BJUI compass最新文献

{"title":"Impact of race and ethnicity on clinical outcomes and recurrence post-ureteral reconstruction","authors":"Dhruv Puri,&nbsp;Eric Cho,&nbsp;Kian Ahmadieh,&nbsp;Nishant Garg,&nbsp;Cesar Delgado,&nbsp;Benjamin Cedars,&nbsp;Michael Witthaus,&nbsp;Michael Pan,&nbsp;Jill C. Buckley","doi":"10.1002/bco2.450","DOIUrl":"10.1002/bco2.450","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Ureteral stricture disease (UTSD) poses significant challenges in reconstructive urology, with recent advances highlighting disparities in healthcare outcomes based on race and ethnicity. This study investigates the impact of race and ethnicity on clinical outcomes following ureteral reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a single-centre prospective analysis of 233 patients who underwent ureteral reconstruction for UTSD from 2014 to 2023. Patient demographics, clinical characteristics, surgical details and outcomes were collected. Patients were stratified by race (White vs. non-White) and ethnicity (Hispanic vs. non-Hispanic). Statistical analyses included Kruskal–Wallis, Mann–Whitney <i>U</i> tests, ANOVA, Kaplan–Meier analysis and multivariate logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our cohort included 233 patients who underwent ureteroplasty with 108 (46.4%) non-White patients, and 71 (30.5%) were Hispanic. No significant differences were found in recurrence rates, complications, or stricture-free survival between racial and ethnic groups. Prior reconstructions were more prevalent among non-White patients (26.9% vs. 16.0%; <i>p</i> = 0.043). Unadjusted and adjusted regressions showed significant associations between non-White race (unadjusted <i>β</i> = 0.76, <i>p</i> = 0.008; adjusted <i>β</i> = 0.82, <i>p</i> = 0.008) and Hispanic ethnicity (unadjusted <i>β</i> = 0.70, <i>p</i> = 0.025; adjusted <i>β</i> = 0.79, <i>p</i> = 0.020) with increased stricture lengths.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study highlights that although recurrence and complication rates do not significantly differ by race or ethnicity, disparities exist in clinical presentations, with non-White and Hispanic patients presenting with longer stricture lengths and higher body mass index. These findings underscore the need for targeted interventions to address underlying disparities in healthcare delivery and access.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 12","pages":"1255-1262"},"PeriodicalIF":1.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916375","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":"Trends in incidence and demographics of testicular cancer in California, 2000–2020","authors":"David J. Benjamin,&nbsp;Anshu Shrestha,&nbsp;Dimitra Fellman,&nbsp;Arash Rezazadeh Kalebasty","doi":"10.1002/bco2.451","DOIUrl":"10.1002/bco2.451","url":null,"abstract":"&lt;p&gt;The incidence of testicular cancer has been rising globally among young adult men for the past five decades for reasons not currently well-understood.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Although a rare genitourinary malignancy that is generally curable, testicular cancer remains a significant public health concern due to long-term medical, psychological and social burden associated with treatment and its short- and long-term toxicities.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Risk factors leading to the development of testicular cancer include age, family or personal history of testicular cancer, cryptorchidism, race/ethnicity and recreational drug use such as marijuana.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;White males have historically had the highest incidence rates of testicular cancer, while Black males have the lowest incidence rates. However, data from 2001 to 2016 extracted from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) programme demonstrated that the incidence of testicular cancer was rising throughout the United States and Asian/Pacific Islander men had the largest increases in incidence followed by Hispanic men.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Given that California is the most populous state in the United States and one of the most racially/ethnically diverse populations, we sought to evaluate trends in demographics including race/ethnicity from updated population data up to the year 2020.&lt;/p&gt;&lt;p&gt;Males diagnosed with testicular cancer between 2000 and 2020 were identified through the California Cancer Registry (CCR) database, one of the largest cancer registries in the United States. Cases were excluded if the age at the time of diagnosis was unknown. Incidence rates per 100 000, stratified by year of diagnosis, race/ethnicity and age were calculated, and age-adjusted to the 2000 US Standard Population. This study involved analysis of de-identified data from the state-mandated cancer registry database and as such, does not require patient informed consent. Therefore, the study was exempt from Institutional Review Board (IRB) approval.&lt;/p&gt;&lt;p&gt;We identified a total of 23 214 cases of testicular cancer during the study period. Most men (71.5%, &lt;i&gt;n&lt;/i&gt; = 16 599) were below age 40 at the time of diagnosis. The majority of men were non-Hispanic white (52.5%, &lt;i&gt;n&lt;/i&gt; = 12 191), followed by Hispanic (37.6%, &lt;i&gt;n&lt;/i&gt; = 8720), Asian/Pacific Islander (5.0%, &lt;i&gt;n&lt;/i&gt; = 1170) and non-Hispanic Black (1.8%, &lt;i&gt;n&lt;/i&gt; = 422). Testicular cancer diagnoses were equally distributed between neighbourhood socio-economic status (nSES) groups (highest quintile (20.3%), upper-middle (21.3%), middle (21.0%), lower-middle (20.2%) and lowest (17.3%)). Additional demographic information including marital status and Charlson comorbidity index are available in Table S1.&lt;/p&gt;&lt;p&gt;Testicular cancer incidence rate rose among all racial/ethnic groups in California between 2000 and 2020. The rates rose at a faster pace among Hispanic and Asian/Pacific Islander men durin","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 12","pages":"1249-1251"},"PeriodicalIF":1.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916415","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":"Investigating the prognostic utility of GSTP1 promoter methylation in prostate cancer","authors":"Ruth Pidsley,&nbsp;Dilys Lam,&nbsp;Wenjia Qu,&nbsp;Phillip Stricker,&nbsp;James G. Kench,&nbsp;Lisa G. Horvath,&nbsp;Susan J. Clark","doi":"10.1002/bco2.445","DOIUrl":"10.1002/bco2.445","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aim to determine the prognostic significance of <i>glutathione S-transferase Pi 1</i> DNA methylation (<i>mGSTP1</i>) in two independent prostate cancer cohorts with long-term clinical follow-up data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Subjects/Patients and Methods</h3>\u0000 \u0000 <p>We first re-examined a published, in-house whole genome bisulphite sequencing (WGBS) prostate cancer dataset, derived from radical prostatectomy (RP) tissue (<i>n</i> = 15) with median follow-up 19.5 years, to confirm and visualise the association between <i>mGSTP1</i> and patient mortality. To validate prognostic significance, we used a quantitative methylation-specific head-loop (MS-HL) assay to measure <i>mGSTP1</i> levels in a larger, independent cohort (<i>n</i> = 186), and performed univariable and multivariable Cox survival analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Re-analysis of WGBS data showed a significant increase in <i>mGSTP1</i> in RP samples from patients with lethal versus non-lethal disease. Subsequent analysis in the larger cohort using the MS-HL assay confirmed that <i>mGSTP1</i> was detectable in 97% of RP samples, validating the diagnostic potential of <i>mGSTP1</i>. Univariable Cox survival analysis revealed a significant association between <i>mGSTP1</i> levels and biochemical recurrence and metastatic relapse free survival, with a near-significant association with prostate cancer specific mortality. Notably, multivariable Cox models demonstrated that <i>mGSTP1</i> did not add independent prognostic value beyond standard clinicopathological features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study supports the importance of DNA methylation as a tissue-based prostate tumour biomarker. <i>GSTP1</i> methylation is well established as a diagnostic marker, and in this study, we find that <i>GSTP1</i> methylation levels are also associated with disease prognosis. Further research is required into the clinical utility of prognostic methylation markers and their functional role in disease progression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 12","pages":"1299-1306"},"PeriodicalIF":1.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916378","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":"Comparing outcomes of Aquablation versus holmium laser enucleation of prostate in the treatment of benign prostatic hyperplasia: A network meta-analysis","authors":"Ansh Bhatia,&nbsp;Renil Titus,&nbsp;Joao G. Porto,&nbsp;Rajvi Goradia,&nbsp;Khushi Shah,&nbsp;Diana Lopategui,&nbsp;Thomas R. W. Herrmann,&nbsp;Hemendra N. Shah","doi":"10.1002/bco2.454","DOIUrl":"10.1002/bco2.454","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Water Jet Ablation Therapy (WJAT) and Holmium Laser Enucleation of the Prostate (HoLEP) represent two common surgical treatments for Benign Prostatic Hyperplasia (BPH). Despite their increasing use, there is no study between these two methods. We aim to evaluate their efficacy and safety through a network meta-analysis (NMA), providing critical insights for clinical decision-making in the management of moderate to severe lower urinary tract symptoms (LUTS) due to BPH.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Pubmed, EMBASE and Cochrane Library were searched. Randomized controlled trials and prospective single-arm studies comparing WJAT and HoLEP with TURP, reporting symptom scores, flow rates and adverse events. Data extraction and quality assessments were independently performed. Bayesian modelling in RStudio was used for statistical analysis, evaluating continuous outcomes through mean difference and categorical variables via risk ratios. Risk-of-Bias (RoB) and GRADE assessments were performed.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Findings&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Twenty-three studies were included (WJAT-11, HoLEP-12). Most studies were at some or high risk of bias. At 12 months, the IPSS, Qol, PVR and Qmax improvements were 4.14 points (95% CI: -0.34 to 8.64, not-significant [NS], GRADE-rating: Low), 0.32-points (95% CI:-10.70 to 3.27, NS, GRADE-rating: Low), 2.45 ml/s (95% CI: -1.85 to 7.05, NS, GRADE-rating: Low), 63.10 ml (95% CI: 39.80 to 87.30, statistically-significant [SS], GRADE-rating: Moderate), respectively, all in favour of HoLEP. Haemoglobin-loss was lower with HoLEP, 1.16 g/dl (95% CI: -2.56 to 0.54 mg/dl, NS, GRADE-rating: Moderate) than WJAT. The risk of incontinence was higher with HoLEP; 4.48 (95% CI: 0.22 to 168.50, NS, GRADE-rating: Very Low) than WJAT in single–arm analysis. The risk of blood transfusion was higher with WJAT (RR = 0.14; 95% CI: 0.00 to 4.21, NS, GRADE-rating: Low) than HoLEP. Risk of Total Serious Adverse Events (Clavien-Dindo grade&gt;3) was higher with HoLEP (RR = 1.12, higher with HoLEP, 95% CI: 0.20 to 12.71, NS, GRADE-rating: Low) than WJAT. Retreatment was lower with HoLEP (RR = 0.46, 95% CI: 0.02 to 10.54 GRADE-rating: Low) than WJAT.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Interpretation&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Our study suggests that both HoLEP and WJAT are effective treatments for BPH, both with similar IPSS and QoL improvements. HoLEP excels in functional outcomes, particularly in improving Qmax and PVR. Conversely, WJAT, with its shorter operation time and hospital stays, presents a compelling alter","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 12","pages":"1231-1245"},"PeriodicalIF":1.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916396","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":"Targeted microwave ablation of localised prostate cancer: Initial results of VIOLETTE trial","authors":"Nicolas Barry Delongchamps,&nbsp;Alexandre Peltier,&nbsp;Eric Potiron,&nbsp;Franck Bladou,&nbsp;Julien Anract,&nbsp;Romain Diamand,&nbsp;Grégoire Robert,&nbsp;Aurel Messas,&nbsp;Roland Van Velthoven","doi":"10.1002/bco2.444","DOIUrl":"10.1002/bco2.444","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of this study was to assess the precision and safety of targeted microwave ablation (TMA) using organ-based tracking (OBT) fusion, in patients with intermediate risk prostate cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and method</h3>\u0000 \u0000 <p>We conducted a prospective, multicentric trial. Eligible patients had a prostate-specific antigen (PSA) &lt; 20 ng/mL, a magnetic resonance imaging (MRI)-visible index tumour of Gleason score 3 + 4, with largest axis ≤15 mm and distant of at least 5 mm from the rectum and apex. TMA was performed with microwave needle applicator using OBT fusion, with a transperineal or a transrectal approach. In this interim analysis, we evaluated precision, safety, urinary and sexual outcomes, and PSA density kinetics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At this point, 37 patients were treated in five centres. Median (interquartile range) age is 68 (63–72) years. Baseline median prostate volume and PSA are of 45 (34–57) mL and 8 (6.2–10.8) ng/mL, respectively. Median largest tumour axis on T2W MRI is of 11 mm (10–13). Patients were treated under general anaesthesia or conscious IV sedation in an outpatient setting. Anaesthesia had a median duration of 78 (66–90) min. A median number of 3 (2–4) 12-W ablations of 2 to 5 min were performed per patient. After a median follow-up of 6 (2.4–10) months, we observed 58 adverse events (AE) in 22 patients. These were of Common Terminology Criteria for Adverse Events (CTCAE) grade 1, 2 and 3 in 43 (74%), 13 (22%) and 2 (4%) cases. Six (15%) patients had an acute urinary retention, five of which considered as severe AE because of rehospitalisation. We did not observe any significant difference in International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire-ejaculatory dysfunction (MSHQ-EjD) and International Index of Erectile Function (IIEF5) from baseline to last follow-up. Median PSA density evolved from 0.2 (0.1–0.3) at baseline to 0.1 (0.07–0.16) at 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These preliminary results suggest that TMA using OBT fusion is precise and safe in patients with intermediate risk localised prostate cancer. Further inclusions and follow-up are needed to assess oncological outcome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 12","pages":"1307-1313"},"PeriodicalIF":1.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916413","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":"Robot-assisted laparoscopic continent cutaneous urinary diversion in adults: A single-centre study","authors":"Thomas Loubersac,&nbsp;Etienne Lavallée,&nbsp;Benédicte Reiss,&nbsp;Marc Lefort,&nbsp;Pierre Kieny,&nbsp;Marc-David Leclair,&nbsp;Jérome Rigaud,&nbsp;Loic Le Normand,&nbsp;Brigitte Perrouin-Verbe,&nbsp;Chloé Lefevre,&nbsp;Marie-Aimée Perrouin-Verbe","doi":"10.1002/bco2.449","DOIUrl":"10.1002/bco2.449","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To show that robot-assisted laparoscopic cutaneous continent urinary diversion (RALCCUD) is feasible and safe; however, data on clinical outcomes in adults are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and methods</h3>\u0000 \u0000 <p>We conducted a retrospective study of all adults who underwent RALCCUD between 2017 and 2022 at a single tertiary reference centre.</p>\u0000 \u0000 <p>Patient characteristics, clinical information and perioperative outcomes were recorded. All patients underwent pre- and postoperative urodynamic evaluations.</p>\u0000 \u0000 <p>Functional outcomes were evaluated at 3 months, then yearly. Continence was defined as no stomal or urethral leakage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twelve patients, mostly women (<i>n</i> = 11), median (IQR) age 47.4 (19–57) years underwent RALCCUD (four Mitrofanoff, four Yang-Monti and four Casale). The main indication for surgery was inability to perform intermittent self-catheterization through the native urethra.</p>\u0000 \u0000 <p>Eleven patients (92%) had neurogenic lower urinary tract disease caused by spinal cord injury or spinal dysraphism.</p>\u0000 \u0000 <p>Median (IQR) operative time was 313 (285–367) min. Four patients (33%) underwent concomitant procedures: three supratrigonal cystectomy (SC) with augmentation cystoplasty (AC) and one artificial urinary sphincter (AUS). No conversions to an open approach were required. Median (IQR) follow-up was 51 (40–61) months. One early postoperative complication occurred (Clavien grade III). The late postoperative complication rate was 17%, with three complications occurring in three patients.</p>\u0000 \u0000 <p>At the last follow-up, all patients could self-catheterize through the tube, and the stomal and urethral continence rate was 100%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>RALCCUD is feasible and safe in adults, with a high rate of stomal and urethral continence and a low complication rate.</p>\u0000 </section>\u0000 </div>","PeriodicalId":72420,"journal":{"name":"BJUI compass","volume":"5 12","pages":"1269-1277"},"PeriodicalIF":1.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916409","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":"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}