Urology News Feeds

Independent Validation of the American Joint Committee on Cancer 8th Edition Prostate Cancer Staging Classification

We sought to independently validate the American Joint Committee on Cancer (AJCC) 8th edition prostate cancer (PCa) staging classification, which includes the elimination of pT2 subcategories and the reclassification of patients with PSA≥20ng/ml and Gleason Grade Group (GG)-5 as Stage Group III-A and III-C, respectively.
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Reply by Authors

The comment indicates that laser energy for focal therapy belongs in the MRI suite, ie in bore. However, FLA out of bore performed in clinic can yield an ablation zone indistinguishable from that of in bore FLA (see figure). The key conclusion of our phase I trial is that FLA can be performed safely and satisfactorily by a urologist in a clinic setting out of bore using MRI-US fusion for guidance. Nonrigid registration was used to match MRI to ultrasound and the cancer location was targeted using the same platform for diagnosis and treatment.
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Editorial Comment

Targeted lesion based, zonal based and hemiablation strategies have been proposed for focal therapy. It is intuitive that the smaller the ablated volume to achieve cancer control, the less the potential of side effects from treatment. Laser ablation is precise and allows for targeted ablation up to 2 cm in diameter. Larger ablations necessitate an increase in insertions and time (reference 8 in article). Therefore, laser energy is ideally suited for targeted lesion based ablation and it relies on accurate imaging provided by MRI and biopsy information to guide therapy.
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Prognostic Value of PD-1 and PD-L1 Expression in Patients with High-Grade Upper Tract Urothelial Carcinoma

To investigate the prognostic value of PD-1 and PD-L1 expression in patients with high-grade upper tract urothelial carcinoma (UTUC).
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Genetic Biomarkers Underscore the Difficulties in Elucidating Racial Differences in Semen Analyses

Urology (Gold Journal) In Press - Tue, 06/27/2017 - 00:00
Understanding the variability in semen analysis and the effects of any 1 contributing factor is exceedingly difficult given the multifactorial nature of the physiological process. Epidemiologic issues such as insurance coverage, outpatient treatment settings, and income bias make assessment of patient cohorts subject to a multitude of confounders. As such, Eisenberg1 should be commended for tackling this exceedingly difficult topic as the author has attempted to identify differences in semen quality that are attributable solely to race.
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Editorial Comment

Urology (Gold Journal) In Press - Tue, 06/27/2017 - 00:00
The authors are to be congratulated for presenting innovative data on the role of frailty and overactive bladder in a geriatric population. Statistically, both frailty and overactive bladder are conditions with a higher prevalence as age increases.1-3 The authors prospectively report the association of 1363 patients (>/=65 years old); 201 with OAB and 1162 without OAB. They characterized these patients as “frail” based on their results in the “Timed Up and Go Test” (TUGT), which has been previously used to assess frailty and predict morbidity in the elderly.
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Gaze-Based Technology as a Tool for Surgical Skills Assessment and Training in Urology

Urology (Gold Journal) In Press - Tue, 06/27/2017 - 00:00
To assess the sensitivity of gaze-based metrics in detecting cognitive demands imposed by surgical procedures. We analyzed urologists' gaze entropy and velocity while performing two standardized high-fidelity simulated stone procedures with different levels of complexity.
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Post-Kidney Transplant Robot-Assisted Laparoscopic Ureteral (Donor-Receiver) Anastomosis for Kidney Graft Reflux or Stricture Disease

Urology (Gold Journal) In Press - Tue, 06/27/2017 - 00:00
To report our experience with robot-assisted ureteral anastomosis for kidney graft. Kidney graft complex ureteral strictures and/or symptomatic vesico-ureteral reflux may require complex reconstruction. This is classically done through an open surgical access, which adds to the morbidity of kidney transplantation. The da Vinci robot enables to perform complex laparoscopic procedures, and may hence be used for such reconstructions.
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Population-Based Semen Analysis Results and Fertility among Patients with Inflammatory Bowel Disease: Results From Subfertility Health Assisted Reproduction and the Environment (SHARE) Study

Urology (Gold Journal) In Press - Mon, 06/26/2017 - 00:00
To evaluate male fertility in Crohn's Disease (CD) and Ulcerative Colitis (UC) by examining semen analysis results and paternity from the SHARE study (subfertility health assisted reproduction and the environment), a population-based cohort of semen analysis results from Utah men.
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The Null Effect of Bladder Neck Size on Incontinence Outcomes After Radical Prostatectomy

To determine whether bladder neck size is associated with incontinence scores after robot-assisted laparoscopic radical prostatectomy (RALP).
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Variation in the diagnostic evaluation among persons with hematuria: influence of gender, race, and risk factors for bladder cancer

To determine whether race, gender, and number of bladder cancer risk factors are significant predictors of hematuria evaluation.
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Telementoring and Telesurgery for Minimally Invasive Surgery

Tremendous interest and need lie in the intersection of telemedicine and minimally invasive surgery. Robotics provides an ideal environment for surgical telementoring and telesurgery, given its endoscopic optics and mechanized instrument movement. We review the current status, challenges and future promise of telemedicine in endoscopic and minimally invasive surgery, with particular focus on urologic applications.
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Results of the 3 (AIEOP) cooperative protocol on Wilms tumor (TW2003) and related considerations

TW2003, the 3rd Italian prospective study on Wilms tumor (WT), aimed to improve survival in patients with stage III-IV tumors, de-escalate therapy for stage I-II non-anaplastic tumors, refine the risk stratification of therapy, and develop a national infrastructure for biobanking and central pathology review.
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Changes in Adenosine Triphosphate and Nitric Oxide in the Urothelium of Benign Prostate Hyperplasia in Patients with Detrusor Underactivity

We investigated changes in the levels of adenosine triphosphate (ATP) and nitric oxide (NO) in the urothelium of detrusor underactivity (DU) with benign prostatic hyperplasia (BPH).
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Reply by Authors

Navigating the transition from a fee for service to a value based reimbursement system is bound to be fraught with challenges for all parties involved, including payers, providers and patients. More than just a means to rein in superfluous health care expenditures, these changes also seek to improve the quality of the medical care being delivered.
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Editorial Comment

Accurate assessment of surgical risk is an important component of patient counseling and shared clinical decision making. Risk calculators are readily available to many of our patients. In addition, they are being used with increasing frequency by payers. Therefore, the accessible information needs to be accurate and reproducible.
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Same-Session Bilateral Ureteroscopy: Safety and Outcomes

Urology (Gold Journal) In Press - Sat, 06/24/2017 - 00:00
To assess the complications and outcomes associated with same-session bilateral ureteroscopy in a tertiary referral center, as same-session bilateral ureteroscopy for stone disease has been critiqued for the theoretical risk of injury to both ureters with subsequent risk to renal function.
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Skin-to-Tumor Distance Predicts Treatment Failure of T1a Renal Cell Carcinoma Following Percutaneous Cryoablation

Urology (Gold Journal) In Press - Sat, 06/24/2017 - 00:00
To determine the impact of skin-to-tumor (STT) distance on the risk for treatment failure following PCA.
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Effects of Urinary Incontinence Subtypes on Women's Sexual Function and Quality of Life

Urology (Gold Journal) In Press - Sat, 06/24/2017 - 00:00
To evaluate the effects of different subtypes of UI on sexual function and quality of life (QoL).
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Holding Strength of a Hem-O-Lok / Lapra-Ty Clip Combination on Sutures Used during Partial Nephrectomy

Urology (Gold Journal) In Press - Sat, 06/24/2017 - 00:00
To investigate the anti-slip strength of closing systems employing sutures terminated with a Hem-o-Lok®/Lapra-Ty® clip combination to determine which sutures perform best for this application. Partial nephrectomy (PN) is the reference standard for treatment of small renal masses. The main disadvantage of PN is the risk of technical complications, including renorrhaphy site bleeding and urine leak.
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