Urological Setting Research Articles

SAT-533 Men with Hypogonadism and Osteoporosis Benefit from Long-Term Testosterone Therapy (TTh) with Testosterone Undecanoate Injections (TU) Regardless of Co-Medication with Bisphosphonates: 10-Year Data from a Controlled Registry Study in a Urological Setting

Background: Testosterone and its metabolite estradiol are essential factors in bone metabolism, and hypogonadism is an established risk factor for osteoporosis. Material and Methods: In a registry study of otherwise unselected men with hypogonadism in a urological office, 102 of 805 patients (13%) had osteoporosis diagnosed and treated elsewhere. 69 received TTh with TU 1000 mg/12 weeks (T-group). 33 had opted against TTh and served as controls (CTRL). BMD was measured at least once a year by using a whole body dual-energy X-ray densitometer (Norland XR-800). 10-year data are reported. Changes over time between groups were compared by mixed effects model for repeated measures with random effect for intercept and fixed effects for time, group and their interaction, and adjusted for age, weight, waist circumference, fasting glucose, blood pressure and lipids to account for baseline differences between groups. Results: Baseline age: 54.5±8.2 (T-group), 64.9±4.1 years (CTRL). Mean (median) follow-up was 7.5±2.3 (8) years in the T-group and 8.9±1.1 (9) years in CTRL. 36 (52%) in the T-group had Klinefelter’s syndrome (KS) which, in the majority of cases, was diagnosed secondary to the diagnosis of osteoporosis. 7 patients had primary hypogonadism other than KS, 6 had a history of alcohol abuse, 4 had Crohn’s disease, and 3 had had a kidney transplant. All patients were on Vitamin D-calcium supplements. 64 patients (93%) in the T-group and 23 (70%) in CTRL were on bisphosphonates at baseline. 11 patients (16%) in the T-group and 11 (33%) in CTRL discontinued bisphosphonates due to side effects. T-scores progressively improved from -3.39±0.56 to -1.19±0.03 after 10 years (T-group) and worsened from -3.01±0.3 to -3.83±0.53 in CTRL, adjusted difference between groups: 2.45 (p<0.0001 for all). At the last measurement, 64 patients (93%) in the T-group had osteopenia; only 5 with a maximum treatment duration of 42 months still had osteoporosis. In CTRL, no patient achieved osteopenia. There were 6 fractures in CTRL but none in the T-group. Adherence to TTh was 100 per cent as all injections were administered in the doctor’s office and documented. Conclusion: Long-term TTh with TU in an unselected cohort of hypogonadal men with osteoporosis resulted in sustained improvements in T-scores with a high proportion of resolution of osteoporosis which depended on duration of TTh. In untreated controls, T-scores worsened and fractures occurred. Bisphosphonate treatment did not result in any improvement of bone density in the untreated hypogonadal controls.

MON-091 Profound and Sustained Weight Loss in Men With Hypogonadism and Obesity Receiving Long-Term Testosterone Therapy (TTh) with Testosterone Undecanoate Injections (TU): 10-Year Data from a Registry Study in a Urological Setting

Background: Weight loss in obese subjects is notoriously difficult to achieve through lifestyle interventions, and even harder to maintain long-term. Testosterone therapy has shown promising results in long-term but not short-term studies. Material and Methods: In an observational registry study of 805 men with hypogonadism in a urological office, 462 (57.4%) were obese. 273 received TTh with TU 1000 mg/12 weeks (T-group) while 189 opted against TTh and served as controls (CTRL). Measurements were performed 1-4 times a year. 10-year data are reported. Changes over time between groups were compared by mixed effects model for repeated measures with random effect for intercept and fixed effects for time, group and their interaction, and adjusted for age, weight, waist circumference, fasting glucose, blood pressure and lipids to account for baseline differences between groups. Results: Baseline age: 59.8±6.1 (T-group), 63.5±5 years (CTRL). Mean (median) follow-up: 8 (9) years (T-group) and 7.5 (8) years (CTRL). Total observation time: 3588 patient-years. Weight progressively decreased by 22.9±0.3 kg (p<0.0001) (T-group) and increased by 3.2±0.5 kg (p<0.0001) in CTRL, estimated adjusted difference between groups: 26.1 kg (p<0.0001). Waist circumference declined by 12.5±0.2 cm (p<0.0001) (T-group) and increased by 4.6±0.4 cm (p<0.0001) in CTRL, difference between groups: 17.1 cm (p<0.0001). BMI decreased by 7.3±0.1 kg/m2 (p<0.0001) (T-group) and increased by 0.9±0.2 kg/m2 (p<0.0001) in CTRL, difference between groups: 8.2 kg/m2 (p<0.0001). Per cent weight loss was 20.3±0.3% (p<0.0001) in the T-group, per cent weight gain 3.9±0.4% (p<0.0001) in CTRL, difference between groups: 24.3% (p<0.0001). Waist-to-height ratio decreased by 0.07±0.001 (p<0.0001) (T-group) and increased by 0.03±0.002 (p<0.05) in CTRL, difference between groups: 0.1 (p<0.0001). Adverse events: During the entire observation time, there were 12 deaths (4.4%) in the T-group. In CTRL, there were 57 deaths (30.2%), 47 MIs (24.9%) and 44 strokes (23.3%). Medication adherence in the T-group was 100 per cent as all TU-injections were performed in the office and documented. Conclusion: Long-term TTh in men with hypogonadism and obesity resulted in profound and sustained improvements in anthropometric parameters, as well as reduction of mortality and major adverse cardiovascular events. As recommended by the AACE/ACE 2016 obesity guidelines, testosterone should be measured in obese men and testosterone treatment offered if indicated.

OR21-2 Lipid Profiles Improve in Men With Hypogonadism and Pre-existing Cardiovascular Disease Under Long-term Testosterone Therapy (TTh) With Testosterone Undecanoate Injections (TU): 10-year Data From a Controlled Registry Study in a Urological Setting

Background: Effects of testosterone on lipid patterns are inconsistent. While in short-term studies, testosterone usually lowers HDL, long-term studies seem to increase HDL. Total cholesterol, LDL and triglycerides are either reduced by TTh, or effects are neutral. Effects of TTh on lipids may depend on treatment duration. Material and Methods: In a registry study of 805 men with hypogonadism in a urological office, 194 194 had a pre-existing cardiovascular disease, defined as previous myocardial infarction (MI), stroke, or diagnosis of coronary heart disease (CHD). 78 men received parenteral TU 1000 mg/12 weeks following an initial 6-week interval (T-group) for up to 10 years, 116 men decided against TTh and served as controls (CTRL). Most measurements were performed 1-4 times a year for approximately 1,500 patient-years. 10-year data are reported. Mean changes over time between groups were compared by mixed effects model for repeated measures with random effect for intercept and fixed effects for time, group and their interaction and adjusted for age, weight, waist circumference, fasting glucose, blood pressure and lipids to account for baseline differences between groups. Results: Mean baseline age: 61.3±4.7 years (T-group), 63.8±5 (CTRL) (p<0.001). Mean (median) follow-up was 8.6±2.5 (10) years in the T-group and 7.0±2.6 (7) years in CTRL. Total cholesterol (mmol/L) decreased by 2.6±0.1 in the T-group and increased by 1.2±0.1 in CTRL, estimated adjusted difference between groups: 3.8 (p<0.0001 for all). HDL (mmol/L) increased by 0.4±0.0 in the T-group and decreased by 0.2±0.0 in CTRL, estimated adjusted difference between groups: 0.6 (p<0.0001 for all). LDL (mmol/L) decreased by 1.9±0.1 in the T-group and increased by 0.8±0.1 in CTRL, estimated adjusted difference between groups: 2.8 (p<0.0001 for all). Triglycerides (mmol/L) decreased by 1.1±0.1 in the T-group and increased by 0.4±0.1 in CTRL, estimated adjusted difference between groups: 1.5 (p<0.0001 for all). Non-HDL (mmol/L) decreased by 4.2±0.3 in the T-group and increased by 3.8±0.3 in CTRL, estimated adjusted difference between groups: 7.9 (p<0.0001 for all). Remnant cholesterol (mmol/L) decreased by 1.1±0.1 in the T-group and increased by 0.6±0.1 in CTRL, estimated adjusted difference between groups: 1.7 (p<0.0001 for all). Outcomes T-group: 8 deaths (10.3%). 1 deaths was a traffic accident, 7 were due to surgery (sepsis or thromboembolism). Outcomes CTRL: 39 deaths (33.6%), all cardiovascular, 26 non-fatal myocardial infarctions (22.4%), and 27 non-fatal strokes (23.3%). Medication adherence to testosterone was 100% as all injections were administered in the medical office and documented. Conclusion: In men with hypogonadism and pre-existing cardiovascular disease, long-term TTh improves the lipid profile which may be a contributing factor to the observed reduction in cardiovascular events and mortality.

Clinical utility study of confirms mdx for prostate cancer in a community urology practice.

94 Background: There is an unmet need for methods to better identify patients most likely to benefit from repeat prostate biopsy after an initial negative biopsy. ConfirmMDx is a molecular test clinically validated for detection of prostate cancer (PCa) in tissue from PCa-negative biopsies. In this clinical utility study, we evaluated the impact of ConfirmMDx on the management of patients being considered for repeat prostate biopsy in a community urology practice. Methods: The study population consisted of 605 men with a prior PCa-negative prostate biopsy, who were counseled on the need to undergo repeat biopsy at a large community urology practice due to persistent elevated risk of PCa. All tissue cores from each PCa-negative patient were tested with the ConfirmMDx methylation-specific PCR test, and positive or negative ConfirmMDx results based on the presence or absence of GSTP1, APC or RASSF1 methylation in the biopsy tissue. ConfirmMDx results were provided to the physician for use in repeat biopsy decision-making. Medical record review was conducted at a minimum of nine months after ConfirmMDx results were reported. Results: Of the 605 subjects enrolled, 308 (51%) had a negative ConfirmMDx test result and 297 (49%) were positive. For the entire study population, average age was 64 (median 64, interquartile range 59 to 69), average serum PSA level 6.8 ng/mL (5.7, 4.3 to 8.1). The median follow-up for both Confirm positives and negatives was 10 months post-testing. Repeat biopsy rates for ConfirmMDx positive and negative men were 32.3% (96/297) and 5.8% (15/308), respectively (P &lt; 0.001). For patients who received a biopsy during the follow-up period, the time between ConfirmMDx and repeat biopsy was shorter for ConfirmMDx positive men versus ConfirmMDx negatives (median 4 vs. 8 months, P = 0.007). Conclusions: In this utility study, ConfirmMDx had a significant impact on repeat prostate biopsy decision-making in a U.S. community urology setting. Repeat biopsy rates in ConfirmMDx positive men were six-fold higher than in ConfirmMDx negatives. These results reflect the clinical utility of ConfirmMDx for biopsy decision-making in real world clinical practice.

Clinical Rating Scales for Urinary Symptoms in Parkinson Disease: Critique and Recommendations.

The prevalence of lower urinary tract symptoms (LUTS) is high in Parkinson's disease (PD). These problems negatively affect quality of life and include both storage and voiding problems. The International Parkinson and Movement Disorder Society established a task force to review clinical rating scales/questionnaires for the assessment of urinary symptoms in PD. According to prespecified criteria, these scales/questionnaires were classified as "Recommended" or "Recommended with caveats" when clinimetric properties were satisfactory for Recommended status but had not been assessed specifically in PD, "Suggested" or "Listed." These assessments were applied to rate scales as screening tools for the diagnosis of LUTS and for the rating of symptom severity. Among scales that included LUTS but focused on overall autonomic or non-motor symptoms in PD, no scale reached the clinimetric rigor to be designated as Recommended or Recommended with caveats, but some were Suggested for either diagnostic screening tools or severity measures. Among primary urological scales, most are well validated in urological setting, but none was validated specifically in PD. DAN-PSS (Danish PSS), ICIQ (International Consultation for Incontinence Questionnaire)-MLUTS (Male Lower Urinary Tract Symptoms), OABq, OABq-SF (ICIQ-OABqol), OAB-V8 (as screening tool), and OABSS (OAB Symptom Score) met criteria for Recommended with caveats. The Task Force does not recommend the development of a new scale. However, all above-mentioned questionnaires need to be studied further and specifically validated in PD.

The measurement of membranous urethral length using transperineal ultrasound prior to radical prostatectomy

Objective: To compare preoperative membranous urethral length (MUL) measurements using magnetic resonance imaging (MRI) with two-dimensional transperineal ultrasound imaging (TPUS) in two supine positions on two separate days in men prior to radical prostatectomy.Materials and methods: MUL was prospectively measured in 18 male volunteers using MRI and on two separate occasions in two different patient positions using TPUS; the patient supine with the knees extended (Supine) and supine with the knees flexed to 70 degrees (Supine KF). Agreement between TPUS and MRI measurements of MUL was assessed using Bland-Altman method comparison techniques and a two-way mixed-effects single measures intraclass correlation (ICC). Test-retest reliability was assessed using a two-way random effects single measures ICC.Results: The mean difference in MUL measurements between MRI and i) TPUS Supine was −0.8 mm (95% limits of agreement (LOA): −3.2, 1.7) and ii) TPUS Supine KF was −0.8mm (95% LOA: −3.5, 1.9). ICC indicated a point estimate of excellent agreement between MRI and TPUS Supine ICC 0.93 (95% CI: 0.76, 0.98) and TPUS Supine KF ICC 0.91 (95%CI 0.79, 0.97). There was excellent agreement between TPUS Supine and TPUS Supine KF (ICC 0.98, 95% CI: 0.96, 0.99) with a mean difference of 0.3mm (95% LOA: −1.2 to 1.3mm).Conclusions: Preoperative MUL can be reliably measured using TPUS and demonstrates excellent agreement with MRI measurements of MUL. TPUS provides clinicians with an accessible non-invasive alternative to MRI for the measurement of MUL that can be used in outpatient urological settings and for patients where MRI is contraindicated.

Resistenze antibiotiche e nuove molecole: qual è lo scenario attuale?

Antibiotic resistance and new drugs in urologic setting: what we need to know? Urinary tract infections (UTIs) are among the most frequent infectious diseases, and represent an important public health problem with a substantial economic burden. In recent years the chemoresistance of the main uropathogens has significantly increased worldwide. Extended spectrum beta-lactamase (ESBL) production and multi-drug resistant (MDR) clones of Escherichia coli and Klebsiella pneumoniae are limiting available treatment options. Carbapenems and aminoglycosides are still effective in complicated UTI. New beta-lactam combinations such as ceftolozane-tazobactam and ceftazidime-avibactam may be highly useful in treating severe infections while contributing to the carbapenem sparing strategy. For uncomplicated UTI, within older antibiotics, fosfomycin trometamol may be considered a first-choice drug since it is still retaining a good activity against MDR uropathogens. On the other hand, there are extensive data showing that the administration of antimicrobials according to pharmacokinetic/pharmacodynamic (PK/PD) parameters improves the possibility of a positive clinical outcome, particularly in severely ill patients. Evidence is growing that when PK/PD parameters are used to target not only clinical cure. This article discusses the PK/PD characteristics of antimicrobial agents for the treatment of UTIs, and the pharmacological and therapeutic strategies for limiting or preventing bacterial resistance.

Antibiotic stewardship: ripartiamo dalla pratica clinica.

Antibiotic stewardship: a milestone in everyday clinical practice Infectious diseases caused by multi-resistant pathogens are increasing worldwide and are challenging for clinicians, also in urological setting. The alarming situation is worsened by the limited perspective of new antibiotic developments. Several authors demonstrated that in Italy we have alarming data about resistance rates: in Campania about 58% of Escherichia coli are resistant to fluroquinolones, as 46% to sulfamethoxazole-trimethoprim. On the other hand, the resistance rate against fosfomycin is still low less than 5%. More alarming data are reported about Klebsiella pneumoniae: resistance rate to flurquinolones 65% and 58% to sulfamethoxazole-trimethoprim. A continuing uncritical, non-guideline-conform and overuse of antibiotics leads to selection of multidrug-resistant pathogens, which can colonize patients and make the treatment a real challenge. A revision of our approach to urinary tract infections at the light of antibiotic stewardiship principles are urgently required, in particular starting from the everyday clinical practice.

Remission of Type 2 Diabetes in 12% (16 of 133) Hypogonadal Men Receiving Long-Term Testosterone Therapy in a Real-Life Registry Study

Background: According to 2016 AACE/ACE obesity guidelines, hypogonadism should be assessed and treated in indicated in men with type 2 diabetes mellitus (T2DM). Methods: In a registry of hypogonadal men (testosterone ≤12.1 nmol/L) conducted since 2004 in a urological setting, 133/400 patients (33.3%) had T2DM diagnosed and treated in a diabetes center. All men received testosterone undecanoate (TU) injections 1000 mg/12 weeks (T-group) following an initial 6-week interval. Anthropometric and metabolic parameters were measured at least twice a year and fasting insulin obtained from the diabetes center to calculate HOMA-IR. Results: Mean follow-up was 6.9, maximum 11 years. 16 patients (12%) were in remission at the last measurement. Their average baseline age was 60.1 years. HbA1c dropped from 8.3% at baseline to 5.7% at the last measurement, fasting glucose from 7.8 mmol/L to 5.4 mmol/L. Fasting insulin declined from 24.7 to 7.6 µU/mL. HOMA-IR dropped from 8.7 to 1.8. Triglycerides decreased from 3.2 to 2.2 mmol/L. Anthropometric parameters: Body weight declined progressively from 107 to 89 kg, waist circumference from 1to 97 cm. All patients had been on oral antidiabetic medication (metformin) at baseline. Five patients were on insulin at an average dose of 21.6 units per day. The average observation time was 106.3 months (8.9 years). The average time to discontinuation of diabetes medication was 74.8 months (6.2 years). One patient was diagnosed with low-grade prostate cancer and developed new onset T2DM while off TU. He went into remission 48 months after resuming TU therapy. Medication adherence to TU was 100 per cent as all injections were administered in the urology office and documented. Discussion: The registry was not designed to study the effects of testosterone on T2DM. Remission of T2DM has not been described in the literature and was unexpected. Conclusions: Long-term testosterone treatment in hypogonadal men may result in remission of T2DM. Disclosure A. Haider: Research Support; Self; Bayer AG. K.S. Haider: Other Relationship; Self; Bayer AG. F. Saad: Employee; Self; Bayer AG. Stock/Shareholder; Self; Bayer AG, Novo Nordisk A/S.

Review of the evidence on handling drugs and hazardous products in Urology Departments. Consensus document between the Spanish Urological Association and the Spanish Society of Hospital Pharmacy

BackgroundThe intravesical administration of hazardous drug products is a standard practice in the urology setting, which potentially exposing medical personnel to these drug products. It was deemed necessary to have a consensus document among the scientific societies involved (the Spanish Urological Association and the Spanish Society of Hospital Pharmacy) that collects the best available evidence on the safest handling possible of dangerous drug products in the setting of urology departments. MethodsWe reviewed the legislation and recommendations on the handling of dangerous drug products, both at the national and international level. ResultsThere is national legislation and regulations for protecting workers who handle dangerous drugs and products, as well as recommendations for handling to protect both the product and workers. DiscussionFollowing the strategic lines of the European Parliament for 2014–2020 in the chapter on occupational safety and health, the Spanish Urological Association and the Spanish Society of Hospital Pharmacy proposed a series of actions that decrease the risks of exposure for practitioners and caregivers involved in the handling of these products. ConclusionsAfter this review, 19 recommendations were established for handling dangerous drug products, which can be summarized as the need to train all individuals involved (from management teams to patients and caregivers), adopt systems that prevent contaminating leaks, implement exposure surveillance programs and optimize available resources.

Revisión de la evidencia sobre el manejo de medicamentos y productos peligrosos en los servicios de Urología. Documento de consenso entre la Asociación Española de Urología y la Sociedad Española de Farmacia Hospitalaria

BackgroundThe intravesical administration of hazardous drug products is a standard practice in the urology setting, which potentially exposing medical personnel to these drug products. It was deemed necessary to have a consensus document among the scientific societies involved (the Spanish Urological Association and the Spanish Society of Hospital Pharmacy) that collects the best available evidence on the safest handling possible of dangerous drug products in the setting of urology departments. MethodsWe reviewed the legislation and recommendations on the handling of dangerous drug products, both at the national and international level. ResultsThere is national legislation and regulations for protecting workers who handle dangerous drugs and products, as well as recommendations for handling to protect both the product and workers. DiscussionFollowing the strategic lines of the European Parliament for 2014-2020 in the chapter on occupational safety and health, the Spanish Urological Association and the Spanish Society of Hospital Pharmacy proposed a series of actions that decrease the risks of exposure for practitioners and caregivers involved in the handling of these products. ConclusionsAfter this review, 19 recommendations were established for handling dangerous drug products, which can be summarised as the need to train all individuals involved (from management teams to patients and caregivers), adopt systems that prevent contaminating leaks, implement exposure surveillance programmes and optimise available resources.

MP23-09 COMPARISON OF POSTOPERATIVE CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES IN THE UROLOGIC PATIENT WITH A SUPRAPUBIC CATHETER VERSUS TRANSURETHRAL CATHETER

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2018MP23-09 COMPARISON OF POSTOPERATIVE CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES IN THE UROLOGIC PATIENT WITH A SUPRAPUBIC CATHETER VERSUS TRANSURETHRAL CATHETER Jason Warncke, Brittan Sutphin, John Hohenmeyer, E. David Crawford, and Brian Flynn Jason WarnckeJason Warncke More articles by this author , Brittan SutphinBrittan Sutphin More articles by this author , John HohenmeyerJohn Hohenmeyer More articles by this author , E. David CrawfordE. David Crawford More articles by this author , and Brian FlynnBrian Flynn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.741AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary tract infections (UTIs) are the most common type of healthcare-associated infection. Among UTIs acquired in the hospital, 75% are catheter-associated urinary tract infections (CAUTI). CAUTI has gained much attention, as in 2008 Medicare regulations ceased reimbursement for costs related to nosocomial CAUTIs. Traditional teaching has been that suprapubic catheters (SPC) are associated with less risk of CAUTI than transurethral catheters (TUC). However, studies directly comparing the CAUTI rate in patients with SPC versus TUC are lacking, particularly in the postoperative Urologic patient. Thus, in this study we aim to compare the CAUTI rate with SPC versus TUC in the postoperative Urologic patient. METHODS We retrospectively reviewed and compared the medical records of 354 patients over a 5-yr period that underwent Urologic surgery. The SPC group consisted of patients that underwent SPC placement at the time of concomitant autologous rectus fascia pubovaginal sling (PVS) by a single surgeon (BJF). SPC placement was accomplished using the T-Spec device from Swan Valley Medical. The TUC group consisted of patients that underwent TUC placement using an 18 Fr Foley at the time of open radical prostatectomy (RP) by a single surgeon (EDC). Patients without a SPC or TUC and patients with both were excluded from the study. The primary outcome of comparison was the CAUTI rate (defined by the 2017 CDC guidelines) between the SPC and TUC cohorts. A Fisher’s exact test was performed to determine if the difference in CAUTI rate between the two cohorts was statistically significant (p<0.05). RESULTS 252 patients were included, including 145 (57.6%) in the SPC group and 107 (42.5%) in the TUC group, mean age 54.5 and 61.5 yrs, respectively. The mean catheter duration at the time of CAUTI for the SPC and TUC groups were 21.3 and 16.0 days, respectively (p=0.79). The mean catheter duration for the TUC group with and without CAUTI was 25.4 and 14.7 days, respectively (p=0.14). The overall CAUTI rate when catheter duration was less than 15 days compared to greater than 15 days was 3.3% and 5.0%, respectively (p=0.39). The CAUTI rate for the SPC group was 2.1% versus the TUC group 7.5% (p=0.039; OR 3.82). CONCLUSIONS In this study of postoperative Urologic patients, SPC was found to have a statistically significant lower rate of CAUTI when compared to TUC. This information may help guide providers when choosing the appropriate bladder drainage modality for their patients, particularly in the postoperative Urologic setting. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e284 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jason Warncke More articles by this author Brittan Sutphin More articles by this author John Hohenmeyer More articles by this author E. David Crawford More articles by this author Brian Flynn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prevention of bladder cancer incidence and recurrence: tobacco use.

To summarize the current knowledge about smoking carcinogenesis in bladder cancer (BCa), individual susceptibility and impact of smoking on incidence and outcomes of nonmuscle invasive BCa (NMIBC) and muscle-invasive BCa (MIBC). To assess the impact of smoking cessation on oncological outcomes. Smoking pattern, intensity, and duration are responsible for an increased risk of developing BCa and for worse tumor features at presentation. Tobacco consumption is associated with a higher risk of recurrence in NMIBC and with an impaired intravesical therapy efficacy. To date, the impact of smoking on oncological outcomes after radical surgery remains unclear. Smoking cessation decreases the risk of BCa and may also allow benefits on treatment outcomes. Nonetheless, the magnitude of the effect remains unclear and prospective series with the specific aim of weighing smoking cessation on outcomes are needed. Because even a 5-min counseling in the urology setting may be sufficient to significantly enhance smoking cessation rates, adequate knowledge of links between tobacco and BCa, from its molecular pathophysiology and its harms to benefits of cessation is paramount for urologists and for everyday clinical practice.

Efficacy of Tamsulosin alone versus Tamsulosin Phloroglucinol combination therapy for medical expulsion of lower Ureteral calculi.

Objective:To see whether phloroglucinol-added tamsulosin therapy exhibits better efficacy than tamsulosin alone in medical expulsion of lower ureteral stone (LUS).Methods:Sixty four consecutive adult patients presented in a urological setting at Sialkot, Pakistan between January 2015 and December 2016 with solitary, unilateral 3-8mm sized lower ureteral stone (reported by noncontrast computed tomography of the kidney-ureter-bladder) were documented. Group either study or control was allotted, randomly. Same 0.4 mg tamsulosin, once daily was given to all the participants. However, additional 40 mg phloroglucinol, thrice daily was advised for study group (n = 32). The therapy terminated on confirmation of stone expulsion otherwise continued for 6 weeks. Patients were asked to use 50 mg diclophenac Na on colic episode.Results:Demographic characteristics revealed 81.2% (n = 52) male patients while age statistics as M = 42.3, SD = 5.93 (range 32-60) years. The study group showed higher stone expulsion rate (100%) and time to expulsion (M = 10.34 days) than control. The values were statistically significant (p = .02 and p = .0001; χ2 test in SPSS). Similarly, combination therapy had advantage on mono therapy for reporting statistically lesser numbers of colic episode (p = .03) and consumption of analgesic (p = .02). A marked difference in rate of adverse effects i.e. 68.8 vs. 90.6% was observed in study and control groups.Conclusion:Phloroglucinol-added therapy is a better choice for expulsion of LUS than tamsulosin alone with reference to stone expulsion rate and medication time.

Local epidemiology and resistance profiles in acute uncomplicated cystitis (AUC) in women: a prospective cohort study in an urban urological ambulatory setting

BackgroundAcute uncomplicated cystitis (AUC) is a common ailment in the urological setting. Guidelines for urinary tract infections are based on large-scale multi-centre, epidemiological and international studies. The objective of this observational study was to establish whether the results of a multi-centre study on the resistance profile of Escherichia coli (E. coli) in patients with AUC could be directly applied to an urological practice in a major European city or whether there are divergences in the resistance profile.MethodsAn observational study was applied prospectively to 502 patients with AUC between January 2015 and January 2017). Personal data were anonymised. Exclusion criteria were the patient’s age (<18) and treatment with an antibiotic in the week preceding examination.ResultsThe average age was 32 (range 18–56). The most commonly detected bacteria was E. coli with 86%, followed by Enterococcus faecalis with 10% and Klebsiella pneumoniae with 4%. Resistance tests showed E. coli to be highly sensitive to fosfomycin (99.2%), nitrofurantoin (98.1%) and cefpodoxime (92.9%). E. coli exhibited resistance to ciprofloxacin (CIP) in 15.1%, to trimethoprim/sulfamethoxazole (TRS) in 25.2% and to amoxicillin/clavulanic acid (AMC) in 34% of cases.ConclusionThe comparison between data from this study and data from a multi-centre European (ECO-SENSI, ECO-SENSII and the 2014 update) showed relatively good sensitivity rates for fosfomycin and nitrofurantoin but significant differences in respect of resistance levels to TRS, CIP and AMC. AUC should therefore only be treated with TRS, CIP and AMC after a susceptibility test has been carried out.

Solubilization and Stability of Mitomycin C Solutions Prepared for Intravesical Administration.

BackgroundMitomycin C (MMC) is an antitumor agent that is often administered intravesically to treat bladder cancer. Pharmacologically optimized studies have suggested varying methods to optimize delivery, with drug concentration and solution volume being the main drivers. However, these MMC concentrations (e.g. 2.0 mg/mL) supersede its solubility threshold, raising major concerns of inferior drug delivery.ObjectiveIn this study, we seek to confirm that the pharmacologically optimized MMC concentrations are achievable in clinical practice through careful modifications of the solution preparation methods.MethodsMMC admixtures (1.0 and 2.0 mg/mL) were prepared in normal saline using conventional and alternative compounding methods. Conventional methodology resulted in poorly soluble solutions, with many visible particulates and crystallates. However, special compounding methods, which included incubation of solutions at 50 °C for 50 min followed by storage at 37 °C, were sufficient to solubilize drug. Chemical degradation of MMC solutions was determined over 6 h using high-performance liquid chromatography (HPLC) analytics, while physical stability was tested in parallel.ResultsImmediately following the 50 min incubation, both MMC solutions exhibited approximately 5–7% drug degradation. Based on the measured concentrations and linear regression of degradation plots, additional storage of these solutions at 37 °C for 5 h retained chemical stability criterion (< 10% overall drug loss). No physical changes were observed in any solutions at any test time points.ConclusionWe recommend that the described alternative preparation methods may improve intravesicular delivery of MMC in this urological setting, and advise that clinicians employing these changes should closely monitor patients for MMC toxicities and pharmacodynamics (change in clinical outcomes) that result from the potential enhancement of MMC exposure in the bladder.

PD45-03 VOIDING FUNCTION IMPROVES UNDER LONG-TERM TREATMENT WITH TESTOSTERONE UNDECANOATE INJECTIONS (TU) IN HYPOGONADAL MEN FOR UP TO 12 YEARS INDEPENDENT OF PROSTATE SIZE

INTRODUCTION AND OBJECTIVES:Long-term effectiveness and safety of TU in hypogonadal men were studied in a urological setting. One of the concerns regarding testosterone therapy (TTh) in elderly men...

A Survey of Perceptions and Acceptance of Wearable Technology for Health Monitoring in a Urological Patient Population

IntroductionThrough real-time monitoring of biophysical parameters, physical activity monitors may represent a medium by which urologists can actively engage patients and improve treatment outcomes. We examined patient reported acceptance of physical activity monitor technology in an ambulatory urology setting. MethodsPatients treated at a single urology department during a 6-month period were identified. A web based survey was conducted evaluating patient characteristics and acceptance of physical activity monitors. ResultsA total of 1,043 (19%) patients completed the survey, of whom 210 (20%) reported using physical activity monitors for health and wellness. Overall 854 (82%) respondents were willing to use these devices for urological care. Compared to patients who disagreed, those willing to use physical activity monitors for medical care reported greater perceived medical benefit (86% vs 14%), improved communication (85% vs 26%), confidentiality (89% vs 45%), less interference with daily activity (4% vs 55%) and improved health (81% vs 13%, all p <0.0001). Benefits and usefulness among accepting patients included health monitoring convenience (82%), goal related feedback (82%), ease of communication (57%) and monitoring of post-procedure recovery (56%). After controlling for associated patient characteristics, the degree of perceived burden, medical benefit, health improvement and enhancement in communication were modifiable, and independently associated with physical activity monitor acceptance. ConclusionsThere is a high level of acceptance for wearable technology among urology patients. This may have significant implications for improving patient engagement, perioperative care pathways and surgical outcomes. Finally, these findings may assist urologists in directing future efforts to clinically integrate physical activity monitors to enhance patient acceptance and potential outcomes.

Spanish adaptation of the recommendations for the appropriate use of social media in urology of the European Association of Urology

ObjectiveTo adapt to Spanish the recommendations for the appropriate use of social media (SoMe) in the urological setting prepared by the European Association of Urology (EAU). Acquisition of evidenceThe use of SoMe has become fairly popular in the international urological community. Due to the nature of the medical content shared among healthcare professionals through SoMe, however, there is the risk of medical and legal problems. For this reason, various international urological associations such as the American Urological Association, the British Association of Urological Surgeons and EAU have published their recommendations for the appropriate use of social media. Efforts have been made to adapt and summarize the recommendations of the EAU in Spanish and to publish them in Actas Urológicas Españolas (@actasurologicas), the official journal of the Spanish Urological Association (@InfoAEU) and the American Confederation of Urology (@CAU_URO). Synthesis of the evidenceSoMe include well-known platforms such as Twitter, Facebook and YouTube, which have undoubtedly changed the way in which people communicate and interact. SoMe offer clear advantages for communicating between professionals, working in teams, disseminating knowledge and creating professional profiles and are increasingly used by patients and healthcare practitioners. The introduction of SoMe in the urological community has started a revolution in how scientific articles are shared, how people participate in congresses and how international urological associations communicate with their followers. However, SoMe is generally an open public setting, with potential risks for confidentiality and the doctor–patient relationship due to the nature of the shared information. The present recommendations include tools for creating professional profiles, protecting confidentiality and creating honest and responsible content. ConclusionsSoMe represents a fascinating area for the communication and dissemination of knowledge, with considerable applicability in health care and the urological community. New efforts are being directed to extend the use of social media in the urological community, measuring its actual academic impact and standardizing the language employed.

The rationale and the role of lymph node dissection in renal cell carcinoma.

Although the role of lymph node dissection (LND) is well defined in many urological settings, uncertainty regarding need for LND still exists for patients with renal cell carcinoma (RCC). The aim of the current review is to highlight the rationale for performing or omitting LND at the time of renal surgery. Data were identified through a search of PubMed and Web of Science, including studies published in the last 20years in core clinical journals. The review is based on evidence synthesis from a peer-review process of the two authors after a structured data search. Neither imaging, nor predictive tools or molecular/genetic markers accurately identify which patients may warrant a LND. In patients with clinical T1abN0 and absence of unfavorable clinical and pathological characteristics, LND does not appear to offer benefit in terms of staging and cancer control. Conversely, LND can be considered in selected cases (larger tumors, locally advanced diseases or when unfavorable pathological characteristics are likely, as high Fuhrman grade, sarcomatoid features or tumor necrosis) due to the non-negligible risk of associated nodal metastases and possible benefit in terms of cancer control. Although LND does not provide any benefit in the majority of RCC cases (mainly T1abN0M0 cases), it remains an important consideration in intermediate-/high-risk patients for staging purposes, given an increased risk of LNI, and for potential benefit in terms of cancer control. Additional data are urgently needed to improve the accuracy of nodal staging tools and to evaluate the potential role of salvage LND.