Cuaj-Canadian Urological Association Journal最新文献

{"title":"Kidney stone disease: Practice patterns among urologists in Canada.","authors":"Anis Assad, Mahmoud Moustafa, Brendan L Raizenne, Michael Kogon, Jason Y Lee, Michael Ordon, Sero Andonian, Andrea Lantz Powers, Jennifer Bjazevic, Shubha De, Ben H Chew, Naeem Bhojani","doi":"10.5489/cuaj.8955","DOIUrl":"https://doi.org/10.5489/cuaj.8955","url":null,"abstract":"<p><strong>Introduction: </strong>Despite kidney stone disease (KSD) guidelines, high-quality evidence for KSD management in Canada is lacking. We aimed to assess Canadian urologists' practice patterns, preferences, and barriers in managing KSD.</p><p><strong>Methods: </strong>A cross-sectional survey was distributed to Canadian urologists via the Canadian Urological Association (CUA), Quebec Urological Association (QUA), and Canadian Endourology Group (CEG), as well as directly to urology departments nationwide. Descriptive statistics were used to analyze the results.</p><p><strong>Result: </strong>Of 93 respondents, 47% were from academic centers, 43% from community hospitals, and 10% from mixed/private settings. Most performed over 75 ureteroscopies and fewer than 25 percutaneous nephrolithotomies (PCNLs) annually (67% and 58%, respectively). Holmium:YAG (Ho:YAG) lasers were available in 85% of hospitals, thulium fiber laser (TFL) in 70%, and Ho:YAG with Moses effect lasers in 28%. Preferred surgical devices included the TFL (74.5%), followed by the Ho:YAG laser (24.2%) and Ho:YAG with Moses effect laser (21.7%). Endourology fellowship-trained urologists (53%) were more likely to perform their own PCNL access (90% vs. 23%, p<0.001), metabolic workup (73% vs. 48%, p=0.02), and felt more comfortable prescribing prophylactic and medical treatment for KSD (86% vs. 50%, p<0.01) compared to non-endourology fellowship-trained colleagues. Metabolic workup was delegated to nephrologists or specialized clinics by 38%, mainly due to lack of time (25%) and expertise (25%). Additionally, 71% lacked access to multidisciplinary KSD clinics, with 76% believing such clinics would be beneficial.</p><p><strong>Conclusions: </strong>The study highlights variability in KSD management practices and barriers. Addressing these issues could improve KSD care in Canada and inform future guidelines.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808528","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":"A novel tool to predict lymph node metastasis in patients with prostate cancer based on clinical and ⁶⁸Ga-PSMA PET/CT parameters.","authors":"Snir Dekalo, Jonathan Kuten, Tomer Bashi, Ziv Savin, Roy Mano, Avi Beri, Amihay Nevo, Orel Wasserman, Nicola J Mabjeesh, Tomer Ziv-Baran, Einat Even-Sapir, Ofer Yossepowitch","doi":"10.5489/cuaj.8917","DOIUrl":"https://doi.org/10.5489/cuaj.8917","url":null,"abstract":"<p><strong>Introduction: </strong>We sought to develop a model that predicts lymph node invasion (LNI) in patients with intermediate- and high-risk prostate cancer incorporating preoperative clinical and ⁶⁸Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) parameters.</p><p><strong>Methods: </strong>A cohort of 413 consecutive patients diagnosed with prostate cancer who underwent ⁶⁸Ga- PSMA PET/CT prior to radical prostatectomy from 2015-2020 was used to develop and validate the model. The cohort was split into a learning (70%) and a validation group (30%). The former was used to identify clinical and ⁶⁸Ga-PSMA PET/CT parameters (number and diameter of PET-positive lymph nodes) for prediction of pathologic LNI by applying multivariable logistic regression analyses. The discrimination ability of the model was evaluated using the area under the receiver operating characteristic (ROC) curve and internal validation was performed using the validation cohort.</p><p><strong>Results: </strong>One-hundred sixty-three men (39%) were categorized as high-risk, 168 (41%) as unfavorable-intermediate-risk, and 82 (20%) as favorable-intermediate-risk. Thirty-one patients (7.5%) had LNI on final pathology. All underwent extended lymph node dissection. Clinical stage, the presence of PET-positive lymph nodes, and diameter of the largest PET-positive node were included in the final predictive model. Four different categories were defined for estimating the risk for LNI. Internal validation was completed after applying the four-tire classification on both the learning and validation groups and achieving similar results. The sensitivity, specificity, positive predictive value, and negative predictive value of the model were 97%, 54%, 15%, and 99%, respectively, and area under the ROC curve was 0.906 (95% confidence interval 0.83-0.95, p<0.001). Using a 5% cutoff as a threshold for performing lymph node dissection, only one patient with LNI on final pathology would have been classified erroneously as node negative, while 206 (50%) men would have been spared an unwarranted lymph node dissection.</p><p><strong>Conclusions: </strong>We present a novel prediction model for LNI that incorporates clinical staging and molecular imaging data. Pending further validation, this model may improve the risk stratification and patient selection for lymph node dissection at time of radical prostatectomy.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing an urgent treatment gap in advanced prostate cancer.","authors":"Ricardo A Rendon","doi":"10.5489/cuaj.9053","DOIUrl":"10.5489/cuaj.9053","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"18 12","pages":"373"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association des Urologues du Québec Congrès Annuel 2024 - Résumés Session scientifique IVendredi 8 novembre 2024 • Friday, November 8, 2024.","authors":"","doi":"10.5489/cuaj.9081","DOIUrl":"10.5489/cuaj.9081","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"18 12_Suppl_4","pages":"S231-S235"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The safety and efficacy of ambulatory urologic surgery A paradigm shift towards optimizing resource use in outpatient settings.","authors":"Dhiraj S Bal, David Chung, Harliv Dhillon, Maximilian Fidel, Jainik Shah, Alagarsamy Pandian, Jasmir G Nayak, Premal Patel","doi":"10.5489/cuaj.8806","DOIUrl":"10.5489/cuaj.8806","url":null,"abstract":"<p><strong>Introduction: </strong>Amid substantial surgical wait lists, novel methods are needed to improve the delivery of surgical care in Canada. One strategy involves shifting select surgeries from hospitals into community ambulatory centers, which expedite procedures and allow hospitals to prioritize critical and complex patients. We sought to evaluate surgical outcomes at a novel, Canadian urologic clinic and surgical center.</p><p><strong>Methods: </strong>A retrospective study was conducted at a novel, accredited surgical facility and outpatient ambulatory clinic from August 2022 to August 2023. Procedures ranged from scrotal and transurethral surgeries to inflatable penile prosthesis insertion. Traditional outpatient procedures, including vasectomy and cystoscopy, were excluded. All patients were discharged the same day and seen 4-6 weeks post-procedure. Variables of interest included surgery type, anesthesia administered, additional clinic appointments, unplanned family physician appointments, visits to the emergency department (ED), and hospital admissions.</p><p><strong>Results: </strong>In a 12-month period, 519 surgeries were performed. The mean patient age was 49.6±17.3 years, with most classified as American Society of Anesthesiologists (ASA) 1-2 (88.8%). Most (95.8%, n=497) patients did not require medical care outside the clinic before their scheduled followup; 2.5% (n=13) visited the ED presenting for wound concerns, postoperative pain, query infection, or catheter-related concerns. Only 1.7% (n=9) required an unscheduled appointment with their family physician, with concerns being inadequate postoperative pain management (n=4) or suspected infection (n=4). No patient required hospital admission.</p><p><strong>Conclusions: </strong>Many urologic surgeries classically performed in hospital operating rooms can be safely performed in a non-hospital, outpatient surgical facility with preservation of good outcomes. This strategy can potentially improve the efficiency of urologic healthcare delivery in select patients.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"393-397"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing maximal wait times for urologic surgery in Canada in 2024.","authors":"Hassan Razvi, Troy Sitland, Fred Saad","doi":"10.5489/cuaj.9029","DOIUrl":"10.5489/cuaj.9029","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"18 12","pages":"376-378"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upping the ante (with machine-learning) for patients with UTUC.","authors":"Kristen McAlpine","doi":"10.5489/cuaj.9052","DOIUrl":"10.5489/cuaj.9052","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"18 12","pages":"419"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2024 CUA-GUMOC Expert Report: Management of unresectable locally advanced and metastatic urothelial carcinoma.","authors":"Carlos E Stecca, Deepro Chowdhury, Normand Blais, Nimira Alimohamed, Lori Wood, Christina M Canil, Bernie Eigl, Girish S Kulkarni, Peter C Black, Wassim Kassouf, Peter Chung, Scott North, Di Maria Jiang, Srikala S Sridhar","doi":"10.5489/cuaj.8946","DOIUrl":"10.5489/cuaj.8946","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"18 12","pages":"379-390"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Communication breakdown or clashing models?","authors":"Michael Leveridge","doi":"10.5489/cuaj.9061","DOIUrl":"10.5489/cuaj.9061","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"18 12","pages":"367-368"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulatory urologic surgery A paradigm shift towards optimizing resource use in outpatient settings.","authors":"Joseph Moryousef, Udi Blankstein","doi":"10.5489/cuaj.9050","DOIUrl":"10.5489/cuaj.9050","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"18 12","pages":"398"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}