Urology News Feeds

Colpectomy significantly reduces the risk of urethral fistula formation after urethral lengthening in transgender men undergoing genital Gender Affirming Surgery.

To assess the effect of performing a colpectomy before (primary) or after (secondary) gender affirming surgery (GAS) with single-stage urethral lengthening on the incidence of urethral fistulas in transgender men.
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A Critical Analysis of Bulbar Urethroplasty Stricture Recurrence: Characteristics and Management

To evaluate the management of recurrence after urethroplasty for bulbar urethral stricture disease (BUSD) at our institution.
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Impact of the number of cycles of platinum-based first-line chemotherapy for advanced urothelial carcinoma

To evaluate the impact of number of cycles of platinum-based first-line chemotherapy <6 versus the conventional ≥6 on survival of metastatic urothelial carcinoma (UC).
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Cost-Effectiveness of SelectMDx in Prostate Cancer Risk Assessment

SelectMDx is a panel of urinary biomarkers used in conjunction with traditional risk factors to individualize risk prediction for clinically significant prostate cancer. In this study, we sought to characterize the cost-effectiveness of SelectMDx in a population of U.S. men with elevated PSA.
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A Case of Fatal Clostridial Necrotizing Fasciitis after Radical Prostatectomy

Urology (Gold Journal) In Press - Sun, 07/15/2018 - 00:00
A 70-year-old Caucasian male with pT3aN1Mx G3+4 prostate cancer underwent an open radical retropubic prostatectomy with lymphadenectomy without surgical complications. He experienced a slightly prolonged post-operative hospitalization (3 days) secondary to a reaction to an anesthesia study drug (tachycardia and drowsiness) that resolved after discontinuation of said drug and was subsequently discharged. Two weeks later, he was brought to the emergency department after the sudden onset of an acutely severe right groin pain and swelling that began that afternoon.
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Fluoro-urodynamic Image Interpretation Is Not Altered by Using Dilute Intravesical Contrast

Urology (Gold Journal) In Press - Sun, 07/15/2018 - 00:00
To determine if using one 250 mL bottle of intravesical contrast followed by sterile saline alters interpretation of fluoroscopic images during fluoro-urodynamics
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Causes and treatment of chronic prostatitis

MedicalNewsToday - Fri, 07/13/2018 - 21:00
Prostatitis is an inflammation of the prostate that can cause pain, sexual dysfunction, and urination issues. Chronic prostatitis might last for more than 3 months. Possible causes include bacterial infections and damage to the nerves or muscles in the pelvic area. Treatment often involves antibiotics. Learn more here.
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Reply by Authors

We appreciate the comments acknowledging the PCM301 trial as the first published randomized study comparing PGA to active surveillance. We also agree that in carefully selected patients PGA reduces the aggregate treatment burden. This becomes a meaningful clinical benefit and an appropriate end point for clinical trials. After all, the benefit of AS itself is avoidance of the morbidity and the adverse impact on quality of life with RT. If PGA can further reduce the need for RT, it would provide a valuable supplement to active surveillance alone.
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Editorial Comment

These authors completed the first randomized, controlled trial demonstrating a benefit to partial prostate ablation in early stage prostate cancer, now with 4 years of followup. While we have traditionally looked for a benefit in cancer specific or overall survival before concluding that a cancer treatment is effective, this is hard to demonstrate even for prostatectomy for this disease. Thus, a reduction in the burden of care (ie radical whole gland prostate therapy) would also be beneficial as it reduces the cost and side effects of treatment.
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Editorial Comment

In the current issue Gill et al report long-term rates of RT in men enrolled in the PCM301 trial, which compared PGA by VTP and AS in men with low risk prostate cancer.1 They report that conversion rates to RT remained substantially lower at 2, 3 and 4 years of followup among men treated with VTP with the absolute risk reduction remaining constant at each year at 29%. Whether this demonstrates a delay in inevitable RT or whether some men will avoid RT altogether remains uncertain.
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Reply by Authors

Indeed, the relative value of manual evaluation by content experts compared to APMs remains to be seen. Our prior work suggests that APMs likely assess different aspects of surgery, given the statistically significant but low association between manually derived metrics and APMs (reference 12 in article). Moving forward, 1 form of assessment (manual or automated) will likely not replace the other but rather they will complement each other.
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Editorial Comment

Surgical education has moved away from process based curricula toward objective assessments of educational outcomes.1 This effort has increased emphasis on metrics of surgical skill acquisition as an essential component of surgical training programs. Several structured assessment tools have been validated in recent years which rely on manual evaluation (references 9 and 10 in article). While expert review provides the benchmark for skills assessment, because of its labor intensive nature and limitation of scale, there is ongoing work to understand the value of crowd assessed data and automated performance measures.
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Editorial Comment

Urine is an attractive noninvasive source of prostate cancer biomarkers. In this study Larsen et al performed droplet digital PCR to detect DNA methylation changes in GSTP1, APC, RASSF1A, PITX2 and C1orf114 in the urine of men undergoing prostate biopsy. The urinary biomarker panel achieved high accuracy for identifying patients with intermediate to high risk prostate cancer on biopsy when combined with clinical variables. The authors used microfiltration and repeat urine samples to overcome an important technical challenge related to the infrequent shedding of prostatic cells in urine.
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Re: Compartmentalized Activities of the Pyruvate Dehydrogenase Complex Sustain Lipogenesis in Prostate Cancer

J. Chen, I. Guccini, D. D. Mitri, D. Brina, A. Revandkar, M. Sarti, E. Pasquini, A. Alajati, S. Pinton, M. Losa, G. Civenni, C. V. Catapano, J. Sgrignani, A. Cavalli, R. D’Antuono, J. M. Asara, A. Morandi, P. Chiarugi, S. Crotti, M. Agostini, M. Montopoli, I. Masgras, A. Rasola, R. Garcia-Escudero, N. Delaleu, A. Rinaldi, F. Bertoni, J. Bono, A. Carracedo and A. Alimonti
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Re: E-Cigarette Smoke Damages DNA and Reduces Repair Activity in Mouse Lung, Heart, and Bladder as Well as in Human Lung and Bladder Cells

H. W. Lee, S. H. Park, M. W. Weng, H. T. Wang, W. C. Huang, H. Lepor, X. R. Wu, L. C. Chen and M. S. Tang
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Re: A Mucosal Imprint Left by Prior Escherichia coli Bladder Infection Sensitizes to Recurrent Disease

V. P. O’Brien, T. J. Hannan, L. Yu, J. Livny, E. D. Roberson, D. J. Schwartz, S. Souza, C. L. Mendelsohn, M. Colonna, A. L. Lewis and S. J. Hultgren
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Erratum

Volume 199, Number 5, Page 1182: The name of the sixth author in the string beneath the title is spelled Rashid Sayyid.
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Erratum

Volume 199, Number 5, Page 1136: Table 2, column 4, rows 6 and 7 should read Diarrhea +/or colitis… .
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Re: Participation and Dropout in the Bundled Payments for Care Improvement Initiative

K. E. Joynt Maddox, E. J. Orav, J. Zheng and A. M. Epstein
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Re: Association of the Affordable Care Act Medicaid Expansion with Access to and Quality of Care for Surgical Conditions

A. P. Loehrer, D. C. Chang, J. W. Scott, M. M. Hutter, V. I. Patel, J. E. Lee and B. D. Sommers
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