Urology News Feeds
The authors have astutely identified the key issue prompting our analysis of testicular germ cell tumor (TGCT) outcomes in Hispanics, namely, the significant demographic shifts occurring throughout the country. Although our own institution in Texas has historically cared for a large Hispanic population—both native born and recent immigrants—Hispanics are the fastest-growing demographic in the United States,1 and the proportion of Hispanic patients we care for, and indeed the rest of the country cares for, will continue to rise.
Hispanics account for a large and growing share of the population of the United States: they currently make up 1 in 5 of the people living in the U.S. and are projected to account for 1 in 4 residents by 20451. Recent studies have shown that although non-Hispanic white (NHW) men have the highest incidence of testicular germ cell tumors (TGCTs), there has been a significant increase in the rate of TGCTs in Hispanic men in the last 25 years2,3. Over the next decade, incidence rates among Hispanic men are forecast to continue to increase and surpass the rates among NHW men by 20263.
To assess the use of a handheld optical coherence tomography (OCT) probe for the evaluation of intraoperative surgical margins during partial nephrectomy (PN).
IMPACT of ALLERGY and RESISTANCE on ANTIBIOTIC SELECTION for RECURRENT URINARY TRACT INFECTIONS in OLDER WOMEN
To review the impact of antibiotic allergy and resistance in older women with recurrent urinary tract infections (RUTIs) as determinants for a suitable oral antibiotic treatment choice.
Incidental Discovery of Adenocarcinoma of an Augmented Bladder in a Patient with Myelomenigocele Undergoing Cystolithotomy
Bladder malignancy in patients with congenital bladder anomalies who have undergone bladder augmentation is a rare but well recognized condition. These patients present with locally advanced or metastatic disease and have poor survival. We report a case of a patient with myelomeningocele who was incidentally found to have a high grade intestinal type adenocarcinoma of her bladder augment at the time of cystolithotomy. This case highlights the need to continue to follow patients with congenital bladder anomalies and questions if there are better screening methods available.
Percutaneous Tibial Nerve Stimulation in the Office Setting: Real World Experience of Over 100 Patients
To examine the outcomes and compliance with percutaneous tibial nerve stimulation (PTNS) for overactive bladder symptoms (OAB).
Evaluation of Urinary DNA Methylation as a Marker for Recurrent Bladder Cancer: a Two-Center Prospective Study
To clarify the clinical utility of urinary DNA methylation for detection of intravesical recurrence of non-muscle invasive BCa (NMIBC), we performed a 2 center prospective study.
Incidence of Stress Urinary Incontinence Following Posterior Urethroplasty for Radiation-Induced Urethral Strictures
To identify the frequency of de novo SUI after posterior excision and primary anastomotic (EPA) urethroplasty in patients with radiation-induced urethral strictures (RIUS) and compare to patients with pelvic fracture urethral injuries (PFUI).
Population-Based Analysis of Treatment Toxicity among Men with Castration-Resistant Prostate Cancer: a Phase IV Study
To assess the toxicity and effectiveness of contemporary metastatic castrate-resistant prostate cancer (mCRPC) treatments at a population-level, among all patients in Ontario particularly treated with newer agents including abiraterone, enzalutamide, docetaxel and cabazitaxel.
Incidence of Visible Haematuria among Antithrombotic Agents: a Systematic Review of Over 175,000 Patients
To determine the probability of visible haematuria with antithrombotic agents and to evaluate association of urological etiology in antithrombotic-related haematuria
Combined Partial Penectomy with Bilateral Robotic Inguinal Lymphadenectomy Using Near Infrared Fluorescence Guidance.
To describe our novel technique for performing a combined partial penectomy and bilateral robotic inguinal lymphadenectomy (ILDN) using intraoperative near infrared (NIR) fluorescence guidance with Indocyanine Green (ICG) and the DaVinci Firefly camera system.
To improve confirmation of complete tumor thrombus removal in advanced malignancy, we report on our experience using intraoperative vena cavoscopy using a flexible cystoscope to confirm complete thrombus resection. Patients with renal cell carcinoma (RCC) or testicular cancer (TC) associated with inferior vena caval tumor involvement benefit from surgical resection of the primary tumor and tumor thrombus. Intraoperative assessment of the vena cava represents a technical challenge, particularly when the thrombus is friable, involves the hepatic veins, or there is caudal extension of thrombus towards the bifurcation.
We read the editorial comment on our work with great interest and thank the authors for launching an important discussion regarding the underlying reasons for heterogeneous adoption of prostate-specific antigen (PSA) testing recommendations on a state-level.
Following the United States Preventative Services Task Force (USPSTF) recommendation against prostate specific antigen (PSA) testing in 2011, we have seen many publications highlighting that utilization of PSA testing has decreased nationwide.1 The state-by-state analysis published here adds to the growing literature that the USPSTF testing recommendations led to decreased PSA screening. However, the authors of this manuscript cleverly subset this into geography and determine that the adoption of these guidelines isn't uniform.
Rouanne et al raise several important points. We analyzed the HGT1 tissue by TMA. The TMAs were made using 3 sections from each tumor. The sections were taken from spatially distanced areas around the tumor block. However, Rouanne et al correctly indicate that sections of normal bladder and immune infiltrate were not analyzed. Due to only analyzing the tumor areas, we may have missed areas of PD-L1 positivity in the stroma. However, we compared our results to muscle invasive urothelial carcinoma TMAs that were created in the same manner.
When constructing a prognostic nomogram for cancer outcomes, it is critical to consider the clinical and statistical significance of the covariates chosen for the model.1 Clinically most surgeons approach tumors with thrombus confined to the renal vein or lower IVC differently than tumors with upper level (Neves level 3 or 4) IVC thrombus because tumors extending above the hepatic veins frequently require advanced surgical techniques such as occlusion of the hepatic blood supply (Pringle maneuver) or cardiopulmonary bypass/deep hypothermic circulatory arrest.
As discussed in our article, a dose increase in onabotulinumtoxinA from 100 to 150 U was originally permitted per patient request from treatment 3 onward. A planned interim statistical analysis showed that the 150 U dose did not provide additional efficacy, and thus the protocol was amended to allow only the 100 U dose. The efficacy and safety results from this long-term, prospective, open-label trial have been reported in a separate publication.4 In our series treatment with 100 U onabotulinumtoxinA resulted in durable reductions in episodes of urinary incontinence, urgency and voids per day, mirroring the results of other trials.
Re: Differential Expression of PD-L1 in High Grade T1 vs Muscle Invasive Bladder Carcinoma and its Prognostic Implications
This study addresses an important question regarding the prognostic value of PD-L1 expression in high grade T1 (HGT1) urothelial carcinoma of the bladder. Several phase I and II trials evaluating PD-1 or PD-L1 immune checkpoint inhibitors in this clinical setting are currently ongoing. However, few data regarding PD-L1 expression in high risk nonmuscle invasive bladder cancer have been specifically reported in independent retrospective cohorts. Therefore, this article sheds light on a particularly relevant question from a clinical and scientific perspective, and also raises technical issues regarding the method described.
Re: Long-Term Treatment with OnabotulinumtoxinA Results in Consistent, Durable Improvements in Health Related Quality of Life in Patients with Overactive Bladder
Ginsberg et al should be commended for their study of outcomes of repeat 100 U onabotulinumtoxinA (BTX-A) injections for overactive bladder (OAB). However, their report excluded patients who elected dose escalation to 150 U. Earlier dose escalation studies have suggested that 50 U is not effective compared to placebo.1 Moreover, doses higher than 150 U are associated with minimal incremental clinical benefits but significant increases in post-void residual volume and rates of clean intermittent self-catheterization.
Re: Predictive Nomogram for Recurrence following Surgery for Nonmetastatic Renal Cell Cancer with Tumor Thrombus
Abel et al construct and validate a postoperative nomogram for recurrence prediction in patients with renal cell carcinoma (RCC) with venous tumor thrombus. They found that the predictive accuracy of this nomogram was similar in development and validation cohorts (AUC 0.726 and 0.724, respectively), and was higher than the UCLA Integrated Staging System and the Stage, Size, Grade and Necrosis, and Sorbellini models. However, we would like to express several concerns.