Urological Practice Research Articles

Plasma transurethral enucleation of prostate adenoma measuring 640 cm<sup>3</sup>

A case report of successful plasma transurethral enucleation of a giant prostate adenoma (640 cm3) is presented. The short term postoperative follow-up showed the absence of functional and organic complications. The comparison was made with the results of surgical treatment of giant prostate adenoma by classical transurethral prostate enucleation methods obtained at “RZD Meditsina” Nizhny Novgorod Urological Clinic in 2015, it revealed a decrease in the intraoperative period by 55 minutes without an increase in intraoperative blood loss and surgical complications. The results obtained demonstrate the prospects for the widespread introduction of plasma methods of transurethral surgery into urological practice.

Gender specific differences in urethral swabs: a retrospective single-center analysis.

Sexually transmitted infections (STIs) are globally on the rise yet accurate data regarding infection rates remains scarce. There is the assumption that STIs among women with chronic urinary tract infections (UTIs) have been underestimated. This may arise from the reliance on specialised cultivation or Nucleic Acid Amplification Techniques (NAT) for detection, which are more costly than standard urine culture and are typically only conducted by specialists like urologists. A retrospective, observational, single-centre study using medicals records of patients who received a urethral swab in a German urological practice in the past five years has been conducted. 55% had a STI requiring treatment. People with recurrent UTI had a STI in 35% of the casees. Younger age is associated with the detection of STI. The female gender is significantly associated with a positive swab result. Distinguishing between cystitis and urethritis, particularly in women with recurrent UTIs experiencing dysuria, presents a clinical challenge. The prevalence of asymptomatic infections suggests that the true burden of urethritis, particularly STIs, may be substantially higher in the general population. This underscores the urgency of establishing guidelines for referral and diagnostic evaluation, as delayed or inadequate treatment may contribute to escalating infection rates and antibiotic resistance.

Commercial prices and their influence on urology practices: Prostate cancer care among men with Medicare.

For men with prostate cancer, there is substantial variation in the use of conservative management, such as active surveillance. Commercial prices, which vary across urology practices, may afford incentives that foster physician behaviors associated with utilization. Such behaviors may "spillover" to the Medicare population and affect quality. This study evaluated the effects of practice-level commercial prices on health care utilization and quality in men with prostate cancer insured by traditional Medicare. From a 20% Medicare sample, the authors identified men with newly diagnosed prostate cancer between 2014-2019 (n=44,653). Using commercial payments from the MarketScan database, they developed a practice-level commercial price index (ratio of commercial prices to Medicare prices). They examined the association of the price index with price standardized spending, overtreatment (treatment among those with >50% noncancer mortality within 10 years), and underuse of diagnostic testing in active surveillance (at least one prostate-specific antigen test and one confirmatory test-MRI, prostate biopsy, genomic test-within 12 months of diagnosis). Practice-level commercial price indices varied from 1.34 (134% of Medicare prices), for practices in the bottom decile, to 3.00, for practices in the top decile. Increasing price index was associated with lower odds of overtreatment (odds ratio, 0.86; 95% confidence interval, 0.76-0.97; p=.01), but not price standardized spending or underuse of diagnostic testing in active surveillance. Commercial prices vary markedly across urology practices. Among newly diagnosed men with traditional Medicare, those managed by practices with higher commercial price indices had lower odds of overtreatment, suggesting improved prostate cancer care quality.

Updated Research Publication Standards and Expectations for Successful Matching in Urology Residency Following Step 1 Scoring Changes.

To analyze the research productivity of 2024 urology residency applicants and its impact on match outcomes following the transition of the Step 1 exam to a Pass/Fail scoring system. We conducted a retrospective review of PubMed-indexed publications for 98 applicants matched to the top 25 urology residency programs, as ranked by Doximity. Metrics such as the number of publications, citations, journal impact factors, and authorship rank were analyzed. Statistical comparisons of publication rates between top-ranked and lower-ranked programs were made using independent samples t-tests. The average number of publications per applicant was 5.95, with those entering top-ranked programs exhibiting higher research outputs. Most publications were found in journals like "Urology" and "Urology Practice." A significant portion of the research was published in the final year of medical school, indicating a push for paper acceptances prior to the urology application deadline date. The increase in research output among applicants reflects the shifting weights of factors important for residency competitiveness following the Step 1 Pass/Fail scoring changes. Early engagement and mentorship in research have been shown to increase the research output of students. The findings of this study clarify the research expectations of matching successfully into a top urology program and can be used by both medical students and program directors in the current and upcoming cycles.

Evaluating the Importance of Practice-Level Factors on Adherence to Prostate Cancer Treatment Guidelines in Urology

ObjectiveTo evaluate adherence to treatment guideline recommendations across the continuum of prostate cancer care by US community urologists using several prostate cancer (PCa) specific performance indicators (PIs). Additionally, to determine which practice-related factors, such as having a designated PCa patient champion, active patient management in a patient portal, and in-office dispensing of medications, were associated with improved PI performance. MethodsElectronic medical record data was collected retrospectively from the PPS Analytics Patient Population Health Management Platform. The cohort consisted of adult patients with a PCa-related service visit during the period 7/1/2019 to 6/30/2022. Five PIs were reviewed: dual-energy x-ray absorptiometry (DEXA) scanning with androgen deprivation therapy (ADT), systemic therapy in metastatic PCa, external beam radiation therapy (EBRT) concurrent with ADT, image monitoring, and regular testosterone testing and monitoring. ResultsA total of 101,186 patients were identified from 95 urology practices. PI adherence rates ranged from a low of 13.6% for a DEXA scan within 6-months of ADT initiation to a high of 72.3% for EBRT concurrent with ADT in intermediate/high risk localized PCa. The results also demonstrated that several practice-related features were associated with better PI adherence. ConclusionsThe findings suggest there exists a wide range in PI adherence rates for urologists in the delivery of community urology care in the Unites States compared to clinical guideline recommendations. Future research should examine the factors associated with PI nonadherence and promote implementation of interventions that enhance guideline concordant care.

Häufigkeit von sexuell übertragbaren Infektio-nen in deutschen Facharztpraxen

The aim of this study is to analyze the incidence of sexually transmitted infections (STI) in dermatological, urological, and gynecological practices in Germany. Data from the nationwide IQVIA Disease Analyzer database was used for this study. This cross-sectional study included 6,535 patients in 2014 and 6,491 patients in 2023 with an insured diagnosis of a sexually transmitted disease in 69 dermatology, 148 gynecology and 55 urology practices. The number of patients treated for sexually transmitted diseases in these practices changed only minimally between 2014 and 2023. On average, each dermatology practice treated 31 patients with STIs in 2023, each gynecology practice treated 21 patients and each urology practice treated 23 patients. Anogenital warts were the most commonly diagnosed STI in all specialties, with prevalence varying by specialty. Interestingly, the number of patients per practice with anogenital warts increased slightly in dermatology and urology practices between 2014 and 2023, while it decreased in gynecology practices. The average age of patients treated for STDs increased between 2014 and 2023 In summary, this study highlights that despite vaccination efforts and awareness campaigns in various medical specialties, STI patient numbers remain almost the same and thus STI continues to be a persistent and increasing challenge in the ageing patient population. The findings call for further initiatives in the public health sector and an adjustment of everyday practice to the special needs of these patient groups.

Omission of intraoperative drain placement during robotic partial nephrectomy and robotic radical prostatectomy is safe: an analysis of 18,000 patients

PurposePlacement of a drain during robotic assisted partial nephrectomy (RAPN) and robotic assisted radical prostatectomy (RARP) is standard practice for many urologists and can aid in assessment and management of complications such as urine leak, lymphocele, or bleeding. However, drain placement can cause discomfort and delay patient discharge, with questionable benefit. We aim to assess the correlation between drain placement with post operative complications.MethodsThe NSQIP targeted database was queried for patients who underwent RAPN or RARP from 2019 to 2021. Our primary outcomes included 30-day complication rates stratified by intraoperative drain placement. Secondary outcomes included procedure-specific complications, length of stay (LOS), and readmissions. Multivariable regression analyses, with Bonferroni correction, were performed for each post-operative complication.ResultsWe identified 4738 and 13,948 patients who underwent RAPN and RARP, respectively. Drains were not placed in 2258 (47.7%) and 6700 (48%) patients, respectively. On adjusted multivariable analysis in the RAPN cohort, omission of drain placement was associated with decreased LOS (β -0.45; 99.58% CI [-0.59, -0.32]) but no difference in overall complication rates. After adjusted analysis in the RARP cohort, omission of drain placement was associated with decreased risk of any complication (OR 0.73 [0.62–0.87]), infectious complication (OR 0.66 [0.49–0.89]), and LOS (β -0.30 [-0.37, -0.24]).ConclusionsUsing a large contemporary database, this study demonstrates that omission of drains during RAPN and RARP was safe without increased risk of postoperative complications. Despite inherent selection bias in this cohort, our data suggests that routine drain placement is not necessary for these procedures.

Exploring Condition-Specific Variability in the Ureteral Stent Microbiome

(1) Background: Indwelling ureteral stents are commonly used urological devices to maintain ureteral patency, yet they have been associated with complications such as infections. Some studies have shown that bacteria adhere to and create an antimicrobial-resistant biofilm on stents. One factor that may impact biofilm formation is the original condition informing stent placement, such as kidney stones and renal allografts. Both kidney stones and renal allografts are independently associated with infection, yet the differential stent microbiomes of these populations remain poorly characterized. Our objective was to characterize these microbiomes in order to inform urological health practice and help prevent ureteral stent-associated infections. (2) Methods: Stents were collected from kidney stone and renal transplant recipients undergoing routine cystoscopic stent removal. Microbial DNA was extracted from stents and analyzed using 16S Next Generation Sequencing. Descriptive statistics, alpha diversity, and beta diversity methods were used for statistical analysis. (3) Results: The microbiome of ureteral stents in kidney stone and transplant patients is composed of unique species, each with different biofilm-forming abilities. (4) Conclusions: Our findings demonstrate that the microbiome of stents differs based on preceding condition. It is important to conduct future studies that explore this microbiome further to understand what type of stent-associated infection someone may develop based on their initial condition.

Urology Practice in Low- to Middle-Income Countries

The global burden of urological diseases is rising, particularly in low- and middle-income countries (LMICs) undergoing rapid demographic and epidemiological changes [...]

Advanced Imaging for Localized Prostate Cancer

Background/Objectives: Prostate cancer is a prevalent malignancy often presenting without early symptoms. Advanced imaging technologies have revolutionized its diagnosis and management. This review discusses the principles, benefits, and clinical applications of multiparametric magnetic resonance imaging (mpMRI), micro-ultrasound (microUS), and prostate-specific membrane antigen positron emission tomography–computed tomography (PSMA PET/CT) in localized prostate cancer. Methods: We conducted a comprehensive literature review of recent studies and guidelines on mpMRI, microUS, and PSMA PET/CT in prostate cancer diagnosis, focusing on their applications in biopsy-naïve patients, those with previous negative biopsies, and patients under active surveillance. Results: MpMRI has demonstrated high sensitivity and negative predictive value in detecting clinically significant prostate cancer (csPCa). MicroUS, a newer technology, has shown promising results in early studies, with sensitivity and specificity comparable to mpMRI. PSMA PET/CT has emerged as a highly sensitive and specific imaging modality, particularly valuable for staging and detecting metastatic disease. All three technologies have been incorporated into urologic practice for prostate cancer diagnosis and management, with each offering unique advantages in different clinical scenarios. Conclusions: Advanced imaging techniques, including mpMRI, microUS, and PSMA PET/CT, have significantly improved the accuracy of prostate cancer diagnosis, staging, and management. These technologies enable more precise targeting of suspicious lesions during biopsy and therapy planning. However, further research, especially randomized controlled trials, is needed to fully establish the optimal use and inclusion of these imaging modalities in various stages of prostate cancer care.

Testing Similarity of Parametric Competing Risks Models for Identifying Potentially Similar Pathways in Healthcare.

The identification of similar patient pathways is a crucial task in healthcare analytics. A flexible tool to address this issue are parametric competing risks models, where transition intensities may be specified by a variety of parametric distributions, thus in particular being possibly time-dependent. We assess the similarity between two such models by examining the transitions between different health states. This research introduces a method to measure the maximum differences in transition intensities over time, leading to the development of a test procedure for assessing similarity. We propose a parametric bootstrap approach for this purpose and provide a proof to confirm the validity of this procedure. The performance of our proposed method is evaluated through a simulation study, considering a range of sample sizes, differing amounts of censoring, and various thresholds for similarity. Finally, we demonstrate the practical application of our approach with a case study from urological clinical routine practice, which inspired this research.

The LANDMARK project: providing summaries of key papers that have shaped urological practice.

The LANDMARK project: providing summaries of key papers that have shaped urological practice.

Ureteric stenting outside of the operation theatre: challenges and opportunities.

To evaluate the safety, efficacy, tolerability, and cost-effectiveness of bedside or office-based ureteric stent insertion. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 guidelines, we searched PubMed/the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and Dimensions for English-language studies from 1978 to April 2023. Inclusion criteria focused on primary ureteric stent placements outside of the operating theatre (OT). A total of 15 studies involving 2072 stents were included. Success rates for correctly positioned stents in bedside or office-based insertions ranged from 60% to 95.8%, with most studies reporting ≥80% success rates. Common failure reasons included impacted stones and difficulty identifying the ureteric orifice. Pain and tolerability were assessed using various methods, with validated tools indicating moderate pain levels, but most patients would undergo the procedure again under local anaesthesia. Complication rates were generally low, with minor complications such as haematuria or postoperative fever being the most common. Procedural costs were significantly lower in non-OT settings, with estimates indicating savings of up to four-fold. Bedside or office-based ureteric stent insertion is a viable alternative to OT procedures, offering high success rates, manageable pain levels, low complication rates, and substantial cost savings. This approach is particularly advantageous in settings with limited OT access, highlighting its potential for broader adoption in urological practice. Future research should focus on standardising pain assessment methods and randomised studies.

Clinical case: intraluminal incision and tandem ureteral stenting in obstructive upper urinary tract uropathy

One of the common causes of urinary retention and pain symptom in urological practice is ureteric stricture. Surgery remains the only effective method of treatment. Currently, the modern minimally invasive operations are the most relevant. Minimally invasive high-tech surgery: percutaneous endoureterotomy followed by the installation of tandem stents demonstrates effectiveness in treatment of recurrent strictures of the upper urinary tract.

Improving Surgical Care and Outcomes in Older Cancer Patients Through Implementation of a Presurgical Toolkit (OPTI-Surg)-Final Results of a Phase III Cluster Randomized Trial (Alliance A231601CD).

To assess the effect of a practice-level preoperative frailty screening and optimization toolkit (OPTI-Surg) on postoperative functional recovery and complications in elderly cancer patients undergoing major surgery. Frailty is common in older adults. It increases the risk of poor postoperative functional recovery and complications. The potential for a practice-level screening/optimization intervention to improve outcomes is unknown. Thoracic, gastrointestinal, and urologic oncological surgery practices within the National Cancer Institute Community Oncology Research Program (NCORP) were randomized 1:1:1 to usual care (UC), OPTI-Surg, or OPTI-Surg with an implementation coach. OPTI-Surg consisted of the Edmonton Frail Scale and guided recommendations for referral interventions. Patients 70 years old or above undergoing curative intent surgery were eligible. The primary outcome was 8 weeks postoperative function (kcal/wk). The key secondary outcome was complications within 90 days. Mixed models were used to compare UC to the 2 OPTI-Surg arms combined. From July 2019 to September 2022, 325 patients were enrolled in 29 practices. One hundred ninety-nine (64 UC, 135 OPTI-Surg) and 279 (78 UC, 201 OPTI-Surg) were evaluable for primary and secondary analysis, respectively. UC and OPTI-Surg patients did not significantly differ in total caloric expenditure (2.2 UC, 2.0 OPTI-Surg) after adjusting for baseline function ( P =0.53). UC and OPTI-Surg patients did not significantly differ in postoperative complications (25.6% UC, 35.3% OPTI-Surg, P =0.5). Frailty assessment was successfully performed, but the OPTI-Surg intervention did not improve postoperative function nor reduce postoperative complications compared with UC. Future analysis will explore practice-level factors associated with toolkit implementation and the differences between the coaching and noncoaching arms.

Bladder Pain Syndrome (BPS): A Comprehensive Review of Treatment Strategies and Management Approaches.

Bladder pain Syndrome presents a multifaceted challenge in contemporary urological practice, marked by LUTS, negative behavioural, sexual, or emotional experiences, and the potential for sexual dysfunction. We meticulously explored the existing literature of conservative, non-invasive and invasive interventions, aiming to provide clinicians with a nuanced understanding of available options for comprehensive BPS management. We delve into the effectiveness and safety profiles from behavioural approaches through lifestyle changes and physical therapy, to oral or intravesical medications, until the definitive surgical treatment. The best option evaluated is the involvement of a multidisciplinary team, including urologists, urotherapists, gynaecologists, pain specialists, primary care physicians and psychologists, educating those patients regarding the condition and its chronic course and tailoring the perfect treatment for each person. Despite this, BPS remains a challenge for urologists. Indeed, our objective is to contribute to the evolving landscape of BPS management, fostering informed decision-making and personalized care for individuals grappling with this challenging condition.

Can artificial intelligence aid the urologists in detecting bladder cancer?

ABSTRACT Introduction: The emergence of artificial intelligence (AI)-based support system endoscopy, including cystoscopy, has shown promising results by training deep learning algorithms with large datasets of images and videos. This AI-aided cystoscopy has the potential to significantly transform the urological practice by assisting the urologists in identifying malignant areas, especially considering the diverse appearance of these lesions. Methods: Four databases, the PubMed, ProQuest, EBSCOHost, and ScienceDirect were searched, along with a manual hand search. Prospective and retrospective studies, experimental studies, cross-sectional studies, and case–control studies assessing the utilization of AI for the detection of bladder cancer through cystoscopy and comparing with the histopathology results as the reference standard were included. The following terms and their variants were used: “artificial intelligence,” “cystoscopy,” and “bladder cancer.” The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A random effects model was used to calculate the pooled sensitivity and specificity. The Moses–Littenberg model was used to derive the Summary Receiver Operating Characteristics (SROC) curve. Results: Five studies were selected for the analysis. Pooled sensitivity and specificity were 0.953 (95% confidence interval [CI]: 0.908–0.976) and 0.957 (95% CI: 0.923–0.977), respectively. Pooled diagnostic odd ratio was 449.79 (95% CI: 12.42–887.17). SROC curve (area under the curve: 0.988, 95% CI: 0.982–0.994) indicated a strong discriminating power of AI-aided cystoscopy in differentiation normal or benign bladder lesions from the malignant ones. Conclusions: Although the utilization of AI for aiding in the detection of bladder cancer through cystoscopy remains questionable, it has shown encouraging potential for enhancing the detection rates. Future studies should concentrate on identification of the patients groups which could derive maximum benefit from accurate identification of the bladder cancer, such as those with intermediate or high-risk invasive tumors.

Health-related Internet Use Among New Urology Clinic Patients

ObjectiveTo assess internet usage among new patients seen by urologists and impact on post-consultation understanding for four common conditions: kidney stones, elevated prostate specific antigen, male voiding, and female voiding. MethodsWe performed a prospective study of new urology patients at our diverse urban, academic urology practice for the above conditions over a 1-year period. A voluntary questionnaire assessed patients’ internet use related to referred conditions prior to encounters. Questions evaluated quality of information and patient understanding of symptoms/condition at baseline, after online searches, and after their urology visit. A patient-reported Likert scale of 1 (poor) to 10 (excellent) was used and internet “searchers” were compared to “non-searchers.” Results215 patients participated. Most respondents were Latino (41%) or Black (35%) and English-speaking (81%). Cohorts comprised 130 searchers (60%) and 85 non-searchers (40%). Searchers were significantly younger (median 53 vs. 63 years, P<0.001), more likely to have home internet access (P<0.001), and more general medical internet use (P<0.001). Overall, patients’ understanding of visit diagnoses increased after their encounters (median pre-visit rating 5 vs. post-visit rating 10). Searchers reported a greater post-visit understanding compared to non-searchers (median rating 10 vs. 9, P<0.001), and a greater change in understanding from baseline (median +4 vs. +3, P=0.02). ConclusionInternet use is common amongst younger patients referred to urologists and may be associated with improved understanding of their condition after urologic consultation. Continued investigation of patient uses of and attitude towards popular online resources can help urologists curate resources to benefit patients and providers alike.

Sex education for adolescents and adults-Max Hodann (1894-1946) in action

Up to the 1970s, acultural battle raged in Germany and Europe about the question of the sense to inform and educate young people about gender, sex, and sexuality. One physician realized early that it is important to educate adults about their bodies and their genital and genitourinary disorders. Max Hodann (1894-1946), thus, unintentionally flooded urological practices with countless patients.

Маркеры нарушения почечной функции после перкутанной нефролитотрипсии.

Introduction. Kidney stones (KS) is a common disease and occupies a significant place in urological practice. The incidence of KS is actively growing in industrialized countries. Modern technologies make it possible to carry out mini-cut interventions, reducing the risks of complications of standard techniques. However, an increase in the duration of procedures can lead to perfusion-pressor complications and overheating of the irrigated fluid. Acute kidney injury (AKI) during intraoperative intervention worsens the prognosis of rehabilitation and affects the dynamics of morbidity. For reliable and timely diagnosis of renal dysfunction, research is being conducted to develop new AKI biomarkers. The aim of this study was to study the effect of various percutaneous access methods on the level of acute renal injury in patients with urolithiasis. Materials and methods. The study was conducted on the basis of the Center of Urology, Nephrology and Lithotripsy of the N. A. Semashko from 2022 to 2023. The results of surgical treatment of 21 patients with nephrolithiasis were studied. The patients were divided into two groups depending on the percutaneous access method: standard PNL (28 Ch) and mini-PNL (16 Ch). The work used modern biomarkers of renal damage, such as Cystatin C, NGAL, KIM-1 and IL-18 in the postoperative period. Results. An increase in the concentration of Cystatin C and NGAL after PNL prevailed in group 1, which is associated with the release of biomarkers by tubules from a larger area of damaged renal parenchyma. Changes in KIM-1 levels in the postoperative period were greater in group 2, which is associated with the greatest ischemic damage to renal tissue. A decrease in IL-18 levels in group 2 is associated with less damage to the renal tubules and the absence of inflammatory reactions. It was found out that after 48 hours all AKI biomarkers undergo regression. Conclusions. The results of the study showed that the level of renal damage was higher in patients who underwent standard PNL, compared with those who used mini-PNL. This indicates that the use of mini-PNL may reduce the risk of acute renal injury in patients with urolithiasis.