Search

A term infant with prenatally noted ambiguous genitalia and nonpalpable gonads presented with life-threatening hyponatremia, hypertension, acidosis, and anuric renal failure requiring peritoneal dialysis at age 3 months.Sequencing confirmed 46, XY Denys-Drash syndrome (DDS) due to heterozygous Wilms tumor-1 exon 8 mutation encoding p.His445Arg. Renal US identified bilateral multifocal renal masses at age 8 months. Bilateral retroperitoneal nephrectomies found bilateral nephroblastomatosis without Wilms' tumor avoiding chemotherapy, followed by bilateral laparoscopic orchiopexies. We suggest monthly screening of 46, XY DSD cases for DDS by evaluating for proteinuria and electrolyte disarray starting at diagnosis of DSD to prevent acute life-threatening renal failure presentation., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Congenital mesoblastic nephroma is the most common renal neoplasm diagnosed in the first month of life of which 15% occur prenatally. We present a prenatal diagnosis of a 5.8 cm solid renal mass identified on the 36-week ultrasound. Labor was induced at 38 weeks and a female infant was delivered vaginally without complications. The postnatal ultrasound demonstrated a 6.3 cm heterogeneous mass nearly replacing the kidney. The infant underwent a radical nephrectomy on the first day of life and pathology confirmed stage II classic CMN with negative margins and nodes. She is otherwise healthy at follow-up of 1 year with no evidence of recurrence., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Bladder duplication is a rare anomaly classified as sagittal or coronal, depending on the axis of the septum. VACTER association involves congenital anomalies affecting the vertebrae, anus, heart, trachea, esophagus, kidney and genitourinary system. This is the first description of a case of coronal bladder duplication in a patient that also presented with anomalies on the foregut and other organs that correspond to VACTER association. Pertinent literature is systematically reviewed and compared with our case., (Copyright © 2021. Published by Elsevier Inc.)

Objective: To identify key papers in urology using a novel bibliometric index called the disruption score., Methods: A PubMed search was conducted to identify papers published in Journal of Urology, European Urology, Urology, Urologic Oncology, Journal of Endourology, and BJU International, Nature Reviews Urology. Selected urology papers published in other medical journals were also included. Using a validated dataset of disruption scores for all papers published in 1954-2014, the top 100 most-disruptive urology papers, as well as the top 100 most-cited papers, were identified. Comparisons between both lists and across journals were investigated., Results: A total of 72,623 published articles were included. Journal of Urology had the most articles in the most-disruptive papers list (n = 69) followed by BJU International (n = 16). New England Journal of Medicine had the most papers in the most-cited papers list (n = 26) followed by Journal of Urology (n = 23). Only 7 papers were common to both the most-disruptive papers and most-cited papers lists. Oncology was highly represented among the most-cited papers (n = 60), whereas the most-disruptive papers included a broader representation of urology. The most common study design among the most disruptive papers was small case-series/case reports, whereas the most common study design among the most-cited papers was randomized controlled trials., Conclusion: The disruption score identified landmark papers in urology that have introduced innovative ideas. Disruption score captures a unique profile of scientific impact that may be used in combination with other bibliometric indices to identify scholarly achievements in urology., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Male infertility is a common disease. Male infertility is also a core competency of urology training and clinical practice. In this white paper from the Society for the Study of Male Reproduction and the Society for Male Reproduction and Urology, we identify and define different physician productivity plans. We then describe the advantages and disadvantages of various physician productivity measurement systems for male infertility practices. We close with recommendations for measuring productivity that we hope urologists and administrators can use when creating productivity plans for male infertility practices., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To perform bibliometric analysis of the top cited articles in urology as a guide for journal club article selection., Methods: Bibliometric citation analysis was performed using Scopus. Tables illustrating the top cited clinical, basic science, and guidelines/position statements papers were constructed. Linear regression was used to determine association between h-index and number of citations., Results: A total of 3,188,861 publications from 1788 to 2020 were analyzed. The top 100 cited clinical papers from 1788 to 2020, top 100 cited contemporary clinical papers from 2000 to 2020, top 25 cited basic science papers, and the top 25 cited guidelines/position statement papers were reported. Median number of citations in the top 100 cited clinical papers was 1463 (interquartile range 1186-1821). Memorial Sloan Kettering Cancer Center (12), Johns Hopkins University (6), and Harvard University (6) contributed the most top cited clinical papers in urology. Urologic oncology was the most represented subspecialty in both clinical (75%) and basic science (96%) papers. First author and last author h-index were found to correlate with the number paper citations in the top 100 cited clinical papers from 1788 to 2020 (first author β:5.3, P= .003, last author β:4.5, P= .03). Only 7% of the most cited clinical papers in urology were from female first authors, which was not statistically significantly different from those reported in prior publications published in 2009 and 2013., Conclusion: Contemporary citation analysis of indexed manuscripts in urology may serve as a valuable educational tool for urologists and trainees., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To identify key articles about OAB using citation number and bibliometric analysis.Methods: We searched for articles in the Web of Science Core Collection between 1900 and 2022 using terms specific to OAB. We identified relevant OAB articles and selected the top 50 most cited. A bibliometric analysis was performed to collect and analyze data about authorship, title, publication year, total citations, journal, journal impact factor, country, institution, study type, citation index, conflict of interest (COI), and conclusions.Results: A total of 12,200 records were identified. The top 50 most cited articles were published between 1997-2015 in nine countries, across over 30 different institutions, and in 19 journals. The country, institution, and journal which produced the greatest number of articles were the USA, Southmead General Hospital in England, and BJU International, respectively. The mean number of citations per article was 365.66. Observational studies and clinical trials were the most common. Most articles were published in 2006 and were sponsored. The most cited article also had the most citations per year. This study is limited by using a single database and a single parameter as a proxy for paper importance.Conclusion: Bibliometric analyses are an important resource for clinicians to understand the body of knowledge of OAB by identifying landmark papers. This objective approach to literature review can facilitate future research and scholarly efforts. [ABSTRACT FROM AUTHOR]

To review the literature and report the incidence of vaginal stenosis (VS) after vaginoplasty and compare the incidence rates by surgical technique and follow-up duration. We performed a systematic literature review according to PRISMA guidelines. Original research on primary vaginoplasty was included. Exclusion criteria included non-English studies, mixed cohorts without subgroup analysis, revision vaginoplasty, and papers without stenosis rates. The search was ran in Pubmed, Embase, Scopus, and Cochrane on September 9, 2022. Stenosis rates were compared with descriptive statistics using SPSS. Fifty-nine studies with a cumulative 7338 subjects were included. The overall incidence of VS was 5.83% (range 0%-34.2%). Combining VS with introital stenosis (IS) and contracture results in a cumulative incidence of 9.68%. The rate of VS in the penile inversion vaginoplasty subgroup (PIV) was 5.70%, compared to 0.20% in primary intestinal vaginoplasty. The rate of IS in the PIV group was 3.13% and 4.7% in the intestinal vaginoplasty subgroup. The overall rate of VS was 5.83%, which is lower than previously documented. This may be related to the inclusion of more recent studies and analysis limited to primary vaginoplasty. The similar rate of IS in PIV and intestinal vaginoplasty subgroups may be secondary to multiple suture lines and the need for dilation through this anastomosis. Our research demonstrates a need for a standardized definition of VS. [ABSTRACT FROM AUTHOR]

Introduction: Philipp Bozzini, a German army surgeon, in 1807 invented the Lichtleiter, the predecessor of the modern cystoscope. By the mid-1800s, several new instruments were created including one, a variation on Bozzini's instrument by Antoine Desormeaux in Paris. The William P. Didusch Museum of Urologic History acquired the Wales endoscope, a rare and unique cystoscope that was invented around the same time in the United States.Methods: We researched the life of Philip Wales and the description of his cystoscope as well as Horatio Kern, the instrument maker that produced Wales' instrument. We examined the Wales cystoscope acquired by the William P. Didusch Museum.Results: Philip Skinner Wales (1837-1906) was a surgeon who entered the United States Navy in 1856 and served throughout the Civil War. He organized and held charge of the Naval Hospital at New Orleans during the operations of Admiral Farragut's fleet in the Mississippi River. He was one of the first surgeons to attend President Garfield when he was shot. He was Surgeon General of the Navy (1879-1884) and founded the Museum of Naval Hygiene in Washington D.C. which later, combined with the naval laboratory and Department of Instruction, became the prototype of the Naval Medical School. In 1868 he published a series of papers in the Philadelphia Medical and Surgical Reporter on "Instrumental Diagnosis," with a paper entitled "Description of a New Endoscope." The instrument contained a metal shaft with an acute beak and used an ophthalmologic mirror to reflect light down the channel. The surgeon peered through the center hole to look into the bladder. Wales used his instrument multiple times in his private practice. Wales writes that the advantages of his cystoscope were that it was simple to produce and cheap compared to Desormeaux's endoscope. Furthermore it was light, weighing approximately 2 pounds. The main drawbacks of Wales' cystoscope were the inadequate illumination, as the light source was external and projected from the outside through a narrow channel into the bladder, and that without an optical system the image appeared relatively small. Horatio Kern, a well-known instrument maker in Philadelphia, that also supplied surgical sets and instruments for the U.S. Army during the Civil War, produced Wales' cystoscope. While he was Chief of the Bureau of Medicine, a subordinate embezzled Navy funds and Dr, Wales was court-martialed. Though he was eventually exonerated, he lived the rest of his life in disgrace in France.Conclusion: The Wales endoscope is unique in that it had an American inventor, was simple in design and cheap to produce. It is an important historical artifact and is one of the earliest and rarest cystoscopes developed. [ABSTRACT FROM AUTHOR]

To determine the impact of radical local treatment (RLT) on overall survival (OS) and other survival outcomes in patients with OligoMetastatic Prostate Cancer (OMPC). We performed a meta-analysis of randomized controlled trials (RCTs) published in the MEDLINE and CENTRAL databases until May 2023. We included RCTs that randomized patients to RLT (either radical prostatectomy [RP] or external beam radiotherapy [EBRT]) and standard of care and reported on OMPC. Our primary objective was to analyze OS with a minimum median follow-up of 4 years (PROSPERO-CRD42023422736). We analyzed 3 RCTs, presenting data across 5 papers. OS was significantly higher in the RLT group (HR - 0.643, 95%CI 0.514-0.8, P -value <.001). The data on EBRT was drawn from 520 patients and that of RP was from 85. The post-hoc power analysis showed 81% power to detect a difference of 10% with an alpha error of 0.01. Pooled prevalence of grade 3-4 bowel and bladder toxicity was 4.5%. Health-Related Quality of Life was similar in both groups (mean difference - 1.54, 95%CI − 0.625 − 3.705, P -value.163). The risk of bias as per the RoB2 tool was low for all domains and overall bias. As per GRADE criteria, the certainty of evidence was high. Our meta-analysis underscores the evidence-based significance of RLT, particularly emphasizing the benefits of EBRT in patients with OMPC. However, the findings should be interpreted with caution due to the limited number of studies and the relatively small sample sizes, especially in the RP subgroup. Future investigations in OMPC should consider incorporating EBRT in their standard treatment approach. [ABSTRACT FROM AUTHOR]

The filter paper culture-tetrazolium test ressults have been compared with routine hospital streak plate cultures in 400 random urine specimens. Pseudomonas cultures tended to impart a color change to the test pads which rendered interpretation difficult. While a consistently accurate quantitative interpretation of these cultures did emerge during the course of the trial studies, some degree of observer accommodation and bias, in terms of the manufacturer's instructions and description, was necessary to achieve an appropriate reading. When the hospital laboratory results and culture strip test results are compared in terms of colony counts greater than 10-4 bacteria per milliliter and less than 10-4 bacteria per milliliter, the method was found to be 93% sensitive for the total count and 83% sensitive for the gram-negative count with a specificity correlation of 96% for the total and gram-negative counts, respectively.

To synthesize existing evidence to evaluate the outcomes of different urinary catheter removal timing (early vs late) after urethroplasty. We performed a comprehensive search of PubMed, Embase, the Cochrane Library, and Web of Science from inception to August 7, 2022. Articles were initially screened by title, abstract, and subsequently by a full paper review before being included in the final analysis. All comparative studies that assessed the association between urethral catheterization duration and frequency of extravasation and recurrence rate in patients who underwent urethroplasty were included in the analysis. Exclusion criteria were case reports, case series, letters to editors, and non-English studies. The risk of bias was assessed using the Newcastle-Ottawa Scale. Of the 439 relevant records in the literature databases, 5 studies involving 634 patients were included. In all 5 studies, the extravasation rate was not significantly different between the early and late catheter removal groups. Among the 3 studies that reported recurrence rates, the recurrence rate was low, with no statistically significant difference between the early and late catheter removal groups. Wound and urinary tract infections were among the most common complications, with a higher rate in patients with late catheter removal. Early catheter removal following urethroplasty does not increase the rate of extravasation or recurrence during long-term follow-up. The existing evidence can serve as the foundation for additional research with a larger sample size. [ABSTRACT FROM AUTHOR]

Objective: To describe the proportions of peer-reviewed manuscripts authored by women in 5 high-impact, widely available urology journals, and to compare these to the proportion of women in urology. About 9% of attending urologists and 25% of urology residents are women. We hypothesized that women comprised fewer than 25% of first authors and fewer than 10% of last/senior authors.Methods: We searched peer-reviewed original manuscripts in the Journal of Urology, Journal of Pediatric Urology, Neurourology and Urodynamics, Urology, and Urologic Oncology from January 2014 to June 2019. First and last author gender identity was recorded. Observed and expected proportions and temporal trends were compared, with findings considered statistically significant at P < .05.Results: Of 8653 multiple-author papers, 2275 (26.3%) had women as first authors, paralleling the current proportion of women in training (P = .98). Women were senior/last authors in 1255 (14.5%) papers; this was higher than the current proportion of female urologists in practice (P < .0001) for all journals but NAU (P = .59). Only 527 (6.1%) of multiple-author papers had both female first and last authors whereas 5640 (65.3%) of papers had both male first and last authors. The first author was more likely female when the senior author was female (OR = 2.34, 95% CI: 2.06-2.65); most female-first and -last authored manuscripts were published in subspecialty journals and those utilizing double-blind peer review.Conclusion: The proportion of female first- and senior-authored manuscripts is significantly higher than the proportion of women in urology, and may reflect differential subspecialty choices and mentorship opportunities for women. [ABSTRACT FROM AUTHOR]

Objective: To conduct a review of current literature to assess whether an association exists between Pentosan Polysulfate Sodium and the development of macular disease, as it is the only oral medication approved by the Food and Drug Administration for the management of interstitial cystitis.Materials and Methods: A systematic review was conducted by the authors separately, with review methods established prior to the conduct of the review. Databases searched included PubMed, Ovid, Medline, EBSCO, and Google Scholar. A search was conducted for the terms "Pentosan Polysulfate Maculopathy," "Pentosan Polysulfate Retinopathy," and "Interstitial Cystitis Maculopathy." All papers reporting on primary data were included. There were no study sponsors.Results: A total of 14 papers reporting on primary data were identified. Most papers reported on the development of macular disease in the setting of chronic pentosan polysulfate sodium exposure. No randomized controlled trials have been performed to date and data was insufficient to perform a meta-analysis. Nevertheless, patients with interstitial cystitis were more likely to receive a diagnosis of maculopathy after several years of the medication use.Conclusion: Although the nature of the published studies renders them prone to confounders, currently available data suggest an increased risk for developing maculopathy after years of pentosan polysulfate sodium use. In light of this, and the marginal effectiveness of the medication for the average individual, we suggest that education be provided as to the possible association and that regular ophthalmic evaluation be recommended for patients who are continued on chronic Pentosan Polysulfate Sodium. [ABSTRACT FROM AUTHOR]

To explore and document the life and urologic contributions of Dr. Frank B. Bicknell. We researched the life of Dr. Bicknell via his publications, archived documents from the Didusch Museum and through the description of his life and accomplishments by his colleagues including John K. Lattimer and Frank Hinman Jr. Frank B. Bicknell (1907-1999) attended the University of Michigan (1925-1928) and Universityof Michigan Medical School (1928-1932) prior to his internship and urology residency at the Receiving Hospital, Detroit, Michigan (1932-1936). He served in the Merchant Marine in the 1930s, sailing around the world. He was a major in World War II and served as Professor of Urology at Wayne State University. In 1951 Dr. Bicknell got together a small group of eight urologists interested in pediatric urology during the AUA Annual Meeting. Drs. Campbell, Barber, Johnson, Mertz, Hinman Jr., Spence and Lattimer all met in Dr. Bicknell's Chicago hotel room and would form The Society for Pediatric Urology. At the time, Dr. Bicknell's brother-in-law had just become president of the American Academy of Pediatrics (AAP). Dr. John Lattimer with the help of Dr. Bicknell's brother-in-law was able to get a room at the AAP meeting which he filled with 2500 people, thought to be the largest collection of urologists in one room at the time. The success of the session led the AAP to develop a Section of Urology and impressed upon the AUA the magnitude of interest in pediatric urology. This allowed pediatric urologists to secure an exclusive session on the day before the main AUA meeting which has persisted since that time.Dr. Bicknell founded the History Forum in 1966 and chaired this very popular event during its first decade. The forum now occupies an entire afternoon during the AUA annual meeting, with papers presented on historic urologic topics. The highlight of this assembly is the annual lecture on the history of medicine. In 2000, this oration was renamed the Frank Bicknell History of Urology Oration to honor the founder of the History Forum. Dr. Frank Bicknell was an early leader in pediatric urology and urologic history who helped found The Society of Pediatric Urology and the AUA History Forum. [ABSTRACT FROM AUTHOR]

Objective: To determine the characteristics of US medical schools associated with successful urology match applicants.Materials and Methods: Using publicly available data, demographics and bibliometrics were collected for 1814 current urology residents who attend a US-based Accreditation Council for Graduate Medical Education (ACGME) Accredited program, reflecting matched applicants over a 6-year period from 2016-2021. A generated list of US feeder medical schools for urology was analyzed for correlative and predictive factors. Statistical analyses to characterize these factors included Pearson's Correlation Coefficient (PCC) and univariable and multivariable linear regression, respectively, as needed.Results: There were 516 (28.45%) female residents and 58 (3.20%) international medical graduates. The mean number of published papers and abstracts ± SD pre-residency was 5.54 ± 7.20 with a mean h-index of 1.97 ± 2.24. The Cleveland Clinic Lerner College of Medicine had the highest percentage of successful matches into urology (n = 7, 3.65%), while the State University of New York Downstate Medical Center College of Medicine produced the highest absolute number (n = 41, 3.30%). The presence of a home urology program and pre-residency h-index had the strongest correlation with producing urology residents (PCC = 0.5769 and 0.3709, respectively, P<.0001).Conclusion: Understanding the characteristics of a successful urology match applicant and the medical schools that produce them will be vital as USMLE Step 1 exam becomes pass/fail. Further research into these schools' curricula is required to better understand the effect of early exposure to urology on matching into urology. [ABSTRACT FROM AUTHOR]

Objective: To review the literature of 5 pediatric urology topics and conduct gender based and forecasting analyses of first and corresponding authors.Methods: A PubMed search was performed for hypospadias, hydronephrosis, vesicoureteral reflux, bladder and bowel dysfunction, and cryptorchidism over 3 decades from 1990 to 2019. The 50 most relevant "best match" papers from each decade were extracted by topic. Author gender, specialty, and advanced degrees, along with journal and publication variables were collected. Forecasting analyses were conducted through the Holt-Winters method.Results: Among 750 papers analyzed, 78% of corresponding and 70% of first authors were male. A significant upward trend was observed for female-authored publications in both first and corresponding positions over time (P <.01). Forecasting analyses predicted a continuing upward trend for female corresponding (55%) and first authors (83%) by 2049. Most studies originated from pediatric urology (59%), followed by pediatric surgery (9%) and endocrinology/genetics (5%). Papers focused in The Journal of Urology (30%) with the majority originating from the United States (38%). Most were retrospective (44%) and discussed medical (54%) versus surgical management (20%).Conclusion: The majority of pediatric urology literature has been generated by male authors. A persistent, rising trend in female authorship across all examined pediatric urology topics was noted. These encouraging findings are projected to continue to increase in the future, suggesting a movement toward equal and fair gender representation in authorship in pediatric urology. [ABSTRACT FROM AUTHOR]

Objective: To better understand promotion timelines across gender and race/ethnicity and how academic output impacts promotion in urology.Methods: We examined the 2017 census. An academic subset was asked questions regarding their promotion timeline. We obtained demographic, academic output, and family responsibility data.Results: Of 2926 academic urologists who identified a position of Assistant, Associate, or Full professor, 11.2% were women, 75% were White, and 94% were non-Hispanic. Men authored more papers and achieved principal investigator status more often than women. Non-Hispanics authored more papers than Hispanics. On average, women took 1.2 years longer than men to advance from Assistant to Associate Professor (7.3 years [95% CI: 6.8-7.8] vs 6.1 years, [95% CI: 5.8-6.6, P <.001]). Advancement from Associate to Full Professor was similar between women and men (6.0 years [95% CI: 5.1-6.9] vs 6.6 [95% CI: 6.1-7.1, P = .25]). Compared to women, men were more likely to experience rapid promotion (≤4 years) to Associate Professor (odds ratio 3 [95% CI: 1.8-5.1]). There was no statistical difference across race/ethnicity for promotion from Assistant to Associate, Associate to Full Professor, or rapid promotion.Conclusion: We identified disparities in promotion times based on gender but not race and ethnicity. The number of under-represented minority faculty in urology is low. Understanding the causes of disparities should be a priority in order to support fair promotion practices and retention of diverse faculty. [ABSTRACT FROM AUTHOR]

Objective: To review the robustness of hydronephrosis literature with the application of fragility index (FI) and fragility quotient (FQ) calculations.Methods: A literature review was conducted using Pubmed, Medline, and Ovid for "hydronephrosis" and associated terms and we included all studies with at least 2 groups being compared. FI was calculated by populating study results into a 2-by-2 contingency table and generating a P value using Fisher's exact test. Next, events were manually added to the group with the fewest events, while removing a nonevent from the same group and Fisher's exact test repeated until the P value was >.05. FQ was calculated by dividing FI by the total sample size.Results: The 130 included articles were published between 1986 and 2018 in 32 journals. Median citation count was 14 (0-252), 30% were RCTs and most papers originated in the United States (28%), Turkey(10%), and Canada(9%). Median FI was 2 (1-112), FQ was 0.023 (0.0010-0.55), and 60 papers (46%) had a FI of 1, indicating extremely fragile results. There was a significant difference in the FI between observational studies and RCTs (10 ± 17 vs 4 ± 5; P = .02); however, there was no difference in FQ (0.032 ± 0.030 vs 0.053 ± 0.080; P = .09) between them.Conclusion: Nearly half of studies in hydronephrosis literature reporting significant results are extremely fragile, requiring addition of only a couple of events in 1 treatment arm to significantly modify the results. As such, objective reporting of robustness of results should include FI and FQ which may help diminish over-reliance on P values as the main indicator of clinical significance in comparative studies. [ABSTRACT FROM AUTHOR]

Objective: To quantify the relationship between the number of Twitter mentions and the number of academic citations a urologic publication receives.Materials and Methods: Two hundred and thirteen papers from 7 prominent urologic journals were examined 37 months after publication. Articles were evaluated with 2 citation based "bibliometrics" (Scopus, Google Scholar) and Twitter mentions were tracked using the Altmetric Bookmarklet. The number of article citations and Twitter mentions were compared using one-way Analysis of variance (ANOVA) and bivariate fit analysis.Results: Seventy-three percent of articles had at least 1 Twitter mention. Forty-two percent of Twitter mentions occurred within the first week of the online publication date. Articles mentioned on Twitter had 2.0-fold more Scopus citations (P <.01), and 2.3-fold more Google Scholar citations (P <. 01) compared to articles with no Twitter mentions. Female urologic articles had the greatest number of Twitter mentions (5.7 mentions/article) while pediatric urology had the fewest mean number of Twitter mentions (0.8 mentions/article). A total of 8.9% of papers were tweeted by their authors. Author tweeted articles were associated with a 12.3 (2.0-fold) and 15.5 (1.8-fold) mean citation increase for Scopus and Google Scholar (P <. 01 and P = . 01) compared to articles not shared by their authors on Twitter.Conclusion: The majority of urologic publications are being shared on Twitter. The number of citations a urologic publication receives up to 3 years after release is positively associated with the number of mentions it has on Twitter. Twitter activity may be an early indicator of ultimate academic impact of an academic urologic paper. [ABSTRACT FROM AUTHOR]

Objective: To characterize men presenting to a tertiary care safety-net hospital with prostate-specific antigen (PSA) values ≥100 ng/mL and to identify a potential population for targeted PSA screening.Materials and Methods: Retrospective review of 100 randomly selected patients of a total of 204 who presented to Grady Memorial Hospital from 2004 to 2011 with initial PSA ≥100 ng/mL was performed. Demographics, disease characteristics, and survival status were obtained via the Tumor Registry and a combination of electronic medical records and older paper charts, with missing data from paper charts excluded on analyses.Results: Sixty-five patients were newly diagnosed with prostate cancer on presentation and 35 were previously diagnosed. Median PSA at presentation was 405.5 ng/mL (minimum, 100 and maximum, 7805), 81% had metastatic disease, and 94% had Gleason ≥7. Median Cancer of the Prostate Risk Assessment score was 8. Median age at presentation was 67.4 years (minimum, 40.8 and maximum, 90.6). Eighty-nine percent of patients were African American, 24% lived alone, 12% were homeless or incarcerated, 51% were insured by Medicare or Medicaid, and 47% were uninsured. Only 1% had human immunodeficiency virus, 19% had diabetes, and 13% had chronic kidney disease. Of the 65 newly diagnosed patients, only 23% had ever been screened and 9% were previously biopsied. Median time from presentation to death was 17.8 months (minimum, 0.16 and maximum, 107.1).Conclusion: Among men presenting with PSA ≥100 ng/ml at a safety-net hospital, the majority were African American, of lower socioeconomic status, and had metastatic disease. Uniform absence of prostate cancer screening may expose greater numbers of at-risk men to similar outcomes. Discussion is needed regarding targeted PSA screening in higher risk, vulnerable patients. [ABSTRACT FROM AUTHOR]

Objective: To examine the historical trends and factors underlying the current state of racial/ethnic representation within the urology workforce at each stage of the educational pipeline.Methods: Using data from the US Census Bureau and the Association of American Medical Colleges, trends in racial/ethnic distribution for 2007-2008 to 2019-2020 were tracked in the educational pipeline for academic urologists. This pipeline was defined as progressively diminishing cohorts, starting with the US population, leading to medical school application, acceptance, and graduation, through to urology residency application, matching, and graduation, and ending with urology faculty appointment. A comparative cohort analysis was performed for academic year 2018-2019 for differences in racial/ethnic distribution across cohorts by binomial tests.Results: From 2007-2008 to 2019-2020, while the proportion of Latinx/Hispanic urology applicants increased by 0.38% per year (95% CI 0.24, 0.52), their proportion in the urology resident population remained unchanged (0.07% per year, 95% CI -0.20, 0.06) from 2011-2012 to 2019-2020. There was a decrease in the proportion of Black urology applicants (-0.13% per year, 95% CI -0.24, -0.02) and no change in the resident population (-0.03% per year, 95% CI -0.11, 0.05), despite an increase in total number of residents (n = 1043 to n = 1734) from 2009-2010 to 2019-2020. In 2018-2019, there were step-wise decreases in proportion of Black and Latinx/Hispanic members represented at critical stages of the educational pipeline (P <0.0001).Conclusion: Attrition in URM urologists occur at key educational stages. This paper offers opportunities for the design of interventions to diversify the urology workforce. [ABSTRACT FROM AUTHOR]

Objective: To identify the currently utilised techniques of anterior urethroplasty described in literature for treatment of urethral strictures, assess the effectiveness of the identified techniques based on re-stricture and complication rates, evaluate, and suggest treatment options based on current evidence for urethral strictures at different locations and of different lengths.Methods: A systematic review of the MEDLINE, EMBASE, Scopus and Cochrane Library databases from conception up to September 2020 was performed. Primary outcomes included success rates measured via re-stricture rates and the post-operative maximum urinary flow rate (Qmax). Secondary outcomes included patient reported complication rates.Results: A total of 52 papers, including 7 RCTs, met the inclusion criteria. Forty studies described the use of free graft urethroplasty with a median success rate of 86.5% (IQR = 8.1). The best outcomes were found in dorsal onlay buccal mucosa grafting in the penile urethra (86.6%). Twelve described the use of pedicled flap urethroplasty with a median success rate of 76% (IQR = 14.4). Excision and Primary Anastomosis results were reported in 5 studies and showed an overall highest success rate of 89.7% (IQR = 7.0) but involved the shortest strictures of median lengths of 2.1 cm (IQR = 0.48).Conclusion: Graft urethroplasty showed optimal outcomes when utilised in penile and bulbar strictures, with dorsal onlay buccal mucosa grafting presenting with the largest evidence base and best outcomes overall. Flap urethroplasty had the highest success rates in panurethral and bulbar strictures, while anastomotic urethroplasty had the greatest success in bulbar and penobulbar strictures. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between SpaceOAR and radiation dosing, toxicity and quality-of-life vs no spacer across all radiotherapy modalities for prostate cancer.Methods: A systematic search of the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase was performed from database inception through May 2020. Two reviewers independently screened titles/abstracts and full papers. Data extraction was performed, and quality assessed by 1 reviewer and checked by a second, using a third reviewer as required. The synthesis was narrative.Results: 19 studies (3,622 patients) were included (only 1 randomized controlled trial, in image-guided intensity-modulated radiotherapy (IG-IMRT), 18 comparatives non-randomized controlled trials in external-beam radiotherapy (EBRT), brachytherapy, and combinations thereof). No hypofractionation studies were found. Regardless of radiotherapy type, SpaceOAR significantly reduced rectal radiation dose (eg, V40 average difference -6.1% in high dose-rate brachytherapy plus IG-IMRT to -9.1% in IG-IMRT) and reduced gastrointestinal and genitourinary toxicities (eg, late gastrointestinal toxicity 1% vs 6% (P = .01), late genitourinary toxicity of 15% vs 32% (P < .001) in stereotactic body radiotherapy). Improvements were observed in most Expanded Prostate Cancer Index Composite quality-of-life domains (eg, bowel function score decrease at 3 and 6 months: Average change of zero vs -6.25 and -3.57 respectively in low dose-rate brachytherapy plus EBRT).Conclusion: The randomized controlled trial in IG-IMRT demonstrated that SpaceOAR reduces rectal radiation dose and late gastrointestinal and genitourinary toxicities, with urinary, bowel, and sexual quality-of-life improvement. These advantages were verified in observational studies in various radiotherapy types. Further research is required in hypofractionation. [ABSTRACT FROM AUTHOR]

We performed a systematic review and meta-analysis to investigate the use of machine learning techniques for predicting stone-free rates following Shockwave Lithotripsy (SWL). Eight papers (3264 patients) were included. Two studies used decision-tree approaches, five studies utilised Artificial Neural Networks (ANN), and one study combined a variety of approaches. The summary true positive rate was 79%, summary false positive rate was 14%, and Receiver Operator Characteristic (ROC) was 0.90 for machine learning approaches. Machine learning algorithms were at least as good as standard approaches. Further prospective evidence is needed to routinely apply machine learning algorithms in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To provide a comprehensive overview of genital anomalies encountered among adolescents, including late effects of problems addressed earlier in childhood.Materials and Methods: The major congenital genital anomalies encountered in pediatric urology were identified. They include hypospadias, exstrophy-epispadias, cloacal malformations, disorders of sexual development, undescended testes, and some acquired penile anomalies seen in adolescence (priapism, adolescent varicocele). Recommendations of the International Consultation on Urological Diseases are provided on various aspects of these conditions, such as postpubertal cosmesis and function, fertility implications, and long-term nephrological considerations (when relevant).Results: Specific recommendations for care, including strength of clinical recommendation, are provided in this paper. Whereas the basis of this paper is to discuss specific management recommendations as they relate to several heterogeneous conditions, general recommendations include patient-centered discussions regarding operative treatment be deferred until the patient is able to articulate goals and participate in shared decision-making and utilization of multidisciplinary teams for conditions where multiple organ systems may be involved.Conclusion: Congenital abnormalities of the genitalia are common and widely heterogeneous. Late effects and concerns often emerge after puberty, and patients should be followed throughout their adult lives to address such concerns. [ABSTRACT FROM AUTHOR]

There is growing evidence suggesting cannabinoids may provide suitable alternatives to conventional treatments in an increasing number of clinical settings. This review evaluates how cannabinoids are used to treat certain benign urological pathologies and to clarify the clinical value of this data. This review includes 62 papers and was undertaken per PRISMA's guidelines, it evidences the therapeutic potential of cannabinoids in the management of specific benign urological diseases, most notably neurogenic bladder dysfunction (clinical studies), renal disease (animal studies), and interstitial cystitis (animal studies). However, whilst cannabinoids are increasingly used, they cannot be considered reliable alternatives to more recognised treatments. [ABSTRACT FROM AUTHOR]

Retrograde intrarenal surgery (RIRS) is one of the primary treatments for renal stones. The ureteral access sheath (UAS) was widely used in RIRS. 1,2 The aim of this paper is to introduce a new UAS, the distal active flexible vacuum-assisted ureteral access sheaths (DAFV-UAS), for the renal calculus during RIRS. A 56-year-old female presented to the outpatient clinics of our hospital with a left renal lower calyx stone. Abdominal CT demonstrated that the left kidney's lower calyx stone size was 10.54 × 10.38 mm, and the mean Hounsfield density was 965HU. After adequate anti-infective treatment, the DAFV-UAS was used in RIRS. No perioperative complications were observed. The left renal stone had been cleared completely. The DAFV-UAS (10/12.5 Fr, 38 cm, creek, Jiangsu, China) includes a good flexibility and deformability tube at the tip, about 10 cm long. It has an active bending function, negative pressure suction function, and the function of convenient flexible ureteroscopy (f-URS) entry and exit of the ureter. 3 In this case, the f-URS adopted a 7.5 Fr single-use digital f-URS. The Irrigation method was automated irrigation system, and the flow was 30 mL/min. The suction level was 0.02 mpa. With the help of DAFV-UAS, the field of view is always clean, the small gravel particles can be sucked out from the sheath gap, and the larger gravel particles are sucked out by withdrawing the scope intermittently. DAFV-UAS is a promising new device which allows for negative pressure suction directed right at a renal stone and efficient and effective stone clearance. [ABSTRACT FROM AUTHOR]