Cuaj-Canadian Urological Association Journal最新文献

{"title":"Practice patterns of Canadian penile prosthesis implanters: A survey-based analysis.","authors":"Ahmed M Almuhanna, Dhiraj S Bal, Karim Sidhom, Jesse Ory, Udi Blankstein, Ryan Flannigan, Premal Patel","doi":"10.5489/cuaj.9191","DOIUrl":"https://doi.org/10.5489/cuaj.9191","url":null,"abstract":"<p><strong>Introduction: </strong>Penile prosthesis implantation is a well-established treatment for refractory erectile dysfunction; however, significant variations exist in surgical techniques and practice patterns, often influenced by individual surgeon experience and training. Our study aimed to identify these variations among Canadian implanters, assessing their approach to penile prosthesis surgery.</p><p><strong>Methods: </strong>A cross-sectional, questionnaire-based study was conducted to evaluate the practice patterns of Canadian surgeons performing penile prosthesis implantation. The study included implanters from all provinces who perform more than five cases annually. An anonymous electronic survey was distributed, assessing practice patterns, surgical approach, and recommendations for improving penile prosthesis surgery in Canada.</p><p><strong>Results: </strong>Seventeen Canadian urologists performing over five annual cases participated in the study, with the annual volume varying among respondents. The majority (88.2%, n=15) routinely checked HbA1c levels, with 54.5% (n=6) using a cutoff of 8%. Additionally, 58.8% (n=10) routinely ordered a urine culture, and 94.1% (n=16) performed a preoperative scrub. Juts over half (52.9%, n=9) prescribe preoperative antibiotics, the majority (88.2%, n=15) used an antibiotic dip, and postoperatively, 94.1% (n=16) of respondents prescribed antibiotics. Most implanters (76.5%, n=13) primarily used a penoscrotal approach and 47.1% (n=8) did not routinely place a drain. Respondents also indicated perceived ways to improve penile prosthesis education across Canada, focusing on patient education and surgical simulation.</p><p><strong>Conclusions: </strong>While key aspects, such as the ideal surgical approach, HbA1c cutoffs, antibiotic regimens, and intraoperative techniques, remain debated, our findings underscore the need for further standardization. High-quality educational resources and consensus guidelines could help implanters refine their practice and improve patient outcomes.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977063","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":"Ureteral stent in ureteroneocystostomy for vesicoureteral reflux: Analysis of the data from National Surgical Quality Improvement Program-Pediatrics.","authors":"Joan Marie Flor, Maryam Noparast, Kourosh Afshar","doi":"10.5489/cuaj.9242","DOIUrl":"https://doi.org/10.5489/cuaj.9242","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to assess the association between stent placement during ureteral reimplantation for vesicoureteral reflux (VUR) and short-term postoperative outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of National Surgical Quality Improvement Program-Pediatrics (NSQIP-P). Independent variables included stent placement, age, sex, urologic comorbidity, prior VUR procedures, severity of reflux, preoperative urinary tract infections (UTIs), American Society of Anesthesiologists (ASA) classification, and operative approach. Outcomes of interest were emergency department (ED) visits, operative time, readmissions, unplanned operations, length of hospital stay (LOHS), and postoperative UTIs. Descriptive statistics were performed, and Chi-squared and Mann-Whitney U tests were used for univariate analysis. For multivariate analyses, logistic regression, linear regression, and negative binomial models were applied.</p><p><strong>Results: </strong>A total of 4550 patients were identified (median age 47.36 months, 68.7% female, 48.8% stented). In multivariate analyses, ureteral stenting was significantly associated with higher rates of ED visits (p=0.0019), related readmissions (p<0.0001), and postoperative UTIs (p<0.0001). The expected length of hospitalization for the stent group was 37% longer than for the non-stent group (p<0.0001), and the operative time was, on average, 31 minutes longer (p<0.0001).</p><p><strong>Conclusions: </strong>This study reveals an association between ureteral stenting and short-term adverse postoperative outcomes following ureteral reimplantation for VUR. Consideration should be given to the selective use of stents at the time of ureteral reimplantation for VUR. There are limitations to the study due to absence of some surgical data in the database, such as type of reimplant, long-term success rate, and type of stent used.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977076","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":"Modified early apical release vs. non-early apical release in holmium laser prostatic enucleation Impact on stress urinary incontinence.","authors":"Abdulghani Khogeer, Adel Elatreisy, Ahmed S Zugail, Yousef Almehmadi, Ahmed Ibrahim, Serge Carrier, Mélanie Aubé-Peterkin","doi":"10.5489/cuaj.9099","DOIUrl":"10.5489/cuaj.9099","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to compare the incidence of de novo stress urinary incontinence (SUI) of two apical release techniques for holmium laser prostatic enucleation (HoLEP): modified early apical release (EAR) and non-early apical release (non-EAR).</p><p><strong>Methods: </strong>We conducted a retrospective database review analyzing the records of patients who underwent HoLEP with the modified EAR and non-EAR techniques for symptomatic benign prostatic hyperplasia. The study period spanned from January 2012 to December 2021 in a single center. Patient demographics, perioperative data, and functional and technical outcomes were compared between the techniques.</p><p><strong>Results: </strong>The study included a total of 786 patients; 556 patients underwent the non-EAR technique (group 1), and 230 underwent the modified EAR technique (group 2). The mean enucleated prostate weight in group 1 was 68.2±45.6 g compared to 93.3±51.9 g in group 2 (p<0.001). De novo SUI within a month of surgery was reported in 34 cases (6.1%) in group 1 compared to eight cases (3.5%) in group 2. The percentage of patients with persistent SUI at one year postoperatively dropped to 2.7% and 0.9% in the non-EAR and modified EAR groups, respectively. Moreover, persistent SUI after one year from surgery was reported in 1.4 % of the non-EAR group compared to 0.44% in the modified EAR group. Multivariate regression analysis demonstrated that age >70 years (p=0.06), operative time >90 minutes (p=0.011), and the non-EAR technique (p=0.004) were significantly associated with the onset of postoperative de novo SUI.</p><p><strong>Conclusions: </strong>Our research indicates that both modified EAR and non-EAR techniques employed during HoLEP yield comparable efficacy and safety outcomes. Nonetheless, the modified EAR technique is associated with reduced postoperative de novo SUI.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"242-248"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996841","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":"Comparative analysis of apixaban vs. enoxaparin for thromboprophylaxis after radical cystectomy A single-center, observational, before-after study.","authors":"Cory S Macklin, Gabrielle Reznik, Martin E Gleave, Miles P Mannas, Peter C Black, Marie-Pier St-Laurent","doi":"10.5489/cuaj.9312","DOIUrl":"10.5489/cuaj.9312","url":null,"abstract":"<p><strong>Introduction: </strong>Radical cystectomy (RC) is the standard treatment for muscle-invasive and select high-risk non-muscle-invasive bladder cancer. Venous thromboembolism (VTE) is a common and preventable postoperative complication. Extended thromboprophylaxis with low-molecular-weight heparin, such as enoxaparin, is recommended, but direct-acting oral anticoagulants like apixaban are a possible alternative. This study evaluated the safety and efficacy of apixaban compared to enoxaparin for extended postoperative thromboprophylaxis following RC.</p><p><strong>Methods: </strong>A single-center, observational, before-after study of RCs performed between October 2021 and August 2024 was conducted. Patients receiving 28 days of post-discharge thromboprophylaxis with either enoxaparin or apixaban were included. The primary outcome was postoperative VTE within 30 days. Secondary outcomes included 90-day postoperative VTE, 30-day post-discharge emergency room (ER) visits, readmissions, complications such as bleeding, and 90-day postoperative mortality.</p><p><strong>Results: </strong>A total of 102 patients who received enoxaparin and 83 patients who received apixaban for VTE thromboprophylaxis were included. No significant differences were found in 30-day postoperative VTE rates (0 [0%] apixaban vs. 2 [2%] enoxaparin, p=0.5), 90-day VTE rates, 90-day overall survival, or 30-day post-discharge ER visits, readmissions, or hemorrhagic complications (p>0.05).</p><p><strong>Conclusions: </strong>Apixaban appears to be a safe and effective alternative to enoxaparin for extended postoperative VTE prophylaxis following RC for bladder cancer.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"19 8","pages":"236-241"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796038","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":"Randomized controlled trial comparing the effects of methoxyflurane and local anesthesia combination to local anesthesia alone in scrotal surgery.","authors":"Jainik Shah, David Chung, Maximilian Fidel, Avinash Sarcar, Harliv Dhillon, Connor Roque, Yool Ko, Kayla Reynolds, Kulvir Badh, Robert Bard, Jasmir G Nayak, Premal Patel","doi":"10.5489/cuaj.9311","DOIUrl":"10.5489/cuaj.9311","url":null,"abstract":"<p><strong>Introduction: </strong>Outpatient scrotal surgery under local anesthesia (LA) has been associated with excellent safety, tolerability, and efficacy; however, needle phobia and periprocedural anxiety remain areas for improvement. This study evaluated the efficacy of methoxyflurane as an adjunct to LA in alleviating pain and anxiety during local anesthesia-based scrotal urologic surgeries.</p><p><strong>Methods: </strong>A non-blinded, randomized controlled trial was conducted at Men's Health Clinic Manitoba for patients undergoing scrotal surgery under LA. A power calculation determined a required sample size of 40. Patients were randomized to receive either LA alone or LA with inhaled methoxyflurane. Pain and anxiety were assessed pre- and postoperatively using a visual analog scale (VAS) and the State-Trait Anxiety Index (STAI). Comparisons of VAS pain scores and anxiety measures between groups were performed using the Mann-Whitney U-test.</p><p><strong>Results: </strong>Forty patients underwent scrotal procedures under LA without intraoperative or postoperative adverse events. Patients in the methoxyflurane group reported similar intraoperative pain levels compared to the LA group (1.35 vs. 1.85, p=0.3); however, intraoperative anxiety in the methoxyflurane group was significantly less than the control group (0.4 vs. 1.65, p=0.01). Patients receiving methoxyflurane also reported significantly higher procedural tolerability compared to controls (9.6 vs. 7.4, p=0.01).</p><p><strong>Conclusions: </strong>Scrotal surgery under LA is well tolerated; however, inhaled methoxyflurane as an adjunct to LA is an effective means of reducing anxiety and further improving patient-reported experiences during scrotal urologic procedures.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"19 8","pages":"230-235"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796041","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":"Optimizing therapy for high-risk biochemically recurrent non-metastatic prostate cancer Current and emerging strategies.","authors":"Christian Kollmannsberger, Antonio Finelli, Andrew Loblaw, Tamim Niazi, Frédéric Pouliot, Ricardo A Rendon, Bobby Shayegan, Fred Saad","doi":"10.5489/cuaj.9100","DOIUrl":"10.5489/cuaj.9100","url":null,"abstract":"<p><p>Prostate cancer is a leading malignancy affecting men globally and in Canada. Biochemical recurrence (BCR), marked by rising prostate-specific antigen (PSA) levels post-curative-intended local treatment, is prevalent in nearly one-third of prostate cancer patients and is associated with increased risk of metastases and mortality. The management of patients with BCR is evolving rapidly, highlighting the need for practical guidance. This review aims to provide guidance to clinicians on the use and subsequent implications of advanced imaging results in patients with BCR. In addition, current management approaches, including salvage therapies post-radical prostatectomy, as well as the integration of androgen deprivation therapy (ADT) plus androgen receptor pathway inhibitors (ARPI), are explored.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"282-288"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057563","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":"2025 Canadian Urological Association-Canadian Uro-oncology Group Guideline: Metastatic castration-resistant prostate cancer (Update).","authors":"Fred Saad, Alan I So, Armen Aprikian, Antonio Finelli, Neil E Fleshner, Martin E Gleave, Zineb Hamilou, Tamim Niazi, Scott A North, Frédéric Pouliot, Ricardo A Rendon, Bobby Shayegan, Srikala S Sridhar, Nawaid Usmani, Eric Vigneault, Kim N Chi","doi":"10.5489/cuaj.9341","DOIUrl":"10.5489/cuaj.9341","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"19 8","pages":"E276-E289"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796036","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":"Long-term impact of posterior reconstruction urethrovesical anastomosis during robot-assisted prostatectomy A secondary analysis of a randomized cohort.","authors":"Braden Millan, Jen Hoogenes, Michael Uy, Raees Cassim, Bobby Shayegan","doi":"10.5489/cuaj.9121","DOIUrl":"10.5489/cuaj.9121","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to assess early and late continence rates post-robot-assisted radical prostatectomy (RARP), comparing posterior reconstruction (PR) urethrovesical anastomosis (UVA) to conventional urethrovesical anastomosis (C-UVA).</p><p><strong>Methods: </strong>Consecutive patients with clinically localized prostate cancer undergoing RARP underwent simple randomization to PR-UVA or C-UVA. Return to continence outcomes were assessed using a validated questionnaire (Expanded Prostate Cancer Index Composite [EPIC] Short Form-26) at baseline, two-, three-, four-, six-, eight-, and 12-month followups. Five-year outcomes were assessed by frequency of undergoing continence-improving procedures.</p><p><strong>Results: </strong>A total of 163 patients were randomized 1:1 to PR-UVA or C-UVA from April 2014 to July 2015, and 140 patients completed followup. There were no significant clinical or functional differences between groups preoperatively. Using a continence definition of 0-1 pads/day, the continence rates for PR-UVA vs. C-UVA were 39% vs. 38% at two months, respectively (p=1.0), and 93% vs. 86%, respectively, at 12 months (p=0.3). Frequency of urine leak, quantity of pad use, subjective urinary control, and overall bother improved significantly in all patients during the 12-month study period (p<0.001); however, no difference was demonstrated between groups. Five-year results showed no statistically significant difference in the number of patients undergoing a continence-improving procedure (hazard ratio 1.21, 95% confidence interval 0.40-3.65, p=0.7).</p><p><strong>Conclusions: </strong>PR-UVA failed to show a benefit in short-term return to urinary continence or need for an incontinence-improving procedure five years post-RARP.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"269-274"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024989","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 outcomes of the adjustable transobturator male system for post-prostatectomy incontinence and its relationship with detrusor overactivity and radiotherapy with the help of urodynamics.","authors":"Samuel Farag, Salima Ismail, Joanie Pelletier, Le Mai Tu","doi":"10.5489/cuaj.9118","DOIUrl":"10.5489/cuaj.9118","url":null,"abstract":"<p><strong>Introduction: </strong>The adjustable transobturator male system (ATOMS) has recently garnered attention for its surgical simplicity and suitability for mild post-prostatectomy incontinence (PPI). This retrospective study investigated the outcomes of patients who received ATOMS, including subgroup analyses of individuals with overactive bladder (OAB) or previous radiotherapy.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 104 patients who received ATOMS. To classify mild, moderate, and severe incontinence, preoperative severity was defined as <2 pads per day (PPD), 2-4 PPD, and >4 PPD, based on the 24-hour pad count and/or <200 g, 200-400 g, and >400 g, based on the 24-hour pad-test (24h-PT). Postoperative \"dry\" status referred to ≤1 pad/day, while \"improved\" or \"very much improved\" indicated a pad reduction of ≥50% or ≥75%, respectively. Patients who reported \"much better\" or \"very much better\" on the Patient Global Impression of Improvement-Incontinence (PGI-I) questionnaire were considered \"satisfied.\"</p><p><strong>Results: </strong>Thirteen patients were excluded for insufficient followup, leaving 91 patients (mean age 70 years, mean followup 42 months). Most were classified as moderately (44%) or severely (55%) incontinent, with a median of four pads/day and a mean 24-hour pad test of 351 g preoperatively. At final followup, the median pad count was 0.5; 89% improved overall, 58% became dry, and 91% were satisfied. Complications occurred in 27% (five grade III). Patients with prior radiotherapy (n=29) exhibited lower dryness (55% vs. 79%) and improvement (83% vs. 92%), alongside more adjustments and higher total instilled volume. There were no other significant subgroup differences.</p><p><strong>Conclusions: </strong>ATOMS appears to be a safe and effective device for PPI, including for moderate to severe incontinence, although radiotherapy may affect efficacy.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"262-268"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023495","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 CUA…80 and thriving!","authors":"Wassim Kassouf","doi":"10.5489/cuaj.9360","DOIUrl":"10.5489/cuaj.9360","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"19 8","pages":"226"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796043","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}