Cuaj-Canadian Urological Association Journal最新文献

{"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":"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":"E257-E263"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240260/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limitations of ultrasound compared with computed tomography for kidney stone surveillance.","authors":"Ryan Sun, Elijah Sommer, Calyani Ganesan, Alan C Pao, Joseph Liao, John Leppert, Helena Chang, Simon Conti, Timothy Chang","doi":"10.5489/cuaj.9043","DOIUrl":"10.5489/cuaj.9043","url":null,"abstract":"<p><strong>Introduction: </strong>Renal ultrasound (US) offers less radiation exposure than computed tomography (CT) for kidney stone surveillance but has lower sensitivity and specificity for nephrolithiasis diagnosis. Additionally, US may overestimate stone size, leading to unnecessary surgical interventions. Evidence on US performance for kidney stone surveillance is variable, making its clinical utility unclear. We aimed to assess US accuracy against CT and identify factors influencing US performance.</p><p><strong>Methods: </strong>We performed a retrospective review of patients with known nephrolithiasis seen in urology clinic at Stanford who underwent both renal US and CT within 90 days for surveillance from January to December 2022. Patients with spontaneous stone passage or interventions were excluded. Stone characteristics were recorded, and statistical analysis compared the diagnostic accuracy of US and CT.</p><p><strong>Results: </strong>A total of 107 patients and 128 stones were included, with a mean time difference of 25.7 days between US and CT. US sensitivity was 77%, with a positive predictive value (PPV) of 75% for stone detection. The PPV was only 59% for stones >4 mm by CT. Mean stone size was 8.7 mm on US vs. 5.5 mm on CT (p=0.02), with more pronounced overestimation in smaller stones and higher body mass index (BMI) (p<0.05). No significant differences in US performance were found by stone location, laterality, or time between scans. Differences in stone detection (p=0.01) and size (p=0.03) were associated with the individual performing the ultrasound.</p><p><strong>Conclusions: </strong>US performance is limited compared to CT and is influenced by stone size, BMI, and sonographer. Overestimation by US may lead to unnecessary interventions in up to 40% of patients with stones >4 mm.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E229-E237"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675002","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 - Recurrent ureteral inguinal herniation A rare presentation of post-kidney transplant anuria and acute kidney injury.","authors":"Wyatt MacNevin, Liam Power, Laura Harkness, Juan Santiago Rubio, Nicholas R Paterson, Thomas B McGregor","doi":"10.5489/cuaj.9090","DOIUrl":"10.5489/cuaj.9090","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E273-E275"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674992","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":"Open, laparoscopic, and robotic radical nephroureterectomy for upper tract urothelial carcinoma Comparing outcomes and the tetrafecta as a composite marker of surgery quality.","authors":"Maxwell Sandberg, Parth Udayan Thakker, Rory Ritts, Megan Escott, Mary Namugosa, Adam Cohen, Stephen Tranchina, Kimberly Waggener, Madeline Snipes, XiXi Yi, Justin Refugia, Gregory Russell, Timothy O'Rourke, Ashok Kumar Hemal","doi":"10.5489/cuaj.9039","DOIUrl":"10.5489/cuaj.9039","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this study was to compare surgical outcomes and costs between robotic radical nephroureterectomy (RNU), laparoscopic radical nephroureterectomy (LNU), and open radical nephroureterectomy (ONU), and to assess the relevance of the tetrafecta as a composite outcome on survival parameters after nephroureterectomy (NU).</p><p><strong>Methods: </strong>Operative and oncologic followup data was retrospectively collected on patients who underwent NU from 2006-2022 at our institution. The tetrafecta was defined as a true bladder cuff, lymph node dissection, negative surgical margins, and no postoperative complications. Cox proportional hazards regression was used to assess the impact of surgical approach on survival outcomes.</p><p><strong>Results: </strong>A total of 248 patients were included in the analysis (145 RNU, 61 LNU, and 42 ONU). The complication rate differed by approach and was lowest in RNU (p<0.01). Cancer-specific survival (CSS) differed between ONU and RNU patients, with ONU patients 2.51 times as likely to die from their cancer. Retroperitoneal recurrence-free survival (RPFS) differed between ONU and RNU patients, with ONU patients 7.22 times more likely to experience a retroperitoneal recurrence (p=0.0013). Variable surgical costs were lower in LNU compared to ONU (p=0.028) and direct inpatient hospital costs were lowest with RNU (p<0.01). Eighty-one patients met criteria for the tetrafecta. RNU patients were more likely to achieve the tetrafecta compared to LNU (p<0.01) and ONU (p<0.01) patients. No differences in survival parameters existed between patients who did and did not achieve the tetrafecta.</p><p><strong>Conclusions: </strong>Most oncologic outcomes after NU do not differ by approach on long-term followup; however, CSS and RPFS appear to differ between RNU and ONU. ONU has traditionally been considered the approach with the lowest cost; however, our analysis demonstrates both RNU and LNU require lower costs than ONU, depending on the cost parameter analyzed. Among all approaches, the tetrafecta is best achieved with RNU.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E219-E228"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675005","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":"Assessing Canadian medical students' confidence in undergraduate urologic training and preferences for teaching methods.","authors":"Othmane Zekraoui, Sepehr Niakani, Mahmoud Moustafa, Mohamad Baker Berjaoui, Abbas Guennoun, Dean Elterman, Bilal Chughtai, David-Dan Nguyen, David Bouhadana, Naeem Bhojani","doi":"10.5489/cuaj.9018","DOIUrl":"10.5489/cuaj.9018","url":null,"abstract":"<p><strong>Introduction: </strong>Given the aging population, urologic conditions are increasingly prevalent in primary care, necessitating well-prepared medical graduates to recognize and manage essential complaints. This study assessed medical students' confidence in managing common urologic conditions, identified preferred teaching methods, and examined the role of the Canadian Undergraduate Urological Curriculum (CanUUC) in their education.</p><p><strong>Methods: </strong>A survey was distributed to third- and fourth-year Canadian medical students, assessing their self-confidence in history taking, diagnosis, management planning, and physical examination for 12 urologic conditions. The survey also explored preferred teaching methods and awareness of CanUUC. Statistical analysis included ANOVA and t-tests to determine significant differences in confidence across various factors.</p><p><strong>Results: </strong>A total of 117 medical students and 10 first-year urology residents responded. Students felt equally confident about taking histories (3.51±1.19), proposing diagnoses (3.38±1.19), and performing physical examinations (3.58±1.16) while demonstrating lower confidence (p<0.001) for management planning (3.16±1.25). Confidence was highest for urinary tract infections and lowest for male infertility. Furthermore, students who completed urology rotations reported higher confidence in history taking (3.67±0.69, p=0.003) and management planning (3.35±0.66, p=0.003). Direct clinical exposure, simulations, and case-based discussions were the preferred learning methods. Only seven (6%) students were aware of CanUUC, with five (4.3%) using it.</p><p><strong>Conclusions: </strong>Medical students have moderate confidence in handling urologic conditions, with higher comfort among those who completed urology rotations. Implementing targeted curriculum enhancements and integrating resources like the CanUUC could address these educational gaps and lead to improved patient outcomes.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E212-E218"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674979","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":"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":"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>We included patients from our tertiary center who underwent robotic radical prostatectomy (RP) and had their serum vitamin D levels assessed no more than three months before the procedure. 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 the 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 RP.</p>","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E246-E250"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240262/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":"10.5489/cuaj.9065","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":" ","pages":"E264-E268"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240267/pdf/","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":"OA","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":"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":"E238-E245"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240266/pdf/","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":"OA","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":"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 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":"E251-E256"},"PeriodicalIF":1.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240259/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2025 CUA Annual Meeting Abstracts; Ottawa June 27-29, 2025.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50613,"journal":{"name":"Cuaj-Canadian Urological Association Journal","volume":"19 6 Suppl 1","pages":"1-132"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735005","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}