Urology News Feeds

PSA Density is a Good Predictor of Upstaging and Upgrading, According to the New Grading System: the Keys We are Seeking May be Already in Our Pocket.

Urology (Gold Journal) In Press - Fri, 10/13/2017 - 00:00
To analyse the performance of Prostate specific antigen density (PSAD) as a predictor of upstaging and Prognostic Grade Group (PGG) upgrading.
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Hospital Charges and Length of Stay Following Radical Cystectomy in the ERAS Era

Urology (Gold Journal) In Press - Fri, 10/13/2017 - 00:00
To report our center's experience with Enhanced Recovery after Surgery (ERAS) pathway for radical cystectomy (RC), specifically evaluating complications, LOS, 30- and 90-day readmissions, and hospital charges. Pathways of this type have been shown to decrease length of stay (LOS) and post-operative ileus. However, concerns persist that ERAS is costly and increases readmissions. To date, limited studies have evaluated these concerns.
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Outcomes Following Clinical Complete Response to Neoadjuvant Chemotherapy for Muscle Invasive Urothelial Carcinoma of the Bladder in Patients Refusing Radical Cystectomy

Urology (Gold Journal) In Press - Fri, 10/13/2017 - 00:00
To investigate survival outcomes of patients with muscle-invasive bladder cancer (MIBC) that demonstrate complete clinical response (cT0) to neoadjuvant chemotherapy (NAC) and then reject subsequent radical cystectomy (RC).
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Intra-Trigonal Onabotulinum Toxin A improves bladder symptoms and quality of life in Bladder Pain Syndrome /Interstitial Cystitis patients – a pilot, single centre, randomized, double-blind, placebo-controlled trial

To compare efficacy and safety of trigonal injections of onabotulinumtoxinA and saline in Bladder Pain Syndrome/Interstitial Cystitis patients.
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Cycling and male sexual and urinary function: results from a large, multinational, cross-sectional study

To explore the relation between cycling and urinary and sexual function in a large, multinational sample of men.
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A double-blind, randomized trial on the efficacy and safety of hyperbaric oxygenation therapy in the preservation of erectile function after radical protastectomy

To evaluate the efficacy and safety of hyperbaric oxygenation therapy (HBO2T) in the preservation of erectile function (EF) as part of penile rehabilitation (PR) after robot assisted bilateral nerve sparing radical prostatectomy for prostate cancer.
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Everything you need to know about prostate nodules

MedicalNewsToday - Thu, 10/12/2017 - 11:00
A prostate nodule is a firm, knuckle-like area on the prostate. There are several causes of prostate nodules, including prostatitis and prostate cancer.
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This Month in Pediatric Urology

Topics addressed In this issue of The Journal include the decision making process leading to a Malone antegrade continence enema, the natural history of multicystic dysplastic kidneys (MCDKs), the occurrence of complex reconstruction in patients with spina bifida and the impact of the American Academy of Pediatrics guidelines on the use of voiding cystourethrograms (VCUGs).
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Editorial Comment

A key priority for our profession is to improve shared decision making among men diagnosed with prostate cancer. Especially for men with low risk cancers there is substantial variation in treatment with options that include active surveillance, radiation therapy, radical prostatectomy and now a growing list of ablative therapies.1 Berry et al report that compared to the usual clinical care the web based decision aid P3P significantly reduced decisional conflict in men with localized prostate cancer.
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Editorial Comment

The paradigm of shared decision making is becoming ever more entrenched in the patient-provider dyad for decisions with multiple acceptable alternatives.1 An increasing understanding of the widely variable degree to which patients ascribe value to different aspects of treatments and expected outcomes has contributed to the widespread acceptance of this approach by patients, physicians and policymakers. Despite the acceptance of shared decision making in theory, providers face numerous barriers to executing effective shared decision making in practice.
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Editorial Comment

Urologists have long debated whether lymph node dissection is a staging or therapeutic procedure in patients with high risk RCC. A single randomized 2009 trial, EORTC 30881, was negative but limited by a preponderance of patients at good risk with low stage and grade, and positive nodes in only 4% of patients in the node dissection arm (reference 8 in article).
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Reply by Authors

We agree with the assertion that tests performed in clinical practice should have the potential to influence decision making. With regard to androgen deprivation therapy users who establish an ideal serum testosterone level of less than 20 mg/dl (0.7 nmol/l) it seems that repeat testosterone measurement at each followup visit is unwarranted. Elevated testosterone may develop and appear to have no prognostic significance. This suggests that no immediate change in hormonal regimen is necessary in these patients, especially as in most levels less than 20 mg/dl will be reestablished.
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Editorial Comment

In medicine a test should be performed to influence a decision: no decision, no test. This axiom is accepted in theory and widely ignored in practice. Why? Because we are strongly influenced by the anecdote, a disproportionate recollection of an isolated bad outcome and our compulsive tendencies. Not ordering something is always harder than “just being sure.”
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Editorial Comment

In this novel study the authors used tracking technology to sample prior positive sites at approximately 1-year confirmatory biopsy in 352 men enrolled in an active surveillance program at UCLA. They report upgrading (higher Gleason score at second biopsy) in 26% of men overall. The confirmatory biopsy protocol included a modified repeat systematic biopsy in addition to sampling of all prior positive sites and MRI targets. Only 9% of men underwent repeat MRI prior to confirmatory biopsy.
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Editorial Comment

The optimal strategy for following patients on active surveillance for prostate cancer remains a challenge. In up to 50% of patients on AS no cancer is detected at confirmatory or followup biopsy because there is no guarantee that the cancer site at the initial biopsy session is being sampled.1,2
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Reply by Authors

We appreciate this appraisal and agree that urologists will increasingly be called upon in the care of transgender patients. It is therefore imperative to establish best practice techniques in this advancing field. We concur that future studies investigating patient reported outcomes in gender affirming surgery are paramount. We have previously argued that patient reported outcomes should be the gold standard by which these procedures are judged (reference 26 in article).1 A successful postoperative result has often been judged by a low complication profile.
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Editorial Comment

Ascha et al present a highly informative, retrospective comparison of outcomes of 1-stage phalloplasty by pALT or RFFF in gender confirming neophallus creation. Drawbacks of RFFF include donor site scarring and potential hand/forearm dysfunction. pALT avoids vascular anastomosis and has lower donor site morbidity but carries a risk of higher urethral complications. The authors determine which approach to perform with the patient based on BMI and the desire to avoid donor site morbidity. Future studies should use patient reported outcome measures1 and seek novel ways to improve long-term followup to most accurately estimate procedure complication profiles.
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Despite concerns, vasectomy and prostate cancer not linked

MedicalNewsToday - Wed, 10/11/2017 - 04:00
A debate that has raged for more than 30 years may finally be over: prostate cancer risk does not seem to be increased following a vasectomy.
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Utilization of Post-Penile Surgery Illustrated Healing Atlas: a Comparative Study

Urology (Gold Journal) In Press - Wed, 10/11/2017 - 00:00
To determine the effect of the post-penile surgery illustrated healing atlas on caregivers' anxiety levels pre- and post-operatively, the frequency of family's post-operative communication with the urology care team, and the number of unplanned emergency room (ER) return for wound checks.
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Urethral Reconstruction in Aging Male Patients

Urology (Gold Journal) In Press - Wed, 10/11/2017 - 00:00
To report stricture characteristics, complications, and treatment outcomes among elderly men undergoing urethral reconstruction.
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