Canadian Urological Association Research Articles

Canadian Urological Association guideline: Diagnosis, management, and followup of the incidentally discovered adrenal mass.

Canadian Urological Association guideline: Diagnosis, management, and followup of the incidentally discovered adrenal mass.

Relationship Between Opioid Prescriptions and Number of Chronic Pain Conditions in Women With Interstitial Cystitis

(Abstracted from Urogynecology 2022;28:547–553) Up to 8 million women in the United States are affected by interstitial cystitis (IC), which is a chronic condition characterized by coexisting urinary and pelvic pain conditi0ons. Managing the condition frequently proves challenging due to its chronic nature and a lack of effective IC treatments, but several medical organizations (such as the American Urological Association, Canadian Urological Association, the European Association of Urology, and the Royal College of Obstetricians and Gynecologists) have issued guidelines for management.

2022 Canadian Urological Association (CUA)-Canadian Uro Oncology Group (CUOG) guideline: Management of castration-resistant prostate cancer (CRPC).

2022 Canadian Urological Association (CUA)-Canadian Uro Oncology Group (CUOG) guideline: Management of castration-resistant prostate cancer (CRPC).

Availability, Quality, and Implementability of Canadian Clinical Practice Guidelines for Female Sexual Dysfunction

ABSTRACT Introduction Sexual health problems are common among Canadian women, though they often go unaddressed and untreated in clinical settings. Clinical practice guidelines (CPGs) are systematically developed statements that facilitate structured, evidence-based guidance for specific clinical circumstances. Their potential benefits to patients and practitioners are dependent upon comprehensive guideline development processes that consolidate best available evidence, and guide successful implementation into practice. Little is known about the curation, availability, quality, and implementability of Canadian CPGs for women's sexual health problems and female sexual dysfunction (FSD). Objective i) To determine the availability of protocols guiding the curation of Canadian CPGs ii) To assess the availability, quality, and implementability of Canadian CPGs for women's sexual health concerns and FSD. Methods A systematic search for publicly available documents referencing Canadian CPG development processes was conducted. Websites associated with provincial and national health bodies, in addition to relevant professional medical organizations, and electronic databases PubMed and Google Scholar were searched. A separate search was conducted to retrieve Canadian CPGs specific to women's sexual health and FSD using similar methodology. FSD CPGs that met the criteria of including recommendations on FSD screening, management, and resources went on to subsequent analyses using the AGREE-II and AGREE-REX tools to assess CPG quality and implementability, respectively, and qualitative content analysis to identify the scope and thematic content of the CPGs. Results Two national guidelines for Canadian CPG development were identified. 3/13 Canadian provinces and territories had protocols outlining processes for general CPG development. National and provincial documents varied in their recommended methodologies for CPG curation and updating evidence suggesting a lack of standardization. Two Canadian CPGs specific to FSD and sexual concerns were identified: one from the Canadian Urological Association, and one from the Society of Obstetrics and Gynecology of Canada (SOGC). Only the SOGC guideline contained information regarding screening, management, and resources for FSD, and thus underwent subsequent analysis. The SOGC guideline scored highly with respect to the domains of Scope and Purpose (79%), and Clarity of Presentation (86%), though it did not sufficiently address the remaining AGREE-II domains, scoring lowest in Applicability (44%) and Editorial Independence (13%). AGREE-REX scoring was 58%, suggesting it was moderately implementable. Qualitative analysis revealed a focus on the importance of healthcare providers ensuring they have the necessary skills and knowledge to assess and manage sexual health problems, though the details of these skills and knowledge were not consistently defined. Conclusions There is a lack of standardization of the process of CPG curation in Canada and limited Canadian CPGs guiding best practices for screening and management of FSDs, and provision of additional resources. This study highlights the strengths and deficiencies in the current Canadian CPGs for FSD. Canadian CPG developers should consider FSD a topic of priority and continue to make attempts to curate comprehensive, evidence-based CPGs in this field that are implementable in all local Canadian contexts. The ISSWSH Process of Care for the Identification of Sexual Concerns and Problems in Women may serve as a valuable resource in improving Canadian-specific FSD CPGs. Disclosure No

UPDATE - Canadian Urological Association guideline on androgen deprivation therapy: Adverse events and management strategies Summary of changes.

UPDATE - Canadian Urological Association guideline on androgen deprivation therapy: Adverse events and management strategies Summary of changes.

UPDATE - Canadian Urological Association guideline on androgen deprivation therapy: Adverse events and management strategies.

UPDATE - Canadian Urological Association guideline on androgen deprivation therapy: Adverse events and management strategies.

Neonatal Circumcision in Boys With Posterior Urethral Valves

Source: Harper L, Blanc T, Peycelon M, et al. Circumcision and risk of febrile urinary tract infection in boys with posterior urethral valves: result of the CIRCUP randomized trial. Eur Urol. 2022;81(1):64-72; doi:10.1016/j.eururo.2021.08.024Investigators from multiple institutions in France conducted a randomized controlled trial to assess the effect of circumcision on the risk of febrile urinary tract infection (fUTI) in infant boys with posterior urethral valves (PUV). Participants were male neonates 1-28 days old with PUV diagnosed by voiding cystogram, who were enrolled between 2012 and 2017 at 13 pediatric urology centers. Study patients were randomized to circumcision and antibiotic prophylaxis (CATB), or antibiotic prophylaxis alone (ATB) treatment groups. Circumcision was performed at the time of valve resection under general anesthesia. Antibiotic prophylaxis consisted of cefaclor 10 mg/kg/day for 1 month, followed by cotrimoxazole (15 mg/kg/day) until participants were 2 years old. A technetium-99m dimercaptosuccinic acid (DMSA) scan was performed when patients were 1-2 months and 2 years of age to evaluate renal damage. Study children were followed for 2 years. The primary outcome was fUTI, defined as culture-proven infection (≥103 bacteria/mL in catheterized specimens and ≥104 bacteria/mL for urine specimens obtained by suprapubic aspiration) with pyuria, in the presence of fever (>38.5° C) and signs of inflammation (leukocytosis, elevated C-reactive protein, and/or procalcitonin). The risk of fUTI in the 2 treatment groups was assessed using Kaplan-Meier analysis, and Cox regression was used to compare the risks. Adherence to antibiotic prophylaxis was assessed throughout the 2-year follow-up period and compared between groups. Evidence of increased renal damage between the initial and follow-up DMSA scans was determined and compared in those with and without fUTI with a chi-square test.Data were analyzed on 91 boys, including 49 randomized to CATB and 42 to the ATB group; the mean age at enrollment was 4.3 ± 5.0 and 7.1 ± 6.7 days, respectively, and mean age at valve resection was 5.2 ± 5.4 and 9.4 ± 11.6 days, respectively. A total of 64 (70%) children completed the entire 2-year follow-up period (33 in the CATB group and 31 in the ATB group). Overall, the risk of fUTI was 20% in the ATB group and 3% in those randomized to circumcision (hazard ratio [HR], 10.3; 95% CI, 1.3, 82.5). Adherence to the antibiotic prophylaxis regimen declined in participants during the study period but was not significantly different between treatment groups. At the time of the initial DMSA scan, 63% of children had abnormalities identified, and deterioration on DMSA scans was noted on 18% at follow-up, including 33% of those with a history of fUTI and 16% without fUTI (P = 0.29).The authors conclude circumcision decreased the risk of fUTI in boys born with PUV.Dr Sanchez-Kazi has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The prevalence of fUTI is highest during the newborn period in boys with PUV.1 fUTI increases the risk of renal scarring, which can lead to chronic kidney disease. (See AAP Grand Rounds. 2019;42(5):53.)2 The current investigators evaluated whether circumcision reduces the risk of fUTI in boys with PUV. Although the results showed that CATB lowered the risk of fUTI, there was no difference between groups in the degree of kidney scarring as shown on the DMSA scans. Although it may be possible that this lack of significant change is explained by a lower number of participants, high attrition rate, variability in the radiographic interpretation of the DMSAs, short period of follow-up, or the inherent abnormal kidney parenchyma in boys with PUV due to possible dysplasia. However, the most likely explanation is that despite a substantial effect size (the rate of worsening DMSA scans was >2 times higher in those with fUTI than those without), there was insufficient power to detect a statistically significant difference in the outcomes.As stated in the accompanying editorial, circumcision reduced the occurrence of fUTI, but it did not decrease morbidity or mortality related to kidney scars.3 Steroid cream is currently used to manage phimosis in uncircumcised infants with fUTI.4 Will a retractable foreskin have the same advantage in infants with PUV?4 In boys with PUV however, neurogenic bladder and hydronephrosis are additional factors that significantly increase the probability of fUTI.1 In the most recent AAP Policy Statement on Circumcision in boys with a normal urinary tract, the committee left the decision-making to parents.5 The Canadian Urological Association also recommends early parental discussion of circumcision in the presence of an abnormal urinary tract including PUV, since the risk of fUTI is highest within the first 3 months of life.1,6 The results of the current study hopefully will contribute to more knowledgeable parental decision making.Neonatal circumcision in boys with posterior urethral valve decreases the risk of fUTI.

Canadian Urological Association consensus guideline: Management of testicular germ cell cancer.

Canadian Urological Association consensus guideline: Management of testicular germ cell cancer.

Canadian Urological Association best practice report: Diagnosis and management of nocturia.

Canadian Urological Association best practice report: Diagnosis and management of nocturia.

UPDATE - Canadian Urological Association guideline: Male lower urinary tract symptoms/benign prostatic hyperplasia.

UPDATE - Canadian Urological Association guideline: Male lower urinary tract symptoms/benign prostatic hyperplasia.

2022 American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium: Meeting highlights.

The 2022 American Society of Clinical Oncology (ASCO) Genitourinary (GU) Cancers Symposium was held in San Francisco and online from February 17–19, 2022. Following the symposium, on February 22, the Canadian Urological Association (CUA) held an online webinar where Canadian experts highlighted key research findings in prostate, bladder, and kidney cancers. In this report, we summarize these exciting advances in GU oncology. The entire webinar can be viewed on the CUA website, and meeting abstracts can be viewed at the ASCO meeting library.

UPDATE - 2022 Canadian Urological Association recommendations on prostate cancer screening and early diagnosis Endorsement of the 2021 Cancer Care Ontario guidelines on prostate multiparametric magnetic resonance imaging.

UPDATE - 2022 Canadian Urological Association recommendations on prostate cancer screening and early diagnosis Endorsement of the 2021 Cancer Care Ontario guidelines on prostate multiparametric magnetic resonance imaging.

UPDATE - 2022 Canadian Urological Association recommendations on prostate cancer screening and early diagnosis Endorsement of the 2021 Cancer Care Ontario guidelines on prostate multiparametric magnetic resonance imaging - Summary of changes.

UPDATE - 2022 Canadian Urological Association recommendations on prostate cancer screening and early diagnosis Endorsement of the 2021 Cancer Care Ontario guidelines on prostate multiparametric magnetic resonance imaging - Summary of changes.

UPDATE - Canadian Urological Association guideline: Evaluation and medical management of kidney stones.

UPDATE - Canadian Urological Association guideline: Evaluation and medical management of kidney stones.

237 Antibiotic Prophylaxis of Precision Point Prostate Biopsy Under LA: Changed Practice in a District General Hospital

Abstract Aim More than 4 million prostate biopsies are performed worldwide each year (1). Out of three different techniques (Template, transperineal, TRUS), Transperineal precision point biopsy under local anaesthesia is the latest and reported to have fewer infectious complications (2). UTI, Urosepsis, septicaemia are some well-known infectious complications following prostate biopsies. Therefore, the Canadian Urological Association recommended the use of broad-based Gram-negative antibiotic prophylaxis 30 to 60 minutes before the procedure and continued for 2 to 3 days in their guideline (3). Our aim was to compare the outcome of two different antibiotic prophylaxis regimens. Method In our study to assess the outcome of single-dose prophylaxis compared to regular dose, we collected retrospective data of 119 patients who had undergone precision point biopsy in our hospital. Results Among 119 patients, 52 (43.69%) were given 3 days of oral antibiotic followed by preprocedural dose and 67 (56.31%) were given just a single dose before the procedure. None of these patients from both groups were readmitted with any infectious complication post-procedure. 1 patient from the second group (single dose) was admitted with urinary retention but no increased inflammatory markers were found. Conclusions TRUS biopsy breeches the rectal mucosa and carries higher chances of post-biopsy infection so requires antibiotic prophylaxis. Single-dose antibiotic prophylaxis is recommended option for transperineal biopsies as the infection rate is lower. Our study shows the same outcome for single-dose and 3-day regimens for transperineal precision point prostate biopsy. Moreover, the use of single dose will significantly reduce medicine costs and antibiotic resistance to improve patient compliance.

Canadian Urological Association guideline: Management of small renal masses - Summary of recommendations.

Canadian Urological Association guideline: Management of small renal masses - Summary of recommendations.

Canadian Urological Association guideline: Management of small renal masses - Full-text.

Canadian Urological Association guideline: Management of small renal masses - Full-text.

Examining Clinical Practice Guidelines for Male Circumcision: A Systematic Review and Critical Appraisal Using AGREE II

To identify and critically appraise available clinical practice guidelines (CPGs) targeting male circumcision using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. A literature search was conducted using electronic databases, CPG databases, and national/international societies providing recommendations to guide clinical decision making for male circumcision. We selected pediatric-focused CPGs related to male circumcision published between January 2010 and December 2020. Non-English CPGs and publications involving narrative reviews, primary research, training manuals, patient and allied health professional guidelines, and technical guides were excluded from our search. Complete CPG documents (including full-text articles, supplemental documents, and associated information) were reviewed. Quality appraisal of CPGs was conducted in accordance with the AGREE II manual. A total of 163 CPGs were identified, of which 93 were screened and 13 were reviewed. All AGREE II domains demonstrated good to excellent interrater reliability, with intraclass correlation coefficients ranging from 0.82 (95% CI, 0.72-0.89) to 0.93 (95% CI, 0.90-0.95). Most CPGs performed satisfactorily in the clarity of presentation domain and performed poorly in the applicability and editorial independence domains. The top 3 CPGs identified were those of the American Academy of Pediatrics, Centers for Disease Control and Prevention, and Canadian Urological Association. Consistencies among the CPGs were demonstrated across most recommendations. Current CPGs are of variable quality, and our findings should be taken into consideration by clinicians and health care professionals when selecting appropriate guidelines for male circumcision.

Canadian Urological Association guideline: Management of ureteral calculi - Abridged version.

Canadian Urological Association guideline: Management of ureteral calculi - Abridged version.

MP20-19 CONFLICT OF INTEREST DISCLOSURES IN ORAL PRESENTATIONS AT MAJOR UROLOGICAL CONFERENCES IN 2020

You have accessJournal of UrologyEducation Research III (MP20)1 Sep 2021MP20-19 CONFLICT OF INTEREST DISCLOSURES IN ORAL PRESENTATIONS AT MAJOR UROLOGICAL CONFERENCES IN 2020 Anique Le Roux, and Naji Touma Anique Le RouxAnique Le Roux More articles by this author , and Naji ToumaNaji Touma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002005.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reporting conflicts-of-interest are integral to maintaining scientific transparency. However, expectations for disclosure statements at scientific meetings are often varied, and compliance both with the letter of the disclosure guidelines and their intended spirit are often inconsistent. Our aim was to assess the frequency of disclosure slide reporting and their content at major urologic conferences. METHODS: We evaluated oral presentations from two major urological conferences occurring in 2020; namely the European Association of Urology conference (EAU) the American Urologic Association Annual meeting (AUA), as well as the national meeting of the Canadian Urological Association (CUA). We collected information on conflict-of-interest disclosure presentation and compared it between conferences. Major categories evaluated were inclusion of a disclosure slide, number of conflicts listed, types of conflicts described and contextualization of disclosure slide. The data was analyzed using descriptive statistics, the chi-squared test and the kruskal-wallis test with SPSS statistical software version 26.0. RESULTS: In total, 557 speakers were evaluated from the CUA (n=36), AUA (n=160), and EAU (n=361). Overall, 49.01% of speakers had no disclosure slide. Among speakers presenting a disclosure slide, the median number of conflicts was 5 (IQR: 2-11), median time spent on the slide was 4.38 seconds (IQR: 2.76-6.25) and 30.72% gave context to disclosures. Between the different conferences, the number of speakers without a disclosure slide was 43.8% for the EAU, 61.9% for the AUA and 44.4% for the CUA. We found that that the AUA had a lower frequency of disclosure slide reporting, while the EAU and CUA were almost identical (p=0.001). There was also a significant difference for median number of conflicts listed where EAU listed 7, AUA listed 3 and CUA listed 4.5 (p=0.008). CONCLUSIONS: Overall disclosure slide reporting seems inconsistent across urologic conferences. Even when reported, their value is unclear given how little time is spent on them and the lack of contextualization. Improved and explicit disclosure guidelines should be issued across urologic conferences. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e344-e344 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anique Le Roux More articles by this author Naji Touma More articles by this author Expand All Advertisement Loading ...