BJUI compass最新文献

{"title":"Accuracy of warm ischemia time measurement using a surgical intelligence software in partial nephrectomies: A validation study","authors":"Archan Khandekar,&nbsp;Joao G. Porto,&nbsp;Jean C. Daher,&nbsp;Pedro F. S. Freitas,&nbsp;Dotan Asselman,&nbsp;Maritza M. Suarez,&nbsp;Mark L. Gonzalgo,&nbsp;Dipen J. Parekh,&nbsp;Sanoj Punnen","doi":"10.1002/bco2.452","DOIUrl":"10.1002/bco2.452","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objectives of this study are to compare the accuracy of warm ischemia times (WITs) derived by a surgical artificial intelligence (AI) software to those documented in surgeon operative reports during partial nephrectomy procedures and to assess the potential of this technology in evaluating postoperative renal function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>A surgical AI software (Theator Inc., Palo Alto, CA) was used to capture and analyse videos of partial nephrectomies performed between October 2023 and April 2024. The platform utilized computer vision algorithms to detect clamp placement and removal, enabling precise WIT measurement. Expert-reviewed surgical videos served as the ground truth. Platform-derived WITs were compared to those in surgeon operative reports using paired-sample <i>t</i>-tests. Additionally, we analysed the correlation between platform-derived WITs and postoperative creatinine levels extracted from electronic health records (EHRs) integrated via health level seven (HL7) messaging protocols.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 64 eligible cases, 61 were included in the final analysis. Platform-derived WITs were within 1 min of the ground truth in all procedures, within 30 s in 97%, and within 10 s in over 80%. The mean difference between platform-derived WITs and ground truth was 8.3 s, significantly lower than the 2.45 min difference for operative reports (<i>p</i> &lt; 0.001). No significant correlation was found between platform-derived WIT and postoperative creatinine changes, aligning with the view that WIT may not independently determine postoperative renal function. Although not the primary goal of this study, significant correlations were observed between WIT, tumour size and RENAL score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates the high accuracy of a surgical intelligence platform in measuring WIT during partial nephrectomies. The findings support the use of AI-based surgical time measurement for precise intraoperative documentation and highlight the potential of integrating these data with EHRs to advance research on surgical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 12","pages":"1263-1268"},"PeriodicalIF":1.6,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients and generative AI: Who owns your diagnosis?","authors":"Asher Mandel,&nbsp;Michael DeMeo,&nbsp;Ashutosh Maheshwari,&nbsp;Ash Tewari","doi":"10.1002/bco2.420","DOIUrl":"10.1002/bco2.420","url":null,"abstract":"&lt;p&gt;Generative artificial intelligence (AI) chatbots, like Open AI's ChatGPT, have revolutionized the way that humans interact with machines. With a recent market capitalization of $80 billion, investors strongly believe that AI has a future role in many industries. Mounting excitement, however, is also met by cautionary discourse regarding the need for ethical shepherding of AI's rollout. Several United States Congress hearings have centred around AI with the media abuzz with its consequences. Controversies yet to be settled include how to address the use of AI in academic publishing, education and medicine, among others.&lt;span&gt;&lt;sup&gt;1-3&lt;/sup&gt;&lt;/span&gt; An analysis of public perspectives on comfortability with AI in healthcare, drawn from social media content, found drastic heterogeneity.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Results from a recent Pew survey suggest that higher academic level and experience with AI increases the likelihood of having confidence in AI's ability to enhance medical care.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Nonetheless, natural language processing has already begun its infusion into the medical field with use cases including electrocardiogram interpretation and white blood cell count differentials.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Urology is no exception in this regard—embracing the benefits of AI by exploring the utility of agents (i.e., text/voice/video chatbots) and evaluating surgical skill.&lt;span&gt;&lt;sup&gt;7, 8&lt;/sup&gt;&lt;/span&gt; Some products have already resulted in the United States Food and Drug Administration approval, such as one that assists in localizing prostate tumour volume on magnetic resonance imaging and another that diagnoses prostate cancer on histopathology.&lt;span&gt;&lt;sup&gt;9, 10&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;As AI is increasingly adopted in everyday urology practice, to improve efficiency and quality of care, it is imperative that we consider the looming ethical ramifications proactively. A recent review presented by Dr. Hung et al. has illuminated some of these challenges, stirred conversation and presented possible policy-level solutions.&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt; Nevertheless, urologists have still yet to address several other legal and ethical challenges looming in generative AI model development. This editorial seeks to expand the scope of conversation encompassing necessary considerations for adopting AI in urology.&lt;/p&gt;&lt;p&gt;Three important issues to consider include the agency of patients and their data, ownership over the models themselves and the potential competition these models may add in the marketplace. Healthcare institutions are charged with being ethical stewards of patient data. This paternal identity may engender a sense of entitlement over the data, and institutions may act as though they own patient data and use that argument in negotiations; however, these data cannot be legally copyrighted. Second, healthcare systems and AI companies are competing and collaborating in this emerging space. Both may be entitled to the products they deve","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 12","pages":"1246-1248"},"PeriodicalIF":1.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A sustainable and expedited ‘One-Stop’ prostate cancer diagnostic pathway to reduce environmental impact and enhance accessibility","authors":"Lorenzo Storino Ramacciotti,&nbsp;Masatomo Kaneko,&nbsp;Severin Rodler,&nbsp;Muneeb Mohideen,&nbsp;Jie Cai,&nbsp;Gangning Liang,&nbsp;Manju Aron,&nbsp;Michelle Hopstone,&nbsp;Mariana C. Stern,&nbsp;Giovanni E. Cacciamani,&nbsp;Inderbir Gill,&nbsp;Andre Luis Abreu","doi":"10.1002/bco2.447","DOIUrl":"10.1002/bco2.447","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the carbon footprint, accessibility, and diagnostic performance of an expedited ‘One-Stop’ prostate cancer (PCa) diagnostic pathway.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>A total of 1083 consecutive patients undergoing magnetic resonance imaging (MRI) followed by transrectal ultrasound fusion-guided prostate biopsy (PBx) were identified from a prospective database. The patients were divided according to the diagnostic pathway: One-Stop, with MRI and same-day PBx (3 hours apart), or Standard, with MRI followed by a second visit for PBx. Socioeconomic status was evaluated by the Distressed Communities Index (DCI) and the carbon footprint by the United States (U.S.) Environmental Protection Agency Greenhouse Gases Equivalencies Calculator.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 260 patients underwent the One-Stop and 823 the Standard pathway. The One-Stop patients lived farther from the hospital (163 vs. 23 km; <i>p</i> &lt; 0.001), had lower socioeconomic status with DCI scores of 49 versus 30 (<i>p</i> &lt; 0.001), and were more likely to be Latinos (21% vs. 13%, <i>p</i> &lt; 0.001) compared to the Standard patients, respectively. The One-Stop saved 69 575 km in round trips, over 16 tons of travel-related CO₂ emissions, and $8214 U.S. dollars. For patients with Prostate Imaging Reporting &amp; Data System (PIRADS) 3–5, the clinically significant PCa detection (53% vs. 50%, <i>p</i> = 0.55) was similar for the One-Stop and Standard pathways, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The One-Stop PCa diagnostic pathway reduces carbon footprint, distance travelled, and patient-level cost while maintaining clinical outcomes comparable to the Standard pathway. It facilitates access to tertiary-level care for minorities and underserved populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 12","pages":"1278-1287"},"PeriodicalIF":1.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequencing the Barcelona-MRI predictive model and Proclarix for improving the uncertain PI-RADS 3","authors":"Juan Morote,&nbsp;Ana Celma,&nbsp;Olga Méndez,&nbsp;Enrique Trilla","doi":"10.1002/bco2.448","DOIUrl":"10.1002/bco2.448","url":null,"abstract":"&lt;p&gt;Risk-stratified screening of prostate cancer (PCa) is currently recommended by the European Union (EU). Serum prostate-specific antigen (PSA) testing is used to identify men suspected of having PCa, while magnetic resonance imaging (MRI) is used to select candidates for prostate biopsy.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Prostate Imaging-Reporting and Data System (PI-RADS) is a score used to identify lesions suspected of having significant PCa (sPCa) on MRI. Prostate biopsies are typically avoided in men with PI-RADS lesions 1 and 2 (negative MRI), as their negative predictive value reaches 97%. Prostate biopsy is recommended in men with PI-RADS 3 to 5, with PI-RADS 3 being the most uncertain scenario,&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; as its positive predictive value for sPCa is between 16% and 18% with an overall 95% confidence interval (CI) between 13% and 27%.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; To improve the selection of candidates for prostate biopsy in uncertain scenarios, the use of PSA density (PSAD), appropriate predictive models (PMs) and modern tumour markers is recommended.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The European Association of Urology (EAU) currently recommends designing useful pathways that sequence stratifications based on appropriate PMs for men suspected of having PCa before and after MRI, with the objective of improving the efficacy of PCa screening by reducing MRI demand, prostate biopsies and the over-detection of insignificant PCa (iPCa).&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The Barcelona (BCN) risk-organized model, which stratifies men suspected of having PCa through the BCN-PMs one (before MRI) and two (after MRI), has enhanced of the efficacy of detecting sPCa.&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt; The BCN-MRI PM has exhibited higher efficacy than PSAD for selecting men for prostate biopsy, especially in those with PI-RADS 3.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; On the other hand, Proclarix, a new tumour marker that combine serum measurements of thrombospondin, cathepsin and percent free PSA, along with age, has shown good performance for detecting sPCa improving on that observed with PSAD and the Rotterdam-MRI PM. Proclarix has been able to achieve a 100% sensitivity for sPCa within men with PI-RADS 3.&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Since the BCN-MRI PM and Proclarix have shown individually good performances for selecting candidates for prostate biopsy in men with PI-RADS 3, we aim to demonstrate if their sequential use improves the selection of candidates for prostate biopsy.&lt;/p&gt;&lt;p&gt;We have conducted a head-to head analysis of the BCN-MRI PM and Proclarix in 169 men with serum PSA level above 3 ng/mL and/or suspicious digital rectal examination (DRE), and PI-RADS v.2 score 3, consecutively referred from the opportunistic sPCa screening programme of Catalonia, Spain, between January 2018 and March 2019 at one academic institution. All participants underwent 2- to 4-core transrectal MRI-ultrasound fusion targeted biopsies and 12-core systematic biopsies. Blood was obtained j","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 12","pages":"1252-1254"},"PeriodicalIF":1.6,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early oncological outcomes of delayed radical prostatectomy: A prospective, international, follow-up analysis of the COVIDSurg-Cancer study","authors":"Arjun Nathan,&nbsp;Chuanyu Gao,&nbsp;Alexander Light,&nbsp;Cameron Alexander,&nbsp;Vinson Chan,&nbsp;Kevin Gallagher,&nbsp;Sinan Khadhouri,&nbsp;Kevin G. Byrnes,&nbsp;Michael Ng,&nbsp;Michael Walters,&nbsp;Terry Hughes,&nbsp;Rita J. Perry,&nbsp;Kelvin Okoth,&nbsp;Laura Magill,&nbsp;Thomas Pinkney,&nbsp;Yuhao Zhang,&nbsp;James Blackmur,&nbsp;Eric Etchill,&nbsp;Stanley Tang,&nbsp;Damián García Escudero,&nbsp;Alan McNeill,&nbsp;Krishna Narahari,&nbsp;Grant D. Stewart,&nbsp;Veeru Kasivisvanathan,&nbsp;COVIDSurg Collaborative","doi":"10.1002/bco2.433","DOIUrl":"10.1002/bco2.433","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objective of this study is to compare the early oncological outcomes of delayed (&gt;90 days) versus scheduled (≤90 days) radical prostatectomy (RP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>Patients with prostate cancer due to undergo surgery between March 2020 and June 2020 who were enrolled in the COVIDSurg-Cancer international, observational study were prospectively followed up for 1 year. Time to surgery was defined as the difference between the operation date and the multi-disciplinary team decision to offer surgery. The primary outcome was the positive surgical margin (PSM) rate. Biochemical recurrence (BCR), upgradation and upstaging were secondary oncological outcomes. The Independent <i>t</i>-test and Mann Whitney <i>U</i> test were used to compare means between groups and regression models and were used to investigate factors associated with the primary outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four hundred seventy-six (78.7%) patients underwent RP from 605 that were eligible. Three hundred seven (64.5%) patients underwent scheduled RP, and 169 (35.5%) underwent delayed RP. A small proportion of men (<i>n</i> = 35, 6.8%) did not undergo RP within the 1-year follow-up period. More men with high-risk disease (72.8%) underwent scheduled RP compared to men with intermediate-risk disease (60.2%) (<i>p</i> &lt; 0.05). There was no statistically significant difference in the PSM rate between the two groups (<i>p</i> = 0.512). Delay in surgery was not associated with an increased PSM or BCR on univariable or multivariable analyses. There was statistically significantly greater upstaging (<i>p</i> &lt; 0.05) in the delayed group but no difference in upgradation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>High-risk men were prioritised for surgery during the COVID-19 pandemic. Our prospective data support previous retrospective, cancer-registry evidence suggesting no adverse oncological impact after delaying RP across all risk groups. Our study is limited by the short follow-up period, and therefore, longer term conclusions cannot be drawn.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 12","pages":"1314-1323"},"PeriodicalIF":1.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability of mpMRI in diagnosing cancer prostate following intravesical BCG for bladder cancer","authors":"Arjun Pon Avudaiappan,&nbsp;Pushan Prabhakar,&nbsp;Rachel Siretskiy,&nbsp;Andrew Renshaw,&nbsp;Ahmed Eldefrawy,&nbsp;Murugesan Manoharan","doi":"10.1002/bco2.446","DOIUrl":"10.1002/bco2.446","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Detecting carcinoma prostate (CaP) after intravesical Bacillus Calmette Guerin (BCG) immunotherapy for non-muscle invasive bladder cancer (NMIBC) poses diagnostic challenges. Granulomatous prostatitis (GP) has an incidence of 0.8%–3.3% in post-intravesical BCG patients and 6% incidence in a PIRADS 5 lesion on multiparametric MRI (mpMRI). Patients with GP after intravesical BCG may have clinical, biochemical, and radiological features similar to CaP. In our study, we evaluate the reliability of mpMRI in diagnosing CaP after intravesical BCG therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We reviewed the NMIBC patients treated with intravesical BCG therapy between 2017 and 2023 and investigated those who underwent mpMRI and MR fusion biopsy in suspicion of CaP. A total of 120 patients had intravesical BCG immunotherapy, and 10 patients met our selection criteria. We performed a descriptive analysis of these patients and assessed the sensitivity and specificity of mpMRI in diagnosing CaP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The sensitivity of mpMRI in detecting CaP was 100%, and the specificity was 28.6%. Similarly, the negative predictive value for detecting CaP was 100%, and the positive predictive value was 37.5%. Among patients evaluated with mpMRI, a PIRADS 4 or 5 lesion was seen in 8 (80%) patients, and there was no lesion in 2 (20%) patients. The mpMRI detected 1 lesion in 6 patients (60%) and 2 (20%) in 2 patients. The lesions had a PIRADS score of 4 and 5 in 6 (60%) and 2 (20%) patients, respectively. Among these lesions, 8 (80%) were in the peripheral zone and 2 (20%) in the transition zone. In the MR fusion biopsy of these 10 patients, 7 (70%) had granulomatous prostatitis, and 3 (30%) had CaP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In our study on evaluating the reliability of mpMRI in diagnosing CaP among post-intravesical BCG patients, we noted that although PIRADS in mpMRI had high sensitivity in identifying prostate lesions, its specificity for detecting CaP is limited.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1090-1094"},"PeriodicalIF":1.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the long-term impact of the COVID-19 pandemic on non-muscle-invasive bladder cancer outcomes: 12-Month follow-up data from the international, prospective COVIDSurg Cancer study","authors":"Cameron E. Alexander,&nbsp;Arjun Nathan,&nbsp;Alexander Light,&nbsp;Chuanyu Gao,&nbsp;Vinson Chan,&nbsp;Sinan Khadhouri,&nbsp;Kevin Gallagher,&nbsp;Kevin G. Byrnes,&nbsp;Michael Walters,&nbsp;Terry Hughes,&nbsp;Rita Perry,&nbsp;Kelvin Okoth,&nbsp;Laura Magill,&nbsp;Thomas Pinkney,&nbsp;Joseph B. John,&nbsp;John S. McGrath,&nbsp;Alexandra Colquhoun,&nbsp;Yuhao Zhang,&nbsp;James Blackmur,&nbsp;Eric Etchill,&nbsp;Stanley Tang,&nbsp;Damián García Escudero,&nbsp;Grant Stewart,&nbsp;Veeru Kasivisvanathan,&nbsp;COVIDSurg Collaborative","doi":"10.1002/bco2.432","DOIUrl":"10.1002/bco2.432","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study was to report the 12-month oncological outcomes for patients with non-muscle-invasive bladder cancer (NMIBC) within the prospective, international COVIDSurg Cancer study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>Eligible patients were aged ≥18 years and scheduled for elective surgical management of NMIBC with curative intent (transurethral resection of bladder tumour [TURBT] or bladder biopsy) from 21 January to 14 April 2020. The primary outcome was disease recurrence within 12 months of previous elective TURBT/bladder biopsy. Secondary outcomes included disease progression within 12 months of previous elective TURBT/bladder biopsy, site-declared delay to surgery from diagnosis as a consequence of COVID-19 and deviation in standard care due to COVID-19. Comparisons were made to cohorts from the pre-pandemic era.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Bladder cancer accounted for 2.2% (<i>n</i> = 446) of patients in the COVIDSurg Cancer study, with data contributed by 27 centres across 12 countries internationally. Within this included cohort, 229 patients had NMIBC and 12-month follow-up data available. On application of National Institute for Health and Care Excellence (NICE) criteria, 47.2% were classified as having high-risk disease. Overall disease recurrence and progression rates were 29.3% and 9.7% at 12 months, respectively. In purely high-risk pre-pandemic cohorts, the International Bladder Cancer Group (IBCG) estimates a recurrence rate of 25% at 12 months, and the European Association of Urology (EAU) NMIBC 2021 scoring model estimates a 12-month progression rate of 3.5%. As a consequence of the COVID-19 pandemic, 10.9% of patients had site-declared delay to TURBT/bladder biopsy; 7.4% did not undergo intravesical therapy or had early discontinuation of this; 9.2% did not undergo early repeat resection for high-risk disease; and 18.3% had a delay to cystoscopic follow-up surveillance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This prospective study indicates that there were widespread deviations in usual care for NMIBC during the pandemic and that 12-month oncological outcomes appear to be impaired compared to published pre-pandemic outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1044-1051"},"PeriodicalIF":1.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment preferences of patients with muscle invasive bladder cancer: A discrete choice experiment","authors":"Liam Mannion,&nbsp;Verity Watson,&nbsp;Vinod Mullassery,&nbsp;Rajesh Nair,&nbsp;Thomas Charlton,&nbsp;Margaret Northover,&nbsp;Deborah Enting,&nbsp;Mieke Van Hemelrijck,&nbsp;Muhammad Shamim Khan,&nbsp;Ramesh Thurairaja,&nbsp;Suzanne Amery,&nbsp;Kathryn Chatterton,&nbsp;Kate Smith,&nbsp;Simon Hughes","doi":"10.1002/bco2.443","DOIUrl":"10.1002/bco2.443","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>When faced with treatment options, patients are asked to participate in decision-making. We sought to determine which treatment aspects matter most for individuals treated for muscle invasive bladder cancer (MIBC), with an aim to improve understanding of patient preferences and what trade-offs patients are willing to accept. Our study consisted of a discrete choice experiment (DCE): a type of questionnaire used to elicit preferences in the absence of real-world choice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The DCE had five attributives, each with three levels. Participants were asked to complete a questionnaire in which they were asked to choose between two hypothetical MIBC treatments. The data were analysed using a conditional logit model, and preferences for, and trade-offs between, attributes were estimated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We recruited patients with MIBC who had either already completed, were undergoing or had yet to commence radical treatment for MIBC (<i>n</i> = 60). Participants indicated a strong preference for treatments that increased their life expectancy (<i>p</i> = &lt;0.001), had a lower risk of long-term complications (<i>p</i> = &lt;0.001) and less changes to their body image (<i>p</i> = &lt;0.001). Changes to sexual wellbeing (<i>p</i> = 0.09) or an increase in acute side effects (<i>p</i> = 0.99) did not influence preferences. Patients were willing to accept treatments with higher risk of long-term complications to improve their life expectancy or body image.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>When deciding on the type of treatment, increased life expectancy is the most important consideration for people with MIBC. The risk of long-term complications and changes to overall body image as a result of treatment are also important. Our study also highlighted that patients are willing to accept a higher risk of long-term complications to improve other treatment outcomes. Understanding patient preferences is important for shared decision-making, which has an impact on quality of care for people living with MIBC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1059-1068"},"PeriodicalIF":1.6,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between beta-blocker atenolol use and prostate cancer upgrading in active surveillance†","authors":"Ali H. Zahalka,&nbsp;Ethan Fram,&nbsp;Evan Garden,&nbsp;Lauren Howard,&nbsp;Emily Wiggins,&nbsp;Mustufa Babar,&nbsp;Jay Annam,&nbsp;Allison Reagan,&nbsp;Benjamin Eilender,&nbsp;Amanda de Hoedt,&nbsp;Stephen J. Freedland,&nbsp;Ash Tewari,&nbsp;Kara L. Watts","doi":"10.1002/bco2.441","DOIUrl":"10.1002/bco2.441","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The objective of this study is to investigate the association between the use of beta-adrenergic antagonist atenolol and risk of pathologic upgrade in patients on active surveillance, considering growing literature implicating adrenergic innervation with disease progression mediated through beta-adrenergic signalling.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>Men with low-risk or favourable intermediate-risk prostate cancer who were placed on an active surveillance protocol between 2006 and 2020 across three diverse urban hospitals were included. Exposure was duration of atenolol use, and outcome was pathologic grade group upgrading (to GG ≥ 3) on final prostate biopsy. Cox proportional hazard regression models were used to determine the associations between atenolol use and risk of upgrading with time, on a per-examination basis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 467 men with initial GG ≤ 2 were included. Postdiagnosis atenolol use was associated with a decreased risk of pathologic upgrade to GG ≥ 3 on final repeat biopsy (HR 0.81, 95% CI 0.39–0.98). Longer duration of postdiagnosis atenolol use (&gt;2 years) and greater cumulative atenolol dose (&gt;730 defined daily doses) were associated with a more pronounced decreased risk of upgrade to GG ≥ 3 (HR 0.41, 95% CI 0.05–0.88, and HR 0.32, 95% CI 0.15–0.99, respectively). Initiation of atenolol use prior to prostate cancer diagnosis had a slightly greater protective effect than drug initiation postdiagnosis (HR 0.79, 95% CI 0.43–0.98, and HR 0.83, 95% CI 0.30–0.99, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Beta-adrenergic blockade with atenolol use in men on active surveillance is associated with a reduced risk for clinically significant grade group pathologic upgrade.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1095-1100"},"PeriodicalIF":1.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated enhanced recovery after surgery protocol in radical cystectomy for bladder tumour—A retroprospective study","authors":"Waseem Ashraf,&nbsp;Arif Hamid,&nbsp;Sajad Ahmad Malik,&nbsp;Rouf Khawaja,&nbsp;Sajad Ahmad Para,&nbsp;Mohammad Saleem Wani,&nbsp;Saqib Mehdi","doi":"10.1002/bco2.438","DOIUrl":"10.1002/bco2.438","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Enhanced recovery after surgery (ERAS) is a patient-centerd, evidence-based approach to improve postoperative outcomes. The protocol involves multidisciplinary collaboration and standardisation of perioperative interventions. ERAS has shown positive results in reducing hospitalisation and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study conducted in the Department of Urology was a retro-prospective study. It included an ERAS cohort group of 47 patients, studied prospectively from May 2021 to May 2023. These patients were compared to a historical cohort of 47 consecutive patients who underwent radical cystectomy with traditional care before the ERAS pathway was implemented. The primary outcome was hospital length of stay (LOS). Secondary outcomes included perioperative management, time to recovery milestones and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Implementation of ERAS pathway for radical cystectomy was associated with reduced hospital LOS (mean LOS 16.19 ± 2.53 days vs. 10.26 ± 3.33 days 7 days; <i>p</i> &lt; 0.0001), reduced time to key recovery milestones, including days to first flatus (3.17 vs. 2.68; <i>p</i> = 0.013) and days to first solid food (5.19 vs. 3.45 <i>p</i> value &lt; 0.0001), first stool (5.53 vs. 4.23; <i>p</i> &lt; 0.0001), reductions in some complications like postoperative ileus (<i>p</i> value = 0.021) and need for total parental nutrition (<i>p</i> value = 0.023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In conclusion, the implementation of the integrated approach facilitates a more efficient recovery process, potentially reducing healthcare costs and enhancing patient comfort.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 11","pages":"1069-1080"},"PeriodicalIF":1.6,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}