Urology News Feeds
Re: Bacterial Virulence Phenotypes of Escherichia coli and Host Susceptibility Determine Risk for Urinary Tract Infections
H. L. Schreiber, IV, M. S. Conover, W. C. Chou, M. E. Hibbing, A. L. Manson, K. W. Dodson, T. J. Hannan, P. L. Roberts, A. E. Stapleton, T. M. Hooton, J. Livny, A. M. Earl and S. J. Hultgren
Lee et al have comprehensively assessed the consequences of the U.S. Preventive Service Task Force (USPSTF) prostate specific antigen (PSA) screening guidelines on the epidemiology of prostate cancer. They conclude, based on 2 contrasting SEER (Surveillance, Epidemiology and End Results) studies, that it is unclear if the overall incidence of metastatic disease in men older than 75 years has increased in recent years. Although, as the authors note, our assessment of distant metastases differed from that of Jemal et al1 in that we measured quarterly vs yearly incidence,2 the use of collaborative vs summary staging should be further emphasized.
Re: Preoperatively Dilated Ureters Are a Specific Risk Factor for the Development of Ureteroenteric Strictures after Open Radical Cystectomy and Ileal Neobladder
Hautmann et al present an informative article regarding preoperatively dilated ureters being a risk factor for ureteroenteric anastomosis strictures (UEASs) after radical cystectomy (RC) and ileal neobladder (INB) diversion. Dilated ureter before RC in the context of bladder cancer is reported in up to 54% of patients and is an independent prognostic marker for worse cancer specific survival and recurrence-free survival.1,2 Therefore, these new findings highlight another worse outcome for these patients.
In their recent trial of a web based decision support tool the authors sought to evaluate the impact of a decision aid, P3P (Personal Patient Profile-Prostate), on patient decisional conflict when selecting a treatment course for localized prostate cancer. They concluded that “the decision aid significantly reduced decisional conflict” and that it is an “effective adjunct for shared decision making.” The conclusion appears to be based on the results of the multivariable model, which showed a statistically significant 5-point decrease in decisional conflict in the intervention group.
Re: Severity of Preoperative Proteinuria is a Risk Factor for Overall Mortality in Patients Undergoing Nephrectomy
In this retrospective study 1,347 patients underwent urine protein testing before radical or partial nephrectomy. Patients were divided into 3 groups according to amount of proteinuria, and statistical analysis revealed that increased proteinuria was related to overall survival but not to cancer specific survival.
Sweet-smelling urine may be caused by diet, diabetes, or maple syrup urine disease. Learn why urine may smell sweet, treatments, and when to see a doctor.
Nephron sparing surgery for renal cell carcinoma has been advocated in the AUA (reference 3 in article) and EAU (European Association of Urology)1 guidelines, stating that for solitary renal tumors up to a diameter of 7 cm nephron sparing surgery is the standard procedure when technically feasible. The rationale is better preservation of renal function, which was shown to be related to improved cardiac specific survival.
Unconventional Bladder Preservation: Factors predicting Failure to Receive Definitive Surgery following Chemotherapy for Non-metastatic Muscle Invasive Bladder Cancer within the National Cancer Database
Neoadjuvant chemotherapy is an important adjunct to cystectomy in management of muscle invasive bladder cancer. We investigated factors that predict failure to receive surgery following multi-agent chemotherapy for non-metastatic muscle invasive bladder cancer utilizing the National Cancer Database.
Endoscopic Injection of Dextranomer/Hyaluronic Acid as First-Line Treatment in 851 Consecutive Children with High-Grade Vesicoureteral Reflux: Efficacy and Long-Term Results
Endoscopic injection of dextranomer/hyaluronic is widely acknowledged as first-line treatment of lower grade vesicoureteral reflux. Our objective was to demonstrate its long-term efficacy and safety in eradicating high-grade reflux.
A 51-year old male patient presented with lower abdominal pain persisting since about one year. Abdominal computed tomography scan showed a solid tumor interpreted as urachal carcinoma with peritoneal carcinomatosis. Histopathological examination revealed urachal abscess. Awareness of clinical signs and imaging findings of this rare but characteristic condition may avoid emotional distress of patients associated with erroneous suspicion of malignancy.
Preoperative Incidence of Deep Venous Thrombosis in Bladder Cancer Patients Undergoing Radical Cystectomy
To determine the pre-operative incidence of subclinical lower-extremity deep vein thrombosis (DVT), as well as to evaluate the utility of preoperative DVT screening in bladder cancer patients prior to undergoing radical cystectomy.
The role of continuous antibiotic prophylaxis (CAP) in children with urinary tract infection (UTI) and vesicoureteral reflux (VUR) has been a topic of vigorous debate during the last decade. This debate has led to specific guidelines from the AAP (American Academy of Pediatrics), creating a paradigm shift on how children are evaluated after febrile UTI. The current recommendation is not to evaluate children for VUR after the first UTI, primarily based on interpretation of the various studies that suggest that CAP (or other treatments for VUR) does not reduce the risk of UTI.
Predicting the need for surgical intervention is an important outcome. However, to date, a conclusive test or imaging modality to definitively identify cases that will progress to this end point is lacking. Our group has been motivated to find new ways to forecast which patients will ultimately undergo surgery, having applied the renal parenchyma-to-hydronephrosis area ratio to determine hydronephrosis trends toward resolution or surgical intervention.1 More recently we have been using machine learning predictive capability to identify those more likely to undergo surgery in our large prospective prenatal hydronephrosis database.
Fetal hydronephrosis remains a frequent clinical conundrum. Effective communication between maternal-fetal medicine, radiology, urology, nephrology and pediatrics is paramount. Toward this end, the Society for Fetal Urology recently convened experts to develop the UTD grading system to address deficiencies of the SFU grading system (reference 3 in article).
What's Gender Got to Do with It: Difference in the Proportion of Traditionally Female Cases Performed by General Urologists of Each Gender
To examine surgical case volume characteristics in certifying urologists to evaluate practice patterns, given the long-standing understanding but unproven hypothesis that non-fellowship trained female general urologists perform more urogynecologic procedures compared to their equally trained male counterparts.
We heartily thank the authors for their thoughtful comments on our paper on intraoperative flow disruptions and teamwork during robot-assisted laparoscopic prostatectomies. Three points emerged that are potentially relevant for research and surgical practice in this field.
This prospective study from Germany assessed 40 robotic-assisted laparoscopic prostatectomies (RALPs) to identify the type and severity of surgical work flow disruptions, determining the impact on the perception of intraoperative teamwork.1 There were 16 flow disruptions per hour, most commonly related to communication and coordination during the prerobot and docking phase. Not surprisingly, surgeons experienced inferior teamwork during cases with severe work flow disruptions.
We appreciate the reviewer's supportive comments. As they stated, identifying a bidirectional causality between systemic and urologic disease states would be novel and extraordinarily impactful. Doing this in a statistically valid way would likely be in the realm of big data. Our more modest goal is focused on the ability to counsel patients on the likelihood of meaningful impact of our urologic therapies in the context of their broader systemic health. A transurethral resection of prostate may not help urinary frequency in an uncontrolled diabetic on high dose diuretics.
It is now well recognized that men put their lives at risk due to poor health-seeking behavior. The reasons are multifactorial and most marked in men who are in employment. In the UK, men are far more likely to die earlier than women. Forty percent of males die before the age of 75 compared with 26% of females and 1 man in 5 dies before he is 65.1 Therefore, it becomes increasingly important for healthcare providers to seize the few opportunities that arise when men present for a medical consultation to consider their overall wellness.
Learn about the Bence Jones protein urine test that is used to help diagnose multiple myeloma. What can you expect from the test and the results?