Journal of Urology ( White Journal) In Press
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We agree with the points regarding the continued (and successful) role of conservative management, the use of hematoma diameter as a continuous variable and the need for a clinically relevant nomogram to enhance clinical decision-making. However, we disagree with the statement that ureteral stenting is “less relevant in relation to acute management of renal trauma.” Ureteral stenting represents a clinically relevant intervention for renal trauma, especially given that the AAST Organ Injury Scale specifies collecting system injury as an important factor stratifying renal trauma management.
There seems to be signaling that Rezūm therapy at 3-year followup has lower rates of surgical repeat treatment than some of the other minimally invasive therapies for benign prostatic hyperplasia. In addition, I agree that the definition of repeat treatment is narrow. Most patients would suggest that if they are still on a medication years after therapy, they are still on “treatment.” Ultimately the experience in the urological community, governed partly by safety and efficacy as well as reimbursement, will determine the long-term future of any minimally invasive therapy.
Re: Perinephric Hematoma Size is Independently Associated with the Need for Urological Intervention in Multisystem Blunt Renal Trauma
This article is a timely and apt report on imaging specifics associated with urological interventions after renal trauma. As more renal injuries are managed nonoperatively, the importance of injury specifics beyond those captured by the AAST (American Association for the Surgery of Trauma) Organ Injury Scale becomes more apparent. Of 328 patients eligible for this study 194 (59%) had high grade renal injuries and only 7 (4%) underwent nephrectomy. This rate is low compared to a recent multi-institutional study showing a nephrectomy rate of 13% at level 1 United States trauma centers.
Re: Editorial Comment on Three-Year Outcomes of the Prospective, Randomized Controlled Rezūm System Study: Convective Radiofrequency Thermal Therapy for Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia
This editorial comment by Kaplan on our report of long-term outcomes of a randomized controlled trial (RCT) of water vapor thermal therapy for lower urinary tract symptoms/benign prostatic hyperplasia suggests limitations to the credibility of the data presented.1 These putative reservations can be easily addressed.
Re: Variations in the Arterial Blood Supply to the Penis and the Accessory Pudendal Artery: A Meta-Analysis and Review of Implications in Radical Prostatectomy
We read with great interest this systematic review and meta-analysis of arterial blood supply to the penis and the accessory pudendal artery (APA). We recently reviewed our video and surgical files regarding 210 extraperitoneal laparoscopic radical prostatectomies performed between June 2006 and August 2017 by the same surgeon, and our results regarding the incidence and laterality of APAs were similar to those reported by the authors and other laparoendoscopic surgeons.
Large administrative databases increasingly are the source of information used in medical publishing. Inevitably, the reliability of the findings depends on the accuracy of the analyzed data. Errors in decimal point placement on recorded prostate specific antigen (PSA) values used in SEER (Surveillance, Epidemiology, and End Results) data called into question some studies in which PSA was an important variable. Similar issues with the VACCR (Veterans Affairs Central Cancer Registry) are reported by Guo et al (page 000) from Stanford, California.
This article identifies errors in PSA values in the VACCR, a massive national cancer registry, compared to the gold standard of the medical record values. The PSA value in more than 25% of patients was found to be misclassified when using registry data alone.
Many researchers have highlighted that contemporary management of VUR should always be risk adapted and individualized based on the history of pyelonephritis and subsequent renal parenchymal damage, presence of bladder and bowel dysfunction, and parental preference.1,2 Although 30.5% of the patients in our series required more than 1 endoscopic treatment, only 10.4% had the need for a third injection to cure their high grade VUR. In fact, our resolution rate of 69.5% after a single injection of Dx/HA suggests that it makes sense to give a child with grade IV or V reflux at least 1 chance at endoscopic treatment before considering more invasive procedures.
Surgical correction is often considered in children with persistent high grade VUR, renal parenchymal scarring and/or recurrent febrile urinary tract infections. Secondary to its minimally invasive nature, the frequency of endoscopic injection using Dx/HA increased rapidly in the early 2000s, with a subsequent decline in more recent years paralleling an overall decrease in VUR diagnosis and antireflux surgery.1,2 The literature in aggregate suggests that endoscopic injection is a relatively effective treatment for most VUR, while emphasizing the impact of grade and structural/functional bladder anomalies on ultimate success rates.
To evaluate contemporary practice patterns in the management of small renal masses.
Utilization of automated performance metrics to measure surgeon performance during robotic vesicourethral anastomosis and methodical development of a training tutorial
To develop and validate automated performance metrics (APMs) to measure surgeon performance of vesicourethral anastomosis (VUA) during robotic-assisted radical prostatectomy (RRP). Furthermore, we seek to methodically develop a standardized training tutorial for the robotic VUA.
Conservative Management Following Clinical Complete Response to Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: Contemporary Outcomes of a Multi-Institutional Cohort Study
We report the outcomes of patients with muscle-invasive bladder cancer from two institutions who experienced a clinical complete response to neoadjuvant platinum-based chemotherapy and opted for active surveillance. It is unknown if conservative management can be safely implemented in these patients.
Flank positioning has the potential to improve outcomes and decrease complications not only in patients with obesity and pulmonary compromise, but also in a subgroup of patients with certain anomalies who are at higher risk for visceral injury. Mobility of the kidney during tract dilatation, although rare, is a drawback associated with the flank position. Renal mobility may result in short dilatation and failure to enter the calyceal system. Using a bi-prong forceps to dissect and dilate the tract under direct endoscopic vision as well as telescopic dilatation are salvage techniques to overcome kidney mobility.
A. D. Uren, N. Cotterill, C. Harding, C. Hillary, C. Chapple, M. Klaver, D. Bongaerts, Z. Hakimi and P. Abrams
K. N. Timoh, T. Bessede, C. Lebacle, M. Zaitouna, J. Martinovic, D. Diallo, M. Creze, J. M. Chevallier, E. Darai, G. Benoît and D. Moszkowicz
P. P. Smith
Re: Lower Urinary Tract Symptoms and Urodynamic Findings in Children and Adults with Cerebral Palsy: A Systematic Review
B. Samijn, E. Van Laecke, C. Renson, P. Hoebeke, F. Plasschaert, J. Vande Walle, C. Van den Broeck
A. Rantell, L. Cardozo and V. Khullar
Re: Combination of Sacral Nerve and Tibial Nerve Stimulation for Treatment of Bladder Overactivity in Pigs
X. Li, L. Liao, G. Chen, Z. Wang and H. Deng
Re: Administrative Costs Associated with Physician Billing and Insurance-Related Activities at an Academic Health Care System
P. Tseng, R. S. Kaplan, B. D. Richman, M. A. Shah and K. A. Schulman