Canadian Urological Association journal = Journal de l'Association des urologues du Canada最新文献

{"title":"Helping patients holistically.","authors":"Joseph Moryousef","doi":"10.5489/cuaj.8499","DOIUrl":"https://doi.org/10.5489/cuaj.8499","url":null,"abstract":"","PeriodicalId":9574,"journal":{"name":"Canadian Urological Association journal = Journal de l'Association des urologues du Canada","volume":"17 8","pages":"S166"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10426411/pdf/cuaj-8-S166.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10387757","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":"New CUA guideline: A valuable reference for counselling men with azoospermia.","authors":"Peter N Schlegel","doi":"10.5489/cuaj.8472","DOIUrl":"https://doi.org/10.5489/cuaj.8472","url":null,"abstract":"","PeriodicalId":9574,"journal":{"name":"Canadian Urological Association journal = Journal de l'Association des urologues du Canada","volume":"17 8","pages":"242"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10426417/pdf/cuaj-8-242.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10012159","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 CUA annual meeting: Reconnecting, rejuvenating, and reinforcing our sense of community.","authors":"D Robert Siemens","doi":"10.5489/cuaj.8489","DOIUrl":"https://doi.org/10.5489/cuaj.8489","url":null,"abstract":"","PeriodicalId":9574,"journal":{"name":"Canadian Urological Association journal = Journal de l'Association des urologues du Canada","volume":"17 8","pages":"227"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10426428/pdf/cuaj-8-227.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10012165","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":"Being a good doctor: More than just technical skills and medical knowledge.","authors":"Nik Mookerji","doi":"10.5489/cuaj.8504","DOIUrl":"https://doi.org/10.5489/cuaj.8504","url":null,"abstract":"","PeriodicalId":9574,"journal":{"name":"Canadian Urological Association journal = Journal de l'Association des urologues du Canada","volume":"17 8","pages":"S171"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10426425/pdf/cuaj-8-S171.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10387748","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":"PSMA-PET in Canada: More questions than answers.","authors":"Heather Morris, Luke T Lavallée","doi":"10.5489/cuaj.8490","DOIUrl":"https://doi.org/10.5489/cuaj.8490","url":null,"abstract":"The era of PSMA-PET has arrived in Canada, and while patients and physicians are excited about how it may personalize treatment and improve outcomes, in many circumstances, it remains unclear how to apply information from PSMA-PET to patient care and if treatment modification based on PET improves outcomes. Furthermore, current access to PSMA-PET in Canada is limited, inequitable, and costly, forcing physicians to contemplate how to best use this resource. It is well-established that PSMA-PET has superior sensitivity and specificity than conventional imaging for prostate cancer detection.1 While Health Canada approved its first PSMA avid radiopharmaceutical, Gallium-98, in October 2022, routine use of PSMAPET is not established in Canada, and access is mainly through trials, private healthcare, and registries. In this month’s CUAJ, Arifin et al examine the impact of PSMA-PET on prostate cancer management and outcomes.2 The authors examined a cohort of patients with or without access to F-DCFPyL PSMA-PET prior to receiving salvage radiotherapy (RT) following biochemical recurrence (BCR) after radical prostatectomy (RP). The PSMA-PET cohort had a higher median presalvage RT prostate-specific antigen (PSA), a longer time from surgery to RT, and a higher proportion of patients receiving RT to pelvic lymph nodes. Despite the higher PSA levels in the PSMA-PET group, oncological outcomes were similar between the two cohorts. When specifically comparing late-salvage RT PSMA patients to early-salvage non-PSMA patients, the outcomes remained similar. These results insinuate that delays in treatment to access PSMA scans may not impact outcomes, or that information obtained from PSMA scans may allow physicians to tailor treatments to render them more effective. Of note, the authors excluded patients who did not receive RT due to negative PET imaging but acknowledged that future studies could include these patients. Emmet et al found that of the patients with a negative PSMA-PET scan who did not receive salvage RT, 66% had PSA progression, with a mean PSA rise of 1.59 ng/mL over the three-year period.3 Further research that includes patients with treatment de-escalation based on PSMA-PET results is required to determine the safety of this approach. A prospective trial of 635 patients reported PSMA-PET-directed therapy alone resulted in a PSA response in 80% of patients.1 A meta-analysis reported a pooled change in management after PSMA-PET of 56% for patient with BCR.4 Higherlevel evidence will hopefully be available in the coming years from a Canadian randomized control trial (PATRON) that is accruing and will examine if PSMA-PET-guided treatment improves cancer outcomes compared to conventional imaging in patients at high risk of recurrence.5 Other exciting areas of research with PSMA-PET include metastasis-directed therapy6 and directing radioligand therapy.7 While it seems certain PSMA-PET imaging will soon have a more established role for Canadian prosta","PeriodicalId":9574,"journal":{"name":"Canadian Urological Association journal = Journal de l'Association des urologues du Canada","volume":"17 8","pages":"254"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10426419/pdf/cuaj-8-254.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10387751","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 near-death experience.","authors":"Bruce Gao","doi":"10.5489/cuaj.8497","DOIUrl":"https://doi.org/10.5489/cuaj.8497","url":null,"abstract":"","PeriodicalId":9574,"journal":{"name":"Canadian Urological Association journal = Journal de l'Association des urologues du Canada","volume":"17 8","pages":"S164"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10426408/pdf/cuaj-8-S164.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10012158","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":"Hospital encounters and associated costs of prostate evaluation for clinically important disease MRI vs. standard evaluation procedures (PRECISE) study from a provincial-payer perspective.","authors":"Soo Jin Seung,&nbsp;Hasnain Saherawala,&nbsp;Lena Nguyen,&nbsp;Jodi M Gatley,&nbsp;Ning Liu,&nbsp;Marlene Kebabdjian,&nbsp;Craig Earle,&nbsp;Laurence Klotz,&nbsp;Nicole Mittmann","doi":"10.5489/cuaj.8197","DOIUrl":"https://doi.org/10.5489/cuaj.8197","url":null,"abstract":"<p><strong>Introduction: </strong>Systematic transrectal ultrasonography (TRUS) biopsy has been the standard diagnostic tool for prostate cancer (PCa) but is subject to limitations, such as a high false-negative rate of cancer detection. Multiparametric magnetic resonance imaging (mpMRI) prior to biopsy is emerging as an alternative diagnostic procedure for PCa. The PRECISE study found that MRI followed by a targeted biopsy was more accurately able to identify clinically significant cancer than TRUS biopsy.</p><p><strong>Methods: </strong>PRECISE study patients recruited in Ontario between January 2017 and November 2019 were linked to various Ontario provincial administrative databases available at the Institute for Clinical and Evaluative Sciences (ICES ) to determine health resources used, associated costs, and hospitalizations in the 14 days after biopsy. Costs are presented in 2021 CAD.</p><p><strong>Results: </strong>A total of 281 males were included in this study, with 48.4% of the patients in the TRUS biopsy group, 28.1% in the MRI+, and 23.5% in the MRI- group. Twenty-one patients (15%) from the TRUS biopsy group were seen at a hospital in the 14 days after their biopsy compared to fewer than five patients (6%) from the MRI+ group. The mean per person per year (PPPY) costs for the TRUS and all MRI groups (MRI- and MRI+) were $7828 and $8525, respectively.</p><p><strong>Conclusions: </strong>Patients in the TRUS biopsy group experienced more hospital encounters compared to patients who received an MRI prior to their biopsy. This economic analysis suggests that MRI imaging prior to biopsy is not associated with a significant increase in costs.</p>","PeriodicalId":9574,"journal":{"name":"Canadian Urological Association journal = Journal de l'Association des urologues du Canada","volume":"17 8","pages":"280-284"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10426432/pdf/cuaj-8-280.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10012161","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":"\"Who would you like me to call?\"","authors":"Adam Bobrowski","doi":"10.5489/cuaj.8502","DOIUrl":"https://doi.org/10.5489/cuaj.8502","url":null,"abstract":"","PeriodicalId":9574,"journal":{"name":"Canadian Urological Association journal = Journal de l'Association des urologues du Canada","volume":"17 8","pages":"S169"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10426416/pdf/cuaj-8-S169.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10012166","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":"Management of testicular cancer: Practice survey in localized stage.","authors":"Benoît Mesnard,&nbsp;Jean-François Hetet,&nbsp;Emmanuel Couteau,&nbsp;Arthur Fosse,&nbsp;Vincent Bocquillon,&nbsp;Alexis Gignoux,&nbsp;Michel Baron,&nbsp;Nicolas Gaschignard,&nbsp;Jérôme Rigaud","doi":"10.5489/cuaj.8239","DOIUrl":"https://doi.org/10.5489/cuaj.8239","url":null,"abstract":"<p><strong>Introduction: </strong>Management of testicular cancer requires a complete evaluation to confirm the localized stage and effective treatment according to guidelines to ensure the best outcome. The primary objective of this study was to evaluate practices at each stage of care in patients with a localized testicular tumor. The secondary objective was to evaluate the oncological prognosis of these patients according to the modalities of care.</p><p><strong>Methods: </strong>We conducted a multicenter practice evaluation study with retrospective collection and evaluation of patient records. The study was conducted in two French departments (population pool of 2 million inhabitants) between January 1, 2010, and January 31, 2015, enabling a five-year followup of patients. Patients presenting with stage I testicular tumor according to the American Joint Committee on Cancer classification were included in the analysis.</p><p><strong>Results: </strong>A total of 226 records were analyzed; 93% of patients underwent bilateral scrotal ultrasound and 93.25% had a chest-abdomen-pelvis computed tomography scan. A total of 29.65% of patients had a preoperative tumor marker assay in accordance with guidelines; 94% of patients had a total orchiectomy, with a median time of 15 days. At the end of the followup period, 17 patients had suffered a recurrence of their disease. Providing adjuvant care in accordance with guidelines reduced the risk of recurrence in patients with a seminomatous tumor.</p><p><strong>Conclusions: </strong>Our study showed heterogeneity in compliance with guidelines for evaluation and effective treatment of patients with a localized testicular tumor. Some essential practices, such as assays of tumor markers and fertility preservation for patients over 40 years, were not well carried out. Adjuvant management of localized tumors appears to be an important predictor of recurrence.</p>","PeriodicalId":9574,"journal":{"name":"Canadian Urological Association journal = Journal de l'Association des urologues du Canada","volume":"17 8","pages":"E236-E243"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10426415/pdf/cuaj-8-e236.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10387754","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 quantitative analysis of voiding cystourethrogram features confirms the association between high-grade vesicoureteral reflux with male sex, younger age, and hydronephrosis.","authors":"Adree Khondker,&nbsp;Jethro C C Kwong,&nbsp;Priyank Yadav,&nbsp;Justin Y H Chan,&nbsp;Anuradha Singh,&nbsp;Lauren Erdman,&nbsp;Daniel T Keefe,&nbsp;Mandy Rickard,&nbsp;Armando J Lorenzo","doi":"10.5489/cuaj.8460","DOIUrl":"https://doi.org/10.5489/cuaj.8460","url":null,"abstract":"<p><strong>Introduction: </strong>Vesicoureteral reflux (VUR) is commonly diagnosed in the workup of urinary tract infections or hydronephrosis in children. Traditionally, VUR severity is graded subjectively based on voiding cystourethrogram (VCUG) imaging. Herein, we characterized the association between age, sex, and indication for VCUG, by employing standardized quantitative features.</p><p><strong>Methods: </strong>We included renal units with a high certainty in VUR grade (>80% consensus) from the qVUR model validation study at our institution between 2013 and 2019. We abstracted the following variables: age, sex, laterality, indication for VCUG, and qVUR parameters (tortuosity, ureter widths on VCUG). High-grade VUR was defined as grade 4 or 5 The association between each variable and VUR grade was assessed.</p><p><strong>Results: </strong>A total of 443 patients (523 renal units) were included, consisting of a 48:52 male/female ratio. The median age at VCUG was 13 months. Younger age at VCUG (<6 months) was associated with greater odds of severe VUR (odds ratio [OR] 2.0), and there was a weak correlation between age and VUR grade (ρ=-0.17). Male sex was associated with increased odds of high-grade VUR (OR 2.7). VCUGs indicated for hydronephrosis were associated with high-grade VUR (OR 4.1) compared to those indicated for UTI only. Ureter tortuosity and width were significantly associated with each clinical variable and VUR severity.</p><p><strong>Conclusions: </strong>Male sex, younger age (<6 months), and history of hydronephrosis are associated with both high-grade VUR and standardized quantitative measures, including greater ureter tortuosity and increased ureteral width. This lends support to quantitative assessment to improve reliability in VUR grading.</p>","PeriodicalId":9574,"journal":{"name":"Canadian Urological Association journal = Journal de l'Association des urologues du Canada","volume":"17 8","pages":"243-246"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10426409/pdf/cuaj-8-243.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10012160","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}