BJUI compass最新文献

{"title":"Predictive role of ABC transporters in the efficacy of enfortumab vedotin for urothelial carcinoma","authors":"Toshiki Kijima,&nbsp;Atsuko Takada-Owada,&nbsp;Hiroki Shimoda,&nbsp;Hidetoshi Kokubun,&nbsp;Toshitaka Uematsu,&nbsp;Kohei Takei,&nbsp;Hironori Betsunoh,&nbsp;Masahiro Yashi,&nbsp;Kazuyuki Ishida,&nbsp;Takao Kamai","doi":"10.1002/bco2.488","DOIUrl":"10.1002/bco2.488","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the correlation between ATP-binding cassette (ABC) transporter expression and therapeutic efficacy of enfortumab vedotin (EV), an antibody-drug conjugate targeting Nectin-4, in urothelial cancer, as only a few studies have been conducted on this topic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>This retrospective study included 20 patients with metastatic urothelial carcinoma (mUC), including bladder and upper urinary tract cancers, who were treated with EV at Dokkyo Medical University Hospital between 2022 and 2024. Immunohistochemical staining was performed on formalin-fixed, paraffin-embedded tissue samples. Progression-free survival (PFS) was estimated using the Kaplan–Meier method, and differences between subgroups (e.g., Nectin-4 and ABC transporter expression) were compared using the log-rank test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Immunohistochemical analysis indicated that tumours with high ABC transporter expression exhibited shorter PFS time and poorer response to EV. Furthermore, a decrease in Nectin-4 expression and an increase in ABC transporter expression were observed as the disease progressed from non-muscle-invasive to muscle-invasive and metastatic. Patients with Nectin-4-positive and ABC transporter-negative tumours had the longest PFS, underscoring the prognostic significance of these biomarkers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>To our knowledge, this study is the first to show a correlation between ABC transporter expression and EV efficacy in urothelial carcinoma. Future research should focus on optimizing treatment strategies based on Nectin-4 and ABC transporter expression to improve outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061090","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":"The Global RAdical Cystectomy Evaluation and Management (GRACEM) pathway: single-centre prospective observational cohort study protocol","authors":"Bruno Bernardini,&nbsp;Federico Piccioni,&nbsp;Manuele Pastore,&nbsp;Paolo Casale,&nbsp;NicolòMaria Buffi,&nbsp;Giovanni Lughezzani,&nbsp;Massimo Lazzeri,&nbsp;Alberto Saita,&nbsp;Maria Vittoria Fantacci,&nbsp;Stefano Mancon,&nbsp;Filipo Dagnino,&nbsp;Roberto Contieri,&nbsp;Pietro Brin,&nbsp;Stefano Mancin,&nbsp;Andrea Gobbo,&nbsp;Maria Rosaria Martucci,&nbsp;Giovanna Cerina,&nbsp;Sara Ghirmai,&nbsp;Ezio Lanza,&nbsp;Giulia Goretti,&nbsp;Giorgio Ferruccio Guazzoni,&nbsp;Rodolfoi Hurle","doi":"10.1002/bco2.376","DOIUrl":"10.1002/bco2.376","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite guideline recommendations, few institutions have implemented clinical pathways that incorporate frailty into routine decision-making for patients undergoing radical cystectomy (RC). This paper presents an integrated clinical pathway designed to address the needs of frail patients undergoing RC. The purpose of the study is to determine whether a multifaceted prevention programme that tailors interventions to the syndromic components of frailty can improve postoperative morbidity and recovery time for patients. New insights will be gained into how to optimize the physical and mental status and quality of life of patients before and after surgery, up to 1 year later.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>The Global RAdical Cystectomy Evaluation and Management (GRACEM) study is a prospective, observational, single-centre, 2-year cohort study. Patient enrolment began on 27 April 2023, and results are pending.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Endpoints</h3>\u0000 \u0000 <p>The primary endpoints are postoperative morbidity and the in-hospital postoperative care burden. Postoperative morbidity is measured by the number of early (up to 1 month) and late (over 1 month and up to 12 months) complications, graded by severity according to the Clavien–Dindo classification. In-hospital postoperative care burden is measured by the number and duration of key care processes as recorded by the Care Process Monitoring Chart, a tool developed for this study. Secondary endpoints are changes in frailty and health-related quality of life (HRQoL) from pre-intervention to planned follow-up up to 1 year. Frailty is assessed with the Functional Limitations and Geriatric Syndromes Frailty Questionnaire (FLIGS-FQ), another ad hoc tool. HRQoL is assessed using the EQ-5D-5L questionnaire combined with the cystectomy-specific FACT-Bl-cys index from the first month of follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and methods</h3>\u0000 \u0000 <p>The GRACEM study includes patients with non-metastatic, histologically confirmed, muscle-infiltrating bladder cancer who underwent RC surgery with curative intent. This study is unique in that the GRACEM Core Team shares decision-making throughout the pathway, from before the intervention to the end of the patient's follow-up. The pathway involves the patient, family members and community services.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061009","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":"The significance of isolated de novo red patches in the bladder in patients referred with suspected urinary tract cancer: Results from the IDENTIFY study","authors":"Sinan Khadhouri,&nbsp;Kevin Gallagher,&nbsp;Kenneth R. MacKenzie,&nbsp;Taimur T. Shah,&nbsp;Chuanyu Gao,&nbsp;Eleanor Zimmermann,&nbsp;Miles Mannas,&nbsp;Taeweon Lee,&nbsp;Giancarlo Marra,&nbsp;Juan Gomez Rivas,&nbsp;Gautier Marcq,&nbsp;Mark A. Assmus,&nbsp;Taha Ucar,&nbsp;Francesco Claps,&nbsp;Matteo Boltri,&nbsp;Giuseppe Pizzuto,&nbsp;Tara Burnhope,&nbsp;Nkwam Nkwam,&nbsp;George Tanasescu,&nbsp;Nicholas E. Boxall,&nbsp;Alison P. Downey,&nbsp;Troy A. Sukhu,&nbsp;Marta Antón-Juanilla,&nbsp;Sonpreet Rai,&nbsp;Madeline Moore,&nbsp;Kathryn Bandeira de Mello,&nbsp;Sian Parsons,&nbsp;John S. McGrath,&nbsp;Veeru Kasivisvanathan,&nbsp;IDENTIFY Study Group: Pubmed indexed collaborator authors","doi":"10.1002/bco2.475","DOIUrl":"10.1002/bco2.475","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the contemporary malignancy rate in isolated de novo red patches in the bladder and associated risk factors for better selection of red patch biopsy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients</h3>\u0000 \u0000 <p>Patients from the IDENTIFY dataset; Patients referred to secondary care with suspected urinary tract cancer and found to have isolated de novo red patches on cystoscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reported the unadjusted cancer prevalence in isolated de novo red patches that were biopsied; multivariable logistic regression was used to explore cancer-associated risk factors including age, sex, smoking, type of haematuria, LUTS, UTIs and a suspicious-looking red patch (as reported by the cystoscopist). Sub-analysis of these by clinical role and experience was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1110 patients with isolated de novo red patches were included. 41.5% (n = 461) were biopsied, with a malignancy rate of 12.8% (59/461), which was significantly higher in suspicious versus non-suspicious red patches (19.1% vs. 2.81%, p &lt; 0.01). There was a significant association between bladder cancer and age (OR 1.04, 95% CI 1.01–1.07, p = 0.01), smoking history (OR 2.62, 95% CI 1.09–6.27, p = 0.03) and suspicious-looking patch (OR 6.50, 95% CI 2.47–17.1, p &lt; 0.01). The majority of malignancies were in over 60-year-olds. Malignancy rates in suspicious versus non-suspicious red patches did not differ significantly between clinical roles or experiences.</p>\u0000 \u0000 <p>Limitations included subjectivity in classifying a suspicious patch and selection bias as not all patches were biopsied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Many patients still undergo unnecessary biopsies under general anaesthetic for isolated de novo red patches. Clinicians should consider the patient's age, smoking status and how suspicious-looking the patch is, before deciding on surveillance versus biopsy to improve cancer diagnostic yield.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061015","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":"Concealed penis: A review of multilevel classification and surgical reconstruction techniques","authors":"Bo-yu Xiang,&nbsp;Jing-xuan Peng,&nbsp;Xue-jun Shang,&nbsp;Xiong-bing Zu,&nbsp;Dong-jie Li","doi":"10.1002/bco2.470","DOIUrl":"10.1002/bco2.470","url":null,"abstract":"<p>Concealed penis (CP), also known as hidden or buried penis, is an external genital deformity in which a normal-sized penis is covered by skin, subcutaneous tissue or fat tissue in the prepubic area, leading to abnormal exposure. This condition has significant morbidity and a negative effect on certain aspects of the patient's quality of life, including but not limited to hygiene, micturition, self-image and sexual function. Current classification systems for CP are heterogeneous, but most of these further classify CP based on their division into congenital concealed penis (CCP) and adult-acquired buried penis (AABP). The aetiology and pathogenesis of this disease are understood to some extent, but the specific underlying mechanisms need further research. Although conservative treatment may be effective for some children with CCP, surgical intervention is still the main treatment for other children with CCP and AABP. There is no ‘gold standard’ surgical treatment for CP, but there are various surgical methods available; therefore, individualized surgical plans should be created after a comprehensive evaluation based on the classification and aetiology of CP patients.</p>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061610","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":"The feasibility and safety of robotic-assisted salvage radical cystectomy","authors":"Gal Rinott Mizrahi,&nbsp;Nathan Lawrentschuk,&nbsp;Benjamin Thomas,&nbsp;Philip Dundee","doi":"10.1002/bco2.459","DOIUrl":"10.1002/bco2.459","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the feasibility and safety of robotic-assisted salvage radical cystectomy (RA-SRC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We retrospectively searched the prospectively collected surgical database of two highly experienced robotic urological surgeons for cases of RA-SRC, defined as RARC performed post-previous pelvic RT for palliative or oncologic treatment purposes. Collected data included demographic and clinical information and outcome measures including operative course, hospital stay and complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen patients were included in the current analysis. All patients had previous RT to the pelvis with 12 patients also having prior radical pelvic surgery. Indications for salvage cystectomy were either palliation (<i>n</i> = 12) or oncological (MIBC or high risk NMIBC, <i>n</i> = 6). There were no intraoperative complications and no conversions to open surgery. Ninety day postoperative complications were recorded in 11 patients (61.1%), with major complications (Clavien–Dindo grades 3 and 4) in three patients (16.6%). After a median follow-up of 43.5 months, one late postoperative complication was observed requiring surgical intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our data, together with the limited published data from other cohorts of RA-SRC, suggest that in experienced hands, RA-SRC is feasible, with intraoperative and perioperative complication rates that are lower than the published data for open SRC and are equivalent to open primary RC. These data will contribute to treatment decision making both in patients with post-pelvic radiation symptoms requiring palliation and patients with MIBC considering or treated with trimodal treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061007","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":"In silico tools for mechanical analysis of extra- and intra-luminal artificial urinary sphincters","authors":"Gianluca Mazzucco,&nbsp;Paola Pirini,&nbsp;Chiara Giulia Fontanella,&nbsp;Alice Berardo,&nbsp;Maria Vittoria Mascolini,&nbsp;Ilaria Toniolo,&nbsp;Leonardo Marziale,&nbsp;Tommaso Mazzocchi,&nbsp;Gioia Lucarini,&nbsp;Nicolò Spiezia,&nbsp;Emanuele Luigi Carniel","doi":"10.1002/bco2.473","DOIUrl":"10.1002/bco2.473","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To analyse and compare the functionality of extraluminal and intraluminal artificial urinary sphincters (AUSs), an in silico procedure has been defined and applied. Design and reliability assessments of the AUS are typically performed using a clinical approach, which does not provide data on mechanical stimulation of urethral tissues. Mechanical stimulation may determine tissue degeneration, such as urethral atrophy or erosion, the main causes of AUS failure. In silico techniques can provide a quantitative description of stress and strain fields due to the interaction between tissues and AUS and allow investigating an extremely large number of situations, considering different configurations of AUS and urethra.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Computational investigations were carried out to evaluate the mechanical reliability of the main extraluminal and intraluminal AUS, AMS 800 and Relief. The lower urinary tract was modelled based on previous experiments. The AUS models took into account the main components that interact with biological tissues. Urethra and AUS models were coupled and used to investigate mechanical stimulation of urethral tissues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In silico simulations provide quantitative information about the mechanical stimulation of urethral tissue, such as compressive strain and stress and hydrostatic pressure, due to interaction with the AUS. Such mechanical quantities allow a comparison of reliability between extraluminal and intraluminal devices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The activities define and demonstrate the effectiveness of a novel in silico approach to the design and reliability assessment of AUS devices, increasing the investigative possibilities and reducing the time, ethical and economic costs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061067","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":"Safety and feasibility of En-bloc holmium laser enucleation for very large prostates (> 200 cc) with trainee involvement","authors":"Feres C. Maluf,&nbsp;Ansh Bhatia,&nbsp;Archan Khandekar,&nbsp;Diana M. Lopategui,&nbsp;Joao G. Porto,&nbsp;Ryan R. Chen,&nbsp;Jean C. Daher,&nbsp;Mohamadhusni Zarli,&nbsp;Robert Marcovich,&nbsp;Hemendra N. Shah","doi":"10.1002/bco2.469","DOIUrl":"10.1002/bco2.469","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the safety and feasibility of “en-bloc” Holmium Laser Enucleation of the Prostate (HoLEP) with trainee involvement in patients with prostates larger than 200 cc.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on patients undergoing HoLEP using the “en-bloc” technique for prostate sizes &gt; 200 cc between July-2017 and December-2023 at an academic teaching hospital. Perioperative data was collected, including patient demographics, clinical parameters, operative details and functional outcomes. Patients who continued to experience incontinence at 1 year were further followed up at 2 years to update their continence status. Sub-group analysis was performed to compare outcomes between patients with preoperative prostate size of 200–300 cc and &gt; 300 cc.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analysis included 89 patients with a mean age of 73.12 ± 8.10 years. Preoperative prostate weight ranged from 200 to 401 cc with a median of 245 cc, and median PSA was 7.71 ng/ml. Median operative time was 218.5 minutes, and median enucleated prostate volume was 164.2 cc. Median postoperative PSA was 0.4 [0.21–0.78] ng/ml. At 1-year follow-up, mean IPSS was 1 ± 2.4, Qmax was 27.03 ± 11.57 ml/s and PVR was 21.6 ± 28.6 ml. Postoperative complications included blood transfusion (5.6%), acute renal injury (4.5%), urinary tract infection (2.2%), postoperative urinary retention (2.2%) and urethral stricture (5%). Although transient urinary incontinence was noted in 41.6% at 1–3-months, complete continence was achieved in 83.3% and 96.3% at 1 and 2 years postoperatively, respectively. Subgroup analysis showed significant differences in operative time and enucleated weight between prostates 200–300 cc and &gt; 300 cc, but no significant differences in postoperative IPSS, PVR or Qmax at 3-months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>“En-bloc” HoLEP is a feasible and safe procedure for prostates larger than 200 cc, demonstrating favourable perioperative and functional outcomes despite the extended operative times and involvement of trainees.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061005","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":"Does bladder outflow obstruction obfuscate the traditional clinical factors that are used to assess the risk of prostate cancer at rapid-access diagnostic clinics?","authors":"Thomas Philip Cahill,&nbsp;Samuel Joseph Withey,&nbsp;Steve Hazell,&nbsp;Declan Cahill,&nbsp;Netty Kinsella","doi":"10.1002/bco2.478","DOIUrl":"10.1002/bco2.478","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To understand whether bladder outflow obstruction influences the association between traditional clinical predictive factors, particularly prostate-specific antigen (PSA) density and clinically significant prostate cancer (csPCa). This will help facilitate effective and evidence-based triaging of patients in rapid-access clinics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We retrospectively analysed prospectively collected data from 307 suspected prostate cancer patients who underwent diagnostic biopsy from 2019 to 2023 at a single, high-volume, specialist cancer centre. Uroflowmetry testing generated two cohorts: patients with bladder outflow obstruction and non-obstructed patients. The cohort characteristics between the groups were compared and logistic regression analyses were performed to assess associations between clinical predictive factors (age, PSA density, ethnicity, family history, digital rectal examination, urinary symptom severity and magnetic resonance imaging using the PI-RADS scoring system) and clinically significant prostate cancer (csPCa) on biopsy (defined as International Society of Urological Pathology grade of greater than or equal to two).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The obstructed group (<i>n</i> = 80) had significantly larger prostates and worse symptom severity (<i>p</i> &lt; 0.05). There was no significant difference between the other predictive factors or csPCa compared to the non-obstructed (<i>n</i> = 227) cohort. Multivariable logistic regression analysis showed age, PSA density, an abnormal digital rectal examination and scoring PI-RADS 4–5 on magnetic resonance imaging were all significantly associated with csPCa in the non-obstructed cohort (<i>p</i> &lt; 0.05). Contrastingly, only symptom severity and scoring PI-RADS 5 were significantly associated with csPCa for the obstructed patients (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In the presence of bladder outflow obstruction, traditional predictive variables such as age, PSA density, digital rectal examination and scoring PI-RADS 4 are not associated with csPCa. This study suggests that using these predictive variables to triage patients in rapid-access clinics with a patient who has bladder outflow obstruction could lead to the overuse of invasive biopsy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061614","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":"Long-term follow-up of intradetrusor botulinum toxin utilisation: A comparison of patients with multiple sclerosis and idiopathic overactive bladder","authors":"William Chui,&nbsp;Joshua Kealey,&nbsp;Henry H. Yao,&nbsp;Garson Chan,&nbsp;Alvaro Bazo,&nbsp;Richard Parkinson,&nbsp;Helen E. O'Connell,&nbsp;Johan Gani","doi":"10.1002/bco2.479","DOIUrl":"10.1002/bco2.479","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess long-term outcomes (up to 10 cycles) of repeated intradetrusor botulinum toxin (BoNT) utilisation in multiple sclerosis (MS) and idiopathic overactive bladder (OAB).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This is a retrospective, international, multi-centre, observational cohort study of patients diagnosed with MS and neurogenic OAB and treated with intradetrusor BoNT between January 2005 and January 2020 (just prior to COVID-19 interruption). Dose, efficacy, duration of effect, International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and International Consultation on Incontinence Questionnaire Urinary Incontinence (ICIQ-UI) measures and complication rates were recorded. Comparisons were made to those with idiopathic OAB.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven hundred and ninety-two patients received intradetrusor BoNT treatment (104 had MS with neurogenic OAB and 688 had idiopathic OAB). Patients with MS were more likely to receive higher doses of BoNT in all cycles. Self-reported efficacy ranged from 85.7 to 100% (MS) and 87.2 to 100% (idiopathic) with MS patients reporting increased efficacy in cycles 1–3 comparatively (<i>p</i> &lt; 0.05). Duration of effect ranged from 4.5 to 9 months with a reduction in the MS cohort between cycles 1 and 10 (median 8 months vs. 5 months, <i>p</i> = 0.0156).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with MS and neurogenic OAB have a good therapeutic effect from intradetrusor BoNT that is sustained over at least 10 cycles with significant reduction in the duration of action with subsequent cycles.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061085","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":"Post-operative incidence of lymphedema after RARP with or without extended pelvic lymph node dissection in a cohort study","authors":"Andries Clinckaert,&nbsp;Laura Ysenbaardt,&nbsp;Annabel Bijnens,&nbsp;Charlotte Van Calster,&nbsp;Inge Geraerts,&nbsp;Steven Joniau,&nbsp;Nele Devoogdt,&nbsp;Luc Bijnens,&nbsp;Wouter Everaerts","doi":"10.1002/bco2.466","DOIUrl":"10.1002/bco2.466","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Lymphedema of the lower limbs and pubic area is a potential complication following extended pelvic lymph node dissection (ePLND) during robot-assisted radical prostatectomy (RARP). The incidence of lymphedema after ePLND has not been systematically reported in the literature. This study aimed to determine the incidence of lymphedema, describe its clinical characteristics and identify specific risk factors in patients undergoing RARP with or without ePLND.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted at a tertiary referral centre between April 2016 and July 2020. Structured electronic case report forms (eCRFs) integrated into the electronic health record system were used to document intraoperative, perioperative and postoperative data. The primary endpoint was the incidence of lymphedema. Secondary endpoints included risk factors for and localization of the postoperative lymphedema.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 500 patients who underwent RARP were included, with 301 patients undergoing ePLND and 199 patients without any form of PLND. Median follow-up period was 18 (range 3–49) months. Seventy-eight out of 301 (26%) of patients who underwent ePLND developed lymphedema, compared to only 2 out of 199 (1%) patients without ePLND. In most patients (49/301, 16%), lymphedema was mild (grade 1), whereas 29 patients (10%) developed grade 2 lymphedema. Twenty-six patients (9%) received decongestive lymphatic therapy. The most frequent site of lymphedema occurrence were the lower (54%) and the upper legs (40%). The number of nodes removed during RARP was identified as a risk factor for post-operative lymphedema (OR 1.04; <i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this cohort study, approximately one in four patients undergoing RARP with ePLND developed lower limb and/or midline oedema, whereas one in ten patients started decongestive lymphatic therapy for symptomatic lymphedema. These findings provide valuable information for patient counselling about the potential benefits and risks of ePLND.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061088","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}