Cuaj-Canadian Urological Association Journal最新文献

{"title":"Population-based dietary risks for kidney stones Implications for dietary counseling and prevention.","authors":"Anna J Black, Ghizlane Moussaoui, Connor M Forbes","doi":"10.5489/cuaj.8913","DOIUrl":"10.5489/cuaj.8913","url":null,"abstract":"<p><strong>Introduction: </strong>In the context of the increasing incidence of kidney stones, we aimed to assess the percentage of the population who are eating an at-risk diet for kidney stones and to understand the baseline diet for future counseling.</p><p><strong>Methods: </strong>The 2015 Canadian Community Health Survey, a national, cross-sectional instrument administered by Statistics Canada and Health Canada, was queried. Intake of relevant nutrients was compared to dietary risk factors for kidney stone formation. Factors associated with nutrient intake were analyzed in a multivariable regression.</p><p><strong>Results: </strong>Data for 14 275 participants was included, of whom 24% consumed >2.5 L of fluid per day and 9.4% consumed 1000-1200 mg of dietary calcium; 53.9% consumed too much sodium but 61% of the population had the recommended protein intake. Ninety-nine percent (99%) of the population had at least one dietary risk factor for kidney stone formation, while 92% had two or more risk factors. Fluid, sodium, calcium, and protein intake increased significantly with education level, income, and if employed (p<0.05 for all); however, fluid, protein, and sodium intake were lower in patients with hypertension and heart disease (p<0.05 for all).</p><p><strong>Conclusions: </strong>While only a subset of the population will develop stones, this study shows that 99% of the population has a diet that elevates the risk of stone disease. As the incidence of kidney stones increases, population-based dietary interventions should be considered. Furthermore, clinicians may use these data to understand the average diet as a starting point for questioning and counseling patients.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E75-E79"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631316","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":"DR. André Vallières 1931-2024.","authors":"","doi":"10.5489/cuaj.9151","DOIUrl":"10.5489/cuaj.9151","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"19 3","pages":"E127"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558723","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":"Increased oscillation rate may improve morcellation efficiency in HoLEP.","authors":"Cameron McClaine, Thomas M Shelton, Austen Slade, Andrew Adeola, Marcelino E Rivera","doi":"10.5489/cuaj.8873","DOIUrl":"10.5489/cuaj.8873","url":null,"abstract":"<p><strong>Introduction: </strong>Tissue morcellation has become increasingly efficient, yet remains a rate-limiting step in holmium enucleation of the prostate (HoLEP). Limited data exists on how the rate of oscillation by the morcellator blades affects morcellation efficiency (ME).</p><p><strong>Methods: </strong>We undertook a retrospective review of HoLEP procedures performed by two surgeons from July 1, 2019, to August 25, 2022. All morcellation was performed with the Wolf Piranha device and enucleation was performed with Moses 2.0 technology. Surgeon 1 routinely uses 1500 oscillations/min (low rate [LR]) and surgeon 2 uses a rate of 6000 oscillations/min (high rate [HR]). These rates were confirmed upon electronic medical record review of each case. The primary endpoint was ME (g/minute). Secondary endpoints included enucleation efficiency (EE), mean tissue specimen weight, and preoperative prostate volume.</p><p><strong>Results: </strong>A total of 894 HoLEPs were analyzed, 592 by surgeon 1 and 302 by surgeon 2. Surgeon 1 had larger preoperative prostate volumes (126 vs. 101, p<0.001) and specimen tissue weights (86.0 vs. 61.1, p<0.001). EE was higher in the LR group (1.67 vs. 1.33 g/min, p<0.001). Morcellation time was longer in the LR group (11.3 vs. 6.09 min, p<0.001) and ME was lower in the LR group (9.26 vs. 12.1 g/min, p<0.001). The difference in ME was inversely proportional to specimen weight.</p><p><strong>Conclusions: </strong>Increased oscillation rate during morcellation may lead to decrease in morcellation time and increased ME during prostate enucleation. The primary limitation of this paper is the inclusion of only two surgeons. Future studies will serve to evaluate this finding across a larger number of institutions, and evaluate ways to increase ME in large prostate cohorts.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E80-E84"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631233","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 - Emergent management of severe penile and scrotal edema due to prolonged metallic ring entrapment.","authors":"Mohamad Baker Berjaoui, David-Dan Nguyen, Zizo Al-Daqqaq, Justin Y H Chan, Yonah Krakowsky","doi":"10.5489/cuaj.8874","DOIUrl":"10.5489/cuaj.8874","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E119-E21"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631047","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":"Techniques in urology - Tension-relieving microdot vasovasostomies and longitudinal intussuscepted vasoepididymostomy vasectomy reversals A first report.","authors":"Abdullah Alhamam, Kiera Liblik, Luke Witherspoon, Adam Dorner, Ryan Flannigan","doi":"10.5489/cuaj.8899","DOIUrl":"10.5489/cuaj.8899","url":null,"abstract":"<p><strong>Introduction: </strong>Tension and malalignment of vasectomy reversal (VR) anastomoses are hypothesized to contribute to failure. We report VR outcomes using a novel technique introducing a tension-reliving hitch in the multilayer microdot vasovasostomy (VV) and longitudinal intussuscepted vasoepididymostomy (LIVE; VE).</p><p><strong>Methods: </strong>All VR patients between May 2019 and September 2023 from a single surgeon were reviewed. Patients were included if they underwent a VR with at least one semen analysis within six months of surgery and a minimum of six months of followup after the surgery to deem a failure. The primary outcome was patency, which was defined as 1) any sperm in the ejaculate; and 2) functionally as at least two million motile sperm. Late failure was defined as an azoospermic semen analysis result after previously documented presence of sperm.</p><p><strong>Results: </strong>A total of 159 patients were evaluated, of which 136 patients met the inclusion criteria. The patency rate among all VRs was 97.7 %, with an overall functional patency rate of 93.1%. One hundred and one patients underwent bilateral VVs, with a 99% patency rate and 95.5% functional patency rate. Twenty-three patients underwent a mixed VV/VE, with a patency rate of 100% and a functional patency rate of 88.8%. Finally, 12 patients underwent bilateral VE, with a patency rate of 83.3% and a functional patency rate of 77.7%. Among these patients, four VV patients were identified to have a late failure.</p><p><strong>Conclusions: </strong>The combination of tension-relieving stitches for VVs and VEs, along with attention to symmetrical and precise stitch placement, results in high patency rates.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E114-E118"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631332","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":"Length of hospital stay and procedure time after partial nephrectomy or percutaneous thermal ablation A systematic review and meta-analysis.","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, Gordon Guyatt","doi":"10.5489/cuaj.8906","DOIUrl":"10.5489/cuaj.8906","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review addressed the length of hospital stay (LOS) and procedure time in patients with small renal masses (SRM) undergoing open, conventional laparoscopic (OPN), and robot-assisted partial nephrectomy (RAPN), as well as percutaneous thermal ablation (PTA) in different geographic areas.</p><p><strong>Methods: </strong>We conducted a comprehensive search in databases (MEDLINE, EMBASE, CINAHL) until July 2023, and we applied random-effect meta-analysis, with evidence certainty assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.</p><p><strong>Results: </strong>We screened 3456 titles and abstracts, ultimately identifying 60 eligible studies. For the length of LOS (days) following OPN, our pooled estimates revealed means of 5.7 in North America, 7.1 in Europe, and 13.4 in Asia; laparoscopic partial nephrectomy means were 3.1, 5.4, and 5.8, respectively; for RAPN, means were 2.7, 3.8, and 7.1, respectively; and for PTA, means were 1.2, 1.6, and 1.6, respectively. Regarding procedure time (minutes) after OPN, means were 187 in North America, 132 in Europe, and 184 in Asia; after laparoscopic partial nephrectomy, means were 198, 127, and 200, respectively; after RAPN, means were 189, 150, and 192, respectively; and for PTA, mean was 144 in North America and no studies addressed procedure time in Europe and Asia.</p><p><strong>Conclusions: </strong>Our study provides the most trustworthy available estimates of LOS and procedure time for patients undergoing invasive procedures for the management of SRM. These findings emphasize the need for context-specific considerations when informing patients and making treatment decisions.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E104-E113"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479829","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 of marginalization and PSMA-PET in prostate cancer: An analysis of the Ontario PSMA-PET Registry for Recurrent Prostate Cancer.","authors":"Vivian S Tan, Ur Metser, Mohammed Rashid, Deanna L Langer, Pamela MacCrostie, Bo Green, Victor Mak, Girish S Kulkarni, Bobby Shayegan, Stephen Pautler, Luke T Lavallée, Antonio Finelli, Laurence Klotz, Marlon Hagerty, Glenn Bauman","doi":"10.5489/cuaj.9034","DOIUrl":"https://doi.org/10.5489/cuaj.9034","url":null,"abstract":"<p><strong>Introduction: </strong>Prostate-specific membrane antigen positron emission tomography (PSMA PET) is a new standard for the imaging of high-risk or recurrent prostate cancer. While marginalization disparities exist for prostate cancer, less is known in the context of PSMA PET. The objective of the study was to determine if marginalization was associated with access, PET positivity, management change, radiation use, and survival of prostate cancer in a universal healthcare system.</p><p><strong>Methods: </strong>Patients enrolled in the Ontario PSMA PET Registry for Recurrent Prostate Cancer (PREP) between 2018 and 2022 were included. The Ontario Marginalization Index (material resources, racialized/newcomer, age/labor force, household/dwellings) was used. Outcomes included access, PET positivity, management change, radiation use, and survival. Cox proportional hazards and logistic regression models examined the association between marginalization and outcomes. Provincial administrative databases were leveraged to generate a diagnosis and a survivorship cohort of prostate cancer patients who received primary treatment to compare with the PSMA PET cohort.</p><p><strong>Results: </strong>There were 4034 patients in the PSMA PET cohort. Patients at higher material marginalization quintiles were under-represented in the PSMA PET Registry Database. Similar under-representation was noted in the diagnosis (n=123 128) and survival (n=56 753) cohorts. Within the PSMA cohort, marginalization dimensions were not significantly correlated with PET positivity, management change, or radiation use.</p><p><strong>Conclusions: </strong>Marginalization quintiles across PSMA PET access were similar in distribution to prostate cancer diagnoses and survivor cohorts. We found no association of marginalization with PET positivity, management change, or radiation use among those receiving PSMA PET.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544441","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":"Use of AI (GPT-4)-generated multiple-choice questions for the examination of surgical subspecialty residents: Report of feasibility and psychometric analysis.","authors":"Jin Kyu Kim, Michael Chua, Armando Lorenzo, Mandy Rickard, Laura Andreacchi, Michael Kim, Douglas Cheung, Yonah Krakowsky, Jason Y Lee","doi":"10.5489/cuaj.9020","DOIUrl":"https://doi.org/10.5489/cuaj.9020","url":null,"abstract":"<p><strong>Introduction: </strong>Multiple-choice questions (MCQs) are essential in medical education and widely used by licensing bodies. They are traditionally created with intensive human effort to ensure validity. Recent advances in AI, particularly large language models (LLMs), offer the potential to streamline this process. This study aimed to develop and test a GPT-4 model with customized instructions for generating MCQs to assess urology residents.</p><p><strong>Methods: </strong>A GPT-4 model was embedded using guidelines from medical licensing bodies and reference materials specific to urology. This model was tasked with generating MCQs designed to mimic the format and content of the 2023 urology examination outlined by the Royal College of Physicians and Surgeons of Canada (RCPSC). Following generation, a selection of MCQs underwent expert review for validity and suitability.</p><p><strong>Results: </strong>From an initial set of 123 generated MCQs, 60 were chosen for inclusion in an exam administered to 15 urology residents at the University of Toronto. The exam results demonstrated a general increasing performance with level of training cohorts, suggesting the MCQs' ability to effectively discriminate knowledge levels among residents. The majority (33/60) of the questions had discriminatory value that appeared acceptable (discriminatory index 0.2-0.4) or excellent (discriminatory index >0.4).</p><p><strong>Conclusions: </strong>This study highlights AI-driven models like GPT-4 as efficient tools to aid with MCQ generation in medical education assessments. By automating MCQ creation while maintaining quality standards, AI can expedite processes. Future research should focus on refining AI applications in education to optimize assessments and enhance medical training and certification outcomes.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544491","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":"Lidocaine solution vs. lidocaine gel instillation for pain management during intravesical botulinum injections.","authors":"Cristina Negrean, James Ross, Wenhui Yu, Conrad Maciejewski, Humberto R Vigil, Duane Hickling","doi":"10.5489/cuaj.9011","DOIUrl":"https://doi.org/10.5489/cuaj.9011","url":null,"abstract":"<p><strong>Introduction: </strong>Most Canadian urologists use lidocaine solution prior to botulinium toxin (BoNT) administration; however, this requires additional time. The aim was to compare pain scores in patients undergoing office-based BoNT using lidocaine instillation and lidocaine gel vs lidocaine gel alone.</p><p><strong>Methods: </strong>All patients undergoing office based intradetrusor BoNT between March 1 and September 1, 2022, were included. Group 1 received intravesical lidocaine solution (20 ml 2% lidocaine solution + 30 ml 0.9% normal saline) instillation for 30 minutes and lidocaine gel. Group 2 received lidocaine gel only. The Verbal Numeric Rating Scale (VNRS) was used to measure pain. Patient demographics were compared with t-test for continuous and Chi-squared for categorical variables. The Mann-Whitney U test was used to compare pain scores.</p><p><strong>Results: </strong>A total of 79 patients were included (mean age 61 years, 74.7% female, 58.2% with overactive bladder, and 30.4% received first treatment). Group 1 had 39 patients and group 2 had 40. There was no significant difference in pain scores between groups: group 1 median VNRS 3.0 (interquartile range [IQR] 2.5) vs. group 2 median VNRS 4.0 (IQR 2.0) (p=0.11). No significant differences in pain scores were noted between groups based on sex, indication for treatment, or number of previous BoNT treatments (p>0.05). Post-procedural complications were low. Treatment failure did not occur.</p><p><strong>Conclusions: </strong>Lidocaine gel alone may be an acceptable analgesic alternative while improving availability and efficiency of treatment delivery. Our findings are limited by the retrospective nature of the study and the small sample size.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544446","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 the methodologic heterogeneity of Canadian Urological Association guidelines: Adoption of the GRADE approach (2018-2023).","authors":"Maylynn Ding, Vardhil Gandhi, Daniel A Gonzalez-Padilla, Philipp Dahm","doi":"10.5489/cuaj.8926","DOIUrl":"https://doi.org/10.5489/cuaj.8926","url":null,"abstract":"<p><strong>Introduction: </strong>The Canadian Urological Association (CUA) has a longstanding tradition of developing evidence-based guidelines. We conducted this study to assess the heterogeneity of the CUA's guideline methodology for developing recommendations from 2018-2023.</p><p><strong>Methods: </strong>We included guidelines from the CUA website from 2018-2023. Two independent reviewers working independently and in duplicate abstracted all data points and categorized the reported methodologic approaches for formulating recommendations and rating the evidence. We performed descriptive statistics only.</p><p><strong>Results: </strong>We included 23 guideline documents with a total of 654 recommendations. The median number of recommendations per guideline was 25 (interquartile range 17; 35). Seven guidelines (187 recommendations) used a modified Oxford Center for Evidence-Based Medicine approach for both the strength of recommendations and the levels of evidence, and eight guidelines (177 recommendations) reported the use of GRADE both for the strength of recommendations and the certainty of evidence. Of the remaining eight guidelines, four (154 recommendations) blended the GRADE approach for the strength of recommendations with modified Oxford levels of evidence, and the remaining four combined the American Urological Association's approach to recommendations with Oxford levels of evidence (n=1), GRADE certainty of evidence (n=2), or used GRADE but made no recommendations (n=1).</p><p><strong>Conclusions: </strong>CUA guidelines have been marked by considerable methodologic heterogeneity that may confuse end users. Continued advancement in the CUA's approach to guideline development will facilitate greater collaboration and resource sharing, thereby supporting the CUA's mission of promoting high-quality, evidence-based care.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544468","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}