General Urology Practice Research Articles

Graduating resident and fellow readiness for general urologic practice during the COVID-19 pandemic A survey-based assessment of trainees and program directors.

Our goal was to compare the perceived readiness of graduating urologic residents and fellows to program directors (PDs) in U.S.-based postgraduate training programs. Additionally, we set out to assess the impact of COVID-19 on postgraduation plans to pursue fellowship training. Graduating residents, fellows, and PDs of accredited residency/fellowship programs in the U.S. were surveyed. The ranked preparedness of trainees to perform common urologic procedures was measured using a Likert scale from 1 (not comfortable) to 5 (fully proficient). The impact of COVID-19 was measured using a three-point Likert scale. Chi-squared and Kruskal-Wallis analyses were used to compare the groups. From 93 responders, 21 were residents, 19 were fellows, 24 were residency PDs, and 29 were fellowship PDs. The median levels of comfort for trans-urethral resection of the prostate, hydrocelectomy, vasectomy, and urethral sling were at or above (≥3) moderate for both PDs and trainees. PDs were more likely to report underperformance for hypospadias repair (60% vs. 39%), penile prosthesis implantation (39% vs. 26%), and orthotopic neobladder formation (57% vs. 18%) than the trainees. Fifty-three (57.0%) of the surveyors felt that COVID-19 did not impact the trainees' comfort in performing general urologic procedures. COVID-19 influenced trainees' decision to pursue a fellowship or opt to practice as general urologists (p=0.002). Our study suggests there may be a self-reported discrepancy between graduating trainees and their PDs regarding trainees' comfort levels performing general urologic procedures.

A case report of sepsis associated coagulopathy after percutaneous nephrostomy

BackgroundHemorrhage is a common complication of nephrostomy and percutaneous nephrolithotripsy, and it is caused by surgical factors. Here we report a rare case of hemorrhage caused by sepsis-related coagulation dysfunction.Case presentationA 72-years-old male patient with bilateral ureteral calculi accompanied by hydronephrosis and renal insufficiency developed sepsis and hemorrhage on the third day after bilateral nephrostomy. After vascular injury was excluded by DSA, the hemorrhage was considered to be sepsis-associated coagulopathy(SAC/SIC), finally the patient recovered well after active symptomatic treatment.ConclusionsIn patients with sepsis and hemorrhage, SAC/SIC cannot be excluded even if coagulation function is slightly abnormal after surgical factors are excluded. For urologists who may encounter similar cases in their general urology practice, it is important to be aware of these unusual causes of hemorrhage.

Addressing racial disparities in prostate cancer pathology prediction models: external validation and comparison of four models of pathological outcome prediction before radical prostatectomy in the multiethnic SEARCH cohort.

Certain widely used pathological outcome prediction models that were developed in tertiary centers tend to overpredict outcomes in the community setting; thus, the Michigan Urological-Surgery Improvement Collaborative (MUSIC) model was developed in general urology practice to address this issue. Additionally, the development of these models involved a relatively small proportion of Black men, potentially compromising the accuracy of predictions in this patient group. We tested the validity of the MUSIC and three widely used nomograms to compare their overall and race-stratified predictive performance. We extracted data from 4139 (1138 Black) men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database of the Veterans Affairs health system. The predictive performance of the MUSIC model was compared to the Memorial-Sloan Kettering (MSK), Briganti-2012, and Partin-2017 models for predicting lymph-node invasion (LNI), extra-prostatic extension (EPE), and seminal vesicle invasion (SVI). The median PSA of Black men was higher than White men (7.8 vs. 6.8 ng/ml), although they were younger by a median of three years and presented at a lower-stage disease. MUSIC model showed comparable discriminatory capacity (AUC:77.0%) compared to MSK (79.2%), Partin-2017 (74.6%), and Briganti-2012 (76.3%), with better calibration for LNI. AUCs for EPE and SVI were 72.7% and 76.9%, respectively, all comparable to the MSK and Partin models. LNI AUCs for Black and White men were 69.6% and 79.6%, respectively, while EPE and SVI AUCs were comparable between races. EPE and LNI had worse calibration in Black men. Decision curve analysis showed MUSIC superiority over the MSK model in predicting LNI, especially among Black men. Although the discriminatory performance of all models was comparable for each outcome, the MUSIC model exhibited superior net benefit to the MSK model in predicting LNI outcomes among Black men in the SEARCH population.

Intraoperative near-infrared fluorescence visualization of anatomical structures in general surgical and urological practice

Aim: to analyze current literature on the assessment of intraoperative near-infrared fluorescence visualization of anatomical structures in general surgical and urological practice. The experience of using intraoperative near-infrared fluorescence visualization of anatomical structures in general surgical and urological practice is analyzed. The priority areas of the method application are defined, the recent clinical studies in various fields of surgery and urology are reviewed. Conclusions. The method of intraoperative near-infrared fluorescence imaging of anatomical structures with abundant vascularization and for assessing oncological prognosis is the most promising.

Graduating resident and fellow readiness for general urologic practice during the COVID-19 pandemic: A survey-based assessment of trainees and program directors.

Our goal was to compare the perceived readiness of graduating urologic residents and fellows to program directors (PDs) in U.S.-based postgraduate training programs. Additionally, we set out to assess the impact of COVID-19 on postgraduation plans to pursue fellowship training. Graduating residents, fellows, and PDs of accredited residency/fellowship programs in the U.S. were surveyed. The ranked preparedness of trainees to perform common urologic procedures was measured using a Likert scale from 1 (not comfortable) to 5 (fully proficient). The impact of COVID-19 was measured using a three-point Likert scale. Chi-squared and Kruskal-Wallis analyses were used to compare the groups. From 93 responders, 21 were residents, 19 were fellows, 24 were residency PDs, and 29 were fellowship PDs. The median levels of comfort for transurethral resection of the prostate, hydrocelectomy, vasectomy, and urethral sling were at or above (≥3) moderate for both PDs and trainees. PDs were more likely to report underperformance for hypospadias repair (60% vs. 39%), penile prosthesis implantation (39% vs. 26%), and orthotopic neobladder formation (57% vs. 18%) than the trainees. Fifty-three (57.0%) of the surveyors felt that COVID-19 did not impact the trainees' comfort in performing general urologic procedures. COVID-19 influenced trainees' decision to pursue a fellowship or opt to practice as general urologists (p=0.002). Our study suggests there may be a self-reported discrepancy between graduating trainees and their PDs regarding trainees' comfort levels performing general urologic procedures.

EDITORIAL COMMENT

In the realm of surgical training, reliance on operative logs or number of hours worked is simply not adequate to assess and demonstrate competency. Indeed, a recent survey of US graduates of urology residency programs showed a perceived lack of confidence in several procedures that are commonly encountered in a general urologic practice. 1 Okhunov Z. Safiullah S. Patel R. et al. Evaluation of urology residency training and perceived resident abilities in the United States. J Surg Educ. 2019; 76 (Jul–Aug): 936-948 Crossref PubMed Scopus (39) Google Scholar

Somatoforme Syndrome – chronischer Unterbauchschmerz der Frau

Pelvic pain in women is aclinically common symptom and afrequent finding in general practitioner, urological, gynecological, and pediatric practice. The list of possible differential diagnoses is long and the clarification ranges from avisual diagnosis to technical and surgical examinations to complex interdisciplinary consultations. But when do we talk about chronic lower abdominal pain? What can be the cause of this and how can we approach it diagnostically and therapeutically? What should we pay attention to? The difficulty begins with the definition. If we look at the national and international guidelines and publications, we find different definitions for chronic pelvic pain. There are various causes of chronic pelvic pain. There is often acombination of physical and psychological factors, which is why it is often not possible to identify asingle diagnosis behind chronic pelvic pain syndrome. The clarification of these complaints requires abiopsychosocial approach. Multimodal approaches should be considered in assessment and treatment, and experts from other disciplines should be consulted.

Twenty-four-hour Urine Testing and Urinary Stone Disease Recurrence in Veterans

ObjectiveTo determine whether 24-hour urine testing in Veterans with USD (urinary stone disease) reduces or delays urinary stone recurrence. MethodsCohort study of national health record data from Veterans Health Administration from 2007 through 2013. We utilized a study population of 130,129 Veterans with USD based on diagnostic or procedural codes and excluded those with USD claims in the 2 years before cohort entry. We then created a propensity-score matched cohort of 14,854 Veterans based on completion of 24-hour urine testing within 6 months of stone diagnosis. Primary outcome was time-to-next clinically significant stone event, defined as an emergency department visit, inpatient admission related to a urinary stone, or urologic stone procedure with 5-year follow up. ResultsOf 14,854 Veterans in the propensity-score matched cohort, 8560 (57.6%) experienced a recurrent USD event. Completion of 24-hour urine testing was associated with a higher risk of developing a second stone event (hazard ratio [HR] 1.17, 95% confidence interval [95% CI] 1.12-1.22). Among Veterans with known recurrent disease, we examined time to a third stone event. In this cohort of 4736 patients, completion of 24-hour urine testing was not associated with a higher risk of developing a third stone event (HR 1.06, 95% CI 0.99-1.12). ConclusionCompletion of 24-hour urine testing was not associated with a reduction in urinary stone recurrence. These findings challenge the validity of a longstanding recommendation in general medicine, nephrology, and urology practice.

PD21-03 TWENTY-FOUR HOUR URINE TESTING AND URINARY STONE DISEASE RECURRENCE IN VETERANS

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy (PD21)1 Sep 2021PD21-03 TWENTY-FOUR HOUR URINE TESTING AND URINARY STONE DISEASE RECURRENCE IN VETERANS Shen Song, I-Chun Thomas, Calyani Ganesan, Kyla Velaer, Glenn Chertow, Alan Pao, and John Leppert Shen SongShen Song More articles by this author , I-Chun ThomasI-Chun Thomas More articles by this author , Calyani GanesanCalyani Ganesan More articles by this author , Kyla VelaerKyla Velaer More articles by this author , Glenn ChertowGlenn Chertow More articles by this author , Alan PaoAlan Pao More articles by this author , and John LeppertJohn Leppert More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002010.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical practice guidelines differ vis-à-vis the importance of 24-hour urine testing in persons with high-risk or recurrent urinary stone disease (USD). Data supporting the clinical utility of approaches that incorporate 24-hour urine testing in patients with USD are limited. We sought to determine whether 24-hour urine testing in Veterans with USD reduces or delays urinary stone recurrence. METHODS: This is a cohort study of national health record data from the Veterans Health Administration, a large national integrated health care system, from 2007 through 2013. We assembled a cohort of 130,129 Veterans with USD based on diagnostic or procedural codes and excluded those with USD claims in the two years before cohort entry. We created a propensity-score matched cohort of 14,854 Veterans and compared outcomes in patients who did and did not undergo 24-hour urine testing within 6 months of stone diagnosis. The primary outcome was time-to-next clinically significant stone event, defined as an emergency department visit, inpatient admission related to a urinary stone, or urologic stone procedure with 5-year follow-up. We also did a companion analysis looking at time-to-third stone event in Veterans with already two kidney stone events and who were therefore at known high risk of recurrence. RESULTS: Of 130,129 Veterans with USD, 9,286 (7.1%) completed 24-hour urine testing. Of 14,854 Veterans in the propensity-score matched cohort, 8,560 (57.6%) experienced a recurrent USD event. Completion of 24-hour urine testing was associated with a higher risk of developing a second stone event (hazard ratio (HR) 1.17, 95% confidence interval (95% CI) 1.12-1.22). Among Veterans at high risk of recurrence, we examined time to a third stone event. In this cohort of 4,736 patients, completion of 24-hour urine testing was not associated with a higher risk of developing a third stone event (HR 1.06, 95% CI 0.99-1.12). CONCLUSIONS: Completion of 24-hour urine testing was not associated with a reduction in urinary stone recurrence. These findings challenge the validity of a longstanding recommendation in general medicine, nephrology, and urology practice. Source of Funding: NIH/NIDDK © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e374-e375 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shen Song More articles by this author I-Chun Thomas More articles by this author Calyani Ganesan More articles by this author Kyla Velaer More articles by this author Glenn Chertow More articles by this author Alan Pao More articles by this author John Leppert More articles by this author Expand All Advertisement Loading ...

Patient Satisfaction with Telephone Versus Video-Televisits: A Cross-Sectional Survey of an Urban, Multiethnic Population

To examine differences between telephone and video-televisits and identify whether visit modality is associated with satisfaction in an urban, academic general urology practice. A cross sectional analysis of patients who completed a televisit at our urology practice (summer 2020) was performed. A Likert-based satisfaction telephone survey was offered to patients within 7 days of their televisit. Patient demographics, televisit modality (telephone vs video), and outcomes of the visit (eg follow-up visit scheduled, orders placed) were retrospectively abstracted from each chart and compared between the telephone and video cohorts. Multivariate regression analysis was used to evaluate variables associated with satisfaction while controlling for potential confounders. A total of 269 patients were analyzed. 73% (196/269) completed a telephone televisit. Compared to the video cohort, the telephone cohort was slightly older (mean 58.8 years vs. 54.2 years, P=.03). There were no significant differences in the frequency of orders placed for medication changes, labs, imaging, or for in-person follow-up visits within 30 days between cohorts. Survey results showed overall 84.7% patients were satisfied, and there was no significant difference between the telephone and video cohorts. Visit type was not associated with satisfaction on multivariable analyses, while use of an interpreter [OR:8.13 (1.00-65.94); P=.05], labs ordered [OR:2.74 (1.12-6.70); P=.03] and female patient gender [OR:2.28 (1.03-5.03); P=.04] were significantly associated with satisfaction. Overall, most patients were satisfied with their televisit. Additionally, telephone- and video-televisits were similar regarding patient opinions, patient characteristics, and visit outcome. Efforts to increase access and coverage of telehealth, particularly telephone-televisits, should continue past the COVID-19 pandemic.

Practice patterns in classic bladder exstrophy: A global perspective

While evaluation and management options for classic bladder exstrophy (CBE) patients are numerous and varied, little is known regarding the relative utilization of these different methods throughout the world. A large group of exstrophy surgeons practicing globally was surveyed, seeking to document their methods of care. A list of international exstrophy surgeons' email addresses was compiled using professional contacts and referral networking. An online survey was sent to each email address. Surgeons who had not performed a CBE closure within the previous 5 years were excluded. Survey questions queried the respondents' surgical practice type, years since training, and their preferred methods of preoperative evaluation, operative management, and postoperative management. Survey invitations were sent out starting in December 2014 and responses were collected for approximately 6 months. A total of 1152 valid email addresses were invited, resulting in 293 respondents (25%) from 39 countries and every American Urological Association (AUA) section. Seventy-six were excluded, leaving 217 respondents (Table). Respondents reported a median of 17 years since finishing their surgical training (IQR 8-25 years). Practice types included pediatric urology (n=209), general urology (n=9), pediatric surgery (n=59), and other practice makeup (n=3). On subgroup analyses, there were no significant regional practice differences, with the exception of complete primary repair of exstrophy (CPRE) and oral opioid prescribing being significantly higher in North America compared to other regions. Findings indicate that there may be diversity in CBE practice patterns globally. While most responding surgeons from regions outside of North America indicated modern staged repair of exstrophy (MSRE) as their preferred closure technique, a relatively equal distribution of respondents from North America selected CPRE and MSRE. A majority of North American surgeons chose performing osteotomies for both newborn and delayed closures, while an appreciable number of respondents from other regions selected never using osteotomies in their closures. Limitations to this study include a low survey response rate, particularly from surgeons outside of the United States, which may have significantly impacted the ability to draw meaningful global comparisons. Global variation among practices of surgeons performing CBE closures may exist. The wide range of methods demonstrated by this survey suggests the need for more conclusive comparative studies to elucidate whether an optimal standard exists. Local social factors, access to surgical expertise and transportation to referral centers, and finances play a role in what constitutes the best operative approach.

Clinical Use Cases for a Tool to Assess Risk in Superficial Bladder Cancer.

Among the approximately 53,000 patients newly diagnosed with early-stage (superficial) bladder cancer each year, there is substantial variability in the progression to muscle-invasive disease. Enhancing risk stratification and risk-stratified surveillance could minimize risks and harms to patients, as well as unnecessary costs to health systems. As a preliminary step in developing and validating a risk assessment tool for superficial bladder cancer in a population-based clinical cohort, we interviewed urologists who might use such a tool to assess need, determine potential use cases, and identify key features to include. Using an opportunistic and purposeful sampling design, we invited 13 urologists from a variety of practice settings and with a wide range of clinical experience to take part in qualitative interviews; 9 (5 urologic oncologists and 4 general urologists) participated. All urologists reported using some form of risk stratification to determine surveillance schedules for patients with bladder cancer. The following use cases were endorsed by 4 or more interviewees: 1) provide evidence to guide clinical management in specific situations, 2) generate patient-facing communication aids, 3) improve documentation about recurrence/progression risk, and 4) create scheduling and callback supports to improve the quality of follow-up care. Our findings demonstrated several potential clinical-use cases for a risk calculator and clinical decision-support tool for patients with superficial bladder cancer. Clinicians stressed the potential utility of such a tool to improve patient communication, scheduling, and tracking in general urology practice.

Evaluation of Urology Residency Training and Perceived Resident Abilities in the United States

To identify differences and potential deficiencies in urology residency training programs in the United States as they are perceived by residents/recent graduates and program directors. A 45-question and 38-question survey was sent to chief residents/recent graduates and program directors, respectively, at all 120 US urology programs regarding prior medical education, urologic training curricula, and perceived surgical proficiency, among other topics. Survey response rate was 58% and 52% for residents and program directors, respectively. Responses regarding program characteristics (e.g., salary, vacation) and research training were similar between program directors and residents. However, their responses regarding skills training and subspecialty training (e.g., robotics and pediatrics) differed substantially. Program directors reported the availability of advanced skills trainers (robot-88%, laparoscopic-86%), whereas fewer residents felt they were available (robot 54% and laparoscopic 72%). The same discrepancies persisted with questions about subspecialty exposure (e.g., program directors reported 48% renal transplant experience vs. 13% reported by residents). Most residents felt comfortable performing essential urology procedures (e.g., cystoscopy/ureteroscopy, open nephrectomy). In contrast, the majority expressed a lack of confidence in performing unsupervised advanced minimally invasive procedures (e.g., laparoscopic and robotic partial nephrectomy, endopyelotomy). Among the responding residents, 72% pursued fellowship training; nearly two-thirds of these residents chose to enter fellowship in order to overcome perceived training deficiencies. Program directors and residents have differing perceptions regarding the education and resources associated with US urology residency training programs. US graduates of urology residency programs express a perceived lack of confidence in several procedures that are commonly encountered in a general urologic practice.

485 Skin bridges that occur after circumcision operation and surgical treatment: Case presentation

Circumcision is a simple urologic operation of general urology practice but when consideringcomplications and long-term results it is an important sugical procedure. Unwanted life-long physicologic and physical results would be seen after the operation. 13 year-old male patient admitted to our clinic with skin bridges that were occured after the circumcision operation, he was operated at the age of 6. According to physical examination, there were circular and scattered bridge-like adhesions at circumcision line. Revision operation was planned for the patient when considering the cosmetic and hygienic condition of the patient. Under sedoanalgesia skin bridges were excised with lancet and they were seperated from glans penis. The tissues were sutured with 3/0 rapid vycril. There was not any comlication on postoperative early and late period and the cosmetic appearence was very good.(Figure). Although Circumcision is considered as a simple operation in the practice of general urology, it is an important operation that affects the quality of life when early and late results are taken into consideration. In pediatric andrology practice, the prominence is also increasing. It should not be forgotten that the operation to be performed is also very important in terms of cosmetics besides the functional principle.

The Top 5 Surgical Things That I Wish I had Known Earlier in My Career: Lessons Learned From a Career of Prosthetic Urology

Dr Brantley Scott pioneered the field of prosthetic urology in the early 1970s. He actually invented the 2 devices, inflatable penile prosthesis (IPP) and artificial urinary sphincter (AUS), that are relatively unchanged in design almost 50 years later. I finished my urology residency in 1973; joined my father in practice in Fort Smith, AR; and attended Scott’s second instructional course in 1974. It was to be a love affair with prosthetic urology, a tiny specialty niche of urology, for the rest of my career. Beginning with a general urology practice, from the late 80s on, my practice focused on prosthetics. Finally, in 2004, I abandoned all urological practice except the installation of devices for impotence and incontinence. I prided myself on perfecting surgical techniques to promote easier, safer, and quicker implantations. Some of my ideas were paradigm changers. Other innovations were not such game transformers and have been relegated to the list of the top 5 surgical things that I wish I had known earlier in my career. With this invited commentary, I share with you the lessons learned from a 45-year practice in the field of prosthetic urology.

Effectiveness of Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer in the Current Real World Setting in the USA

BackgroundThe use of neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is supported by results from several randomized control trials, including SWOG-8710. ObjectiveTo look at the effectiveness of NAC before RC in current real world practice in the USA. Design, setting, and participantsWe used the National Cancer Data Base (NCDB) to identify patients with nonmetastatic muscle-invasive urothelial carcinoma of the bladder who underwent RC between 2004 and 2012. InterventionReceipt of NAC before RC. Outcome measurements and statistical analysisThe primary endpoint was overall survival (OS). Secondary endpoints were rates of complete pathologic response (pT0), positive pathologic lymph nodes (pN+), and margin status. Using a landmark analysis to adjust for an immortal-time bias, OS comparison was performed using Cox regression analysis. Furthermore, logistic regression models examining secondary outcomes were fitted. To adjust for potential selection bias, propensity score–weighted analyses were performed. Results and limitationsOf 8732 patients who underwent RC, 1619 (19%) received NAC. Following propensity score adjustment, receipt of NAC was not associated with an OS benefit (hazard ratio 0.97; p=0.591). On secondary outcome analysis, higher pT0 rates (odds ratio 5.03; p<0.001) were recorded among patients who received NAC, although rates of pT0 were lower than for patients treated with NAC within the SWOG-8710 trial (13% vs 38%). Limitations include the retrospective design and limited details available regarding type of chemotherapy. ConclusionsImportant baseline differences between patients from the SWOG-8710 trial and those in general urologic practice exist. After adjusting for immortal-time bias, we did not find a clear survival advantage of NAC before RC when compared to RC alone in current general urology practice in the USA. Patient summaryThe benefit of chemotherapy before radical cystectomy is supported by few randomized control trials. In this study, using a large national data set from the USA we found that preoperative chemotherapy is not associated with a survival benefit in all patients in general urology practice. Hence, better selection criteria are needed to determine who will benefit the most from chemotherapy before radical cystectomy.

Female bladder outlet obstruction: Common symptoms masking an uncommon cause.

Bladder outlet obstruction (BOO) in women remains an underdiagnosed condition. Although diagnosed rarely in general urologic practice, its incidence in specialist centers has been reported to be up to 29%. In the present study we evaluated the incidence of female BOO in adult women referred for evaluation of lower urinary tract symptoms or urinary incontinence, assessing its etiology and correlating this with its clinical presentation. The present study consisted of a retrospective review of a prospectively acquired videourodynamic database of 1142 consecutive women referred for evaluation of lower urinary tract symptoms (LUTS) or urinary incontinence from March 2007 to December 2012 and diagnosed with BOO. After exclusions, data from 1014 patients were analyzed. BOO was defined using a combination of radiographic evidence of obstruction during the voiding phase of the urodynamic study and pressure-flow criteria (Solomon-Greenwell nomogram). Diagnosis was confirmed by cystoscopy, maximal urethral closure pressure, and magnetic resonance imaging as clinically indicated. In all, 192 women (19%) were diagnosed with BOO. Functional sphincteric obstruction was diagnosed in 70 women (36%). The most common anatomical cause of BOO was previous anti-incontinence surgery, followed by urethral stricture, diagnosed in 21% and 20% of patients, respectively. The most common presenting symptoms were storage phase symptoms of daytime and night-time urinary frequency. BOO was present in 19% of women with LUTS. Functional sphincteric obstruction was the most common cause (36%), followed by obstruction after anti-incontinence surgery (21%). The most common presenting symptom was daytime urinary frequency. BOO should be suspected in women with refractory LUTS, especially those presenting with urinary frequency.

Mantle Cell Lymphoma of the Prostate Gland Treated with Holmium Laser Enucleation

Mantle cell lymphoma of the prostate is rare and is seldom encountered in general urologic practice. It either arises primarily from the prostate or is a result of metastatic spread from another site. This specific type of lymphoma has an aggressive course and may respond poorly to traditional chemotherapy with frequent relapses. Mantle cell lymphoma occurs in middle age or older, which is also when symptoms of benign prostatic enlargement begin in men. This overlap makes the diagnosis of lymphoma of the prostate difficult and makes the treatment more complex. We describe a case of mantle cell lymphoma of the prostate that caused significant enlargement and bladder outlet obstruction with urinary retention. The obstruction was treated with holmium laser enucleation of the prostate with good functional results.

Is neoadjuvant chemotherapy beneficial before radical cystectomy? Examining the external validity of the SWOG-8710 trial.

331 Background: The use of neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is supported by results from several randomized control trials, including SWOG-8710. We sought to test the applicability of the SWOG-8710 study in the general population. Methods: We used the National Cancer Data Base (NCDB) to identify patients with non-metastatic muscle-invasive urothelial carcinoma of the bladder who underwent RC between 2004 and 2012. The primary endpoint was overall survival (OS). Secondary endpoints were rates of downstaging (pT0), positive pathologic lymph nodes (pN+), margin status, postoperative readmission, length of hospital stay (LOS), and 30 and 90-day postoperative mortality rates. OS comparison using Cox regression analysis was conducted. Furthermore, logistic regression models examining secondary outcomes were fitted. To adjust for potential selection bias, propensity score weighted analyses were performed. Results: Of 8732 patients who underwent RC, 1619 (19%) received NAC. Compared to the SWOG-8710 cohort, our population was older, more commonly female (p=0.002), and had higher clinical stage (p&lt;0.001). Following propensity score adjustment, receipt of NAC was associated with an OS benefit (Hazard Ratio [HR]: 0.88, p=0.017). On secondary outcome analysis, higher downstaging rates (Odds Ratio [OR]: 5.03, p&lt;0.001) and lower 30-day (OR: 0.49, p=0.019) and 90-day (OR: 0.61, p=0.009) postoperative mortality rates were recorded in patients who received NAC. Conclusions: Despite baseline differences between patients from the SWOG-8710 trial and general urologic practice, NAC is associated with an OS advantage relative to RC alone. Continued efforts should focus on promoting the use of NAC in appropriate patients.

National Trends in the Management of Urethral Stricture Disease: A 14-Year Survey of the Nationwide Inpatient Sample

IntroductionUrethral strictures are common in general urology practice and can initially be treated with urethral dilation or incision. Unfortunately, many patients require retreatment. Urethroplasty provides a more durable effect but may be underused. We examined national trends in the management of urethral stricture disease. MethodsUsing the NIS (Nationwide Inpatient Sample) database from 1998 to 2011 we identified patients with a primary or secondary admitting ICD-9 diagnosis code of 598.X (urethral stricture) and excluded patients with urethral cancer, urethritis, urethral stone, abscess or epispadias. Inpatient procedure codes were used to classify 2 treatment groups, including 1) urethral dilation/incision and 2) urethral reconstruction. Linear regression was performed to determine the change in the utilization rate of incision/dilation and urethral reconstruction per 1,000 urethral strictures with time. ResultsA total of 240,108 procedures were identified for 471,596 urethral stricture diagnoses upon hospital admission, including 217,869 (90.7%) for incision/dilation and 22,239 (9.3%) for urethral reconstruction/urethrostomy. Mean utilization of incision/dilation per 1,000 strictures decreased slightly by 10.74 per year (1%) (p ≤0.001). Mean utilization of urethral reconstruction increased slightly by 1.65 per year (0.17%) (p = 0.0062). For every 1 increase in urethral reconstruction there were 12 fewer urethral dilations per 1,000 urethral strictures per year. ConclusionsUrethral dilation/incision continues to be the foremost management of urethral stricture disease with known high recurrence and failure rates. Patients should be referred for urethral reconstruction to optimize treatment outcomes.