMI were unchanged by NAC. Sarcopenic obesity was found to be associated with adverse events among patients receiving NAC in the multivariable analysis. There was a total of 637 preoperative complications with grades 1-2 and 33 complications with grades 3-5.</p><p><strong>Conclusions: </strong>Based on our retrospective cohort study, NAC did not affect obesity and FMI, but there was a significant decrease in SMI. Sarcopenic obesity was associated with increased severity of NAC adverse events. As such, the presence of this factor may help predict tolerance of NAC.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11230692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934019","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":"Analyzing the influence of expanding multispecialty adoption of robotic surgery on robotic urologic care A decade-long assessment of two Canadian academic hospitals.","authors":"Ahmed Ibrahim, Imad Matta, Ahmed S Zakaria, Abdulghani Khogeer, Nick Lee, Tawfik Elseherbini, David-Dan Nguyen, Nicholas J Corsi, David Bouhadana, Adel Arezki, Anindyo Chakraborty, Malek Meskawi, Assaad Elhakim, Kevin C Zorn","doi":"10.5489/cuaj.8524","DOIUrl":"10.5489/cuaj.8524","url":null,"abstract":"<p><strong>Introduction: </strong>Most robot-assisted surgery (RAS) systems in Canada are donor-funded, with constraints on implementation and access due to significant costs, among other factors. Herein, we evaluated the impact of the growing multispecialty use of RAS on urologic RAS access and outcomes in the past decade.</p><p><strong>Methods: </strong>We conducted a retrospective review of all RAS performed by different surgical specialties in two high-volume academic hospitals between 2010 and 2019 (prior to the COVID pandemic). The assessed outcomes included the effect of increased robot access over the years on annual robotic-assisted radical prostatectomy (RARP) volumes, surgical waiting times (SWT), and pathologically positive surgical margins (PSM). Data were collected and analyzed from the robotic system and hospital databases.</p><p><strong>Results: </strong>In total, six specialties (urology, gynecology, general, cardiac, thoracic, and otorhinolaryngologic surgery) were included over the study period. RAS access by specialty doubled since 2010 (from three to six). The number of active robotic surgeons tripled from seven surgeons in 2010 to 20 surgeons in 2019. Moreover, there was a significant drop in average case volume, from a peak of 40 cases in 2014 to 25 cases in 2019 (p=0.02). RARP annual case volume followed a similar pattern, reaching a maximum of 166 cases in 2014, then declining to 137 cases in 2019. The mean SWT was substantially increased from 52 days in 2014 to 73 days in 2019; however, PSM rates were not affected by the reduction in surgical volumes (p<0.05).</p><p><strong>Conclusions: </strong>Over the last decade, RAS access by specialty has increased at two Canadian academic centers due to growing multispecialty use. As there was a fixed, single-robotic system at each of the hospital centers, there was a substantial reduction in the number of RAS performed per surgeon over time, as well as a gradual increase in the SWT. The current low number of available robots and unsustainable funding resources may hinder universal patient access to RAS.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11230696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934020","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":"Our Association's Journal.","authors":"Michael Leveridge, D Robert Siemens","doi":"10.5489/cuaj.8855","DOIUrl":"10.5489/cuaj.8855","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11230691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560262","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":"Incidence and trends in the treatment of kidney stones in Canada A population-based cohort study.","authors":"Michael Ordon, Andrea Lantz Powers, Ben H Chew, Jason Y Lee, Michael Kogon, Sri Sivalingam, Shubha De, Naeem Bhojani, Sero Andonian","doi":"10.5489/cuaj.8596","DOIUrl":"10.5489/cuaj.8596","url":null,"abstract":"<p><strong>Introduction: </strong>Our objective was to assess the incidence of kidney stones requiring acute care, trends in the surgical treatment of stones, and the demographics of stone formers in Canada.</p><p><strong>Methods: </strong>We conducted a population-based, retrospective cohort study using administrative data from the Canadian Institute for Health Information. We included Canadian residents age >18 years, outside of Quebec, who presented between January 1, 2013, and December 31, 2018, with a kidney stone episode. This was defined as a kidney stone resulting in hospital admission, emergency department visit, or stone intervention, specifically shockwave lithotripsy (SWL), ureteroscopy (URS), or percutaneous nephrolithotomy (PCNL).</p><p><strong>Results: </strong>There were 471 824 kidney stone episodes, including 184 373 interventions. The number of kidney stone episode increased from 277/100 000 in 2013 to 290/100 000 in 2018. The median age was 53 (interquartile range 41-65) years and 59.9% were male. The crude rate for stone intervention was 877/100 000. The age- and gender-standardized rate for interventions was highest in Nova Scotia and Newfoundland and Labrador, and lowest in Prince Edward Island. The most common intervention in Canada was URS (73.5%), followed by SWL (19.8%) and PCNL (6.7%). The percent utilization of SWL was highest in Manitoba, whereas for URS, it was highest in Prince Edward Island and Alberta.</p><p><strong>Conclusions: </strong>Our study provides the first population-based data on the demographics of stone formers and treatment trends across Canada. There has been a 4.7% increase in kidney stone episodes over the study period. Those presenting to hospital or requiring intervention for a kidney stone are more likely to be male, aged 41-65, and undergo URS.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11230698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934022","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":"Micro cost-effectiveness analysis of standard vs. mini percutaneous nephrolithotomy A single Canadian institution's experience.","authors":"Ahmed Shoeib, Ailsa Gan, James Watterson, Brian Blew, Nicholas R Paterson","doi":"10.5489/cuaj.8679","DOIUrl":"10.5489/cuaj.8679","url":null,"abstract":"<p><strong>Introduction: </strong>Mini-percutaneous nephrolithotomy (mPCNL ) has been described as an alternative to standard nephrolithotomy (sPCNL ) for select stones. Studies suggest that mPCNL has comparable stone-free rates, with potential for decreased complications and shorter hospital stay. Costs associated with both procedures present a challenge to Canadian institutions due to capital acquisitions of equipment and ongoing disposables. The objective of this study was to compare the cost-effectiveness of both procedures at our institution.</p><p><strong>Methods: </strong>A decision tree analytic model was developed to compare costs and outcomes of both procedures. Primary outcomes included assessment of total capital, operative, and hospitalization costs. Cost and outcome of peri- and postoperative parameters were obtained using a retrospective analysis of 20 mPCNL and 84 sPCNL procedures on 1-2.5 cm stones between January 2020 and June 2022, and supplemented with internal hospital expenditure records and literature outcome data. Descriptive statistics and regression models were performed.</p><p><strong>Results: </strong>The estimated total cost-per-patient was $7427.05 and $5036.29 for sPCNL and mPCNL, respectively, resulting in cost-savings of $2390.76 in favor of mPCNL, with a comparable stone-free rate. The savings were due to lower costs associated with complications and hospital stay. mPCNL had higher capital costs ($95 116.00) compared to sPCNL ($78 517.00), but per-procedure operative costs were lower for mPCNL ($2504.48) compared to sPCNL ($3335.72). Cost-per-case regression of total costs intersected at 5.51 cases when accounting for operative and hospitalization costs, and at 20 cases when only considering operative costs.</p><p><strong>Conclusions: </strong>Despite higher upfront costs, mCPNL may represent a valid, cost-effective alternative to sPCNL for select stones due to clinical and economic benefits in Canadian institutions.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11230685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934023","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}