Search

Objective: To develop and validate a nomogram to improve the specificity of prostate imaging reporting and data system (PI‐RADS) on multiparametric magnetic resonance imaging (MRI) for clinically significant prostate cancer on targeted fusion biopsy. Methods: A retrospective review of patients who underwent fusion biopsy for PI‐RADS 3–5 lesions using UroNav and Artemis systems between 2016 and 2022 was performed. Patients were divided into those with CS disease on fusion biopsy (Gleason grade group ≥2) versus those without. Multivariable analysis was used to identify variables associated with CS disease. A 100‐point nomogram was constructed, and ROC curve was generated. Results: 1485 lesions (1032 patients) were identified, 510 (34%) were PI‐RADS 3, 586 (40%) were PI‐RADS 4, and 389 (26%) were PI‐RADS 5. Of these, 11% of PI‐RADS 3, 39% of PI‐RADS 4, and 61% of PI‐RADS 5 showed CS disease. CS disease was associated with older age (OR 1.04, 95% CI 1.02–1.06, p < 0.01), previous negative biopsy (OR 0.52, 95% CI 0.36–0.74, p < 0.01), presence of multiple PI‐RADS 3–5 lesions (OR 0.61, 95% CI 0.45–0.83, p < 0.01), peripheral zone location (OR 1.88, 95% CI 1.30–2.70, p < 0.01), PSA density (OR 1.48 per 0.1 unit, 95% CI 1.33–1.64, p < 0.01), PI‐RADS score 4 (OR 3.28, 95% CI 2.21–4.87, p < 0.01), and PI‐RADS score 5 (OR 7.65, 95% CI 4.93–11.85, p < 0.01). Area under ROC curve was 82% for nomogram compared to 75% for PI‐RADS score alone. Conclusion: We report a nomogram that combines PI‐RADS score with other clinical parameters. The nomogram outperforms PI‐RADS score for the detection of CS prostate cancer. [ABSTRACT FROM AUTHOR]

Objective: To identify trends in complications following robot-assisted radical cystectomy (RARC) using a multi-institutional database, the International Robotic Cystectomy Consortium (IRCC).Methods: A retrospective review of the IRCC database was performed (2976 patients, 26 institutions from 11 countries). Postoperative complications were categorized as overall or high grade (≥ Clavien Dindo III) and were further categorized based on type/organ site. Descriptive statistics was used to summarize the data. Multivariate analysis (MVA) was used to identify variables associated with overall and high-grade complications.  Cochran-Armitage trend test was used to describe the trend of complications over time.Results: 1777 (60%) patients developed postoperative complications following RARC, 51% of complications occurred within 30 days of RARC, 19% between 30-90 days, and 30% after 90 days. 835 patients (28%) experienced high-grade complications. Infectious complications (25%) were the most prevalent, while bleeding (1%) was the least. The incidence of complications was stable between 2002-2021. Gastrointestinal and neurologic postoperative complications increased significantly (P < .01, for both) between 2005 and 2020 while thromboembolic (P = .03) and wound complications (P < .01) decreased. On MVA, BMI (OR 1.03, 95%CI 1.01-1.05, P < .01), prior abdominal surgery (OR 1.26, 95%CI 1.03-1.56, P = .03), receipt of neobladder (OR 1.52, 95%CI 1.17-1.99, P < .01), positive nodal disease (OR 1.33, 95%CI 1.05-1.70, P = .02), length of inpatient stay (OR 1.04, 95%CI 1.02-1.05, P < .01) and ICU admission (OR 1.67, 95%CI 1.36-2.06, P < .01) were associated with high-grade complications.Conclusion: Overall and high-grade complications after RARC remained stable between 2002-2021. GI and neurologic complications increased, while thromboembolic and wound complications decreased. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the long‐term effects of continent (neobladder) compared with incontinent (ileal conduit) urinary diversion. Methods: We carried out a retrospective review of our departmental database. Estimated glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Neobladder and ileal conduit patients were matched in a 1:2 ratio and a propensity score‐matched analysis was carried out. Data were summarized using descriptive analysis. Trend plots were generated using baseline and follow‐up creatinine values to compare estimated glomerular filtration rate at 3 months, then annually for 5 years. Variables associated with estimated glomerular filtration rate were assessed using multivariate linear analysis. Results: Our cohort consisted of 137 patients (neobladder n = 50 and ileal conduit n = 87) with a median follow‐up time of 3 years (interquartile range 1–7 years). The ileal conduit group had shorter operative times (352 vs 444 min, P < 0.01), intracorporeal diversions were more common (66% vs 44%, P = 0.01), had prior abdominal surgery (66% vs 38%, P < 0.01) and had radiation (9% vs 0%, P = 0.03). The neobladder group more commonly had recurrent urinary tract infections (22% vs 3%, P < 0.01) and a steeper decrease in estimated glomerular filtration rate in the first year. On multivariate linear analysis, age/year (−0.59), body mass index per kg/m2 (−0.52), preoperative estimated glomerular filtration rate per unit (0.51), recurrent urinary tract infections (−14.03) and time versus day 90 (year 1, −7.52; year 2, −9.06; year 3, −10.78) were significantly associated with estimated glomerular filtration rate. Conclusion: Ileal conduits and neobladders showed a similar effect on the estimated glomerular filtration rate up to 5 years after robot‐assisted radical cystectomy. Recurrent urinary tract infections were associated with a worse estimated glomerular filtration rate. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the oncologic outcomes of pT0 after robot-assisted radical cystectomy (RARC).Methods: A retrospective review of the International Robotic Cystectomy Consortium database was performed. Patients with pT0 after RARC were identified and analyzed. Data were reviewed for demographics and pathologic outcomes. Kaplan-Meier curves were used to depict recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS). Multivariate stepwise Cox regression models were used to identify variables associated with RFS and OS.Results: Four hundred seventy-one patients (18%) with pT0 were identified. Median age was 68 years (interquartile range (IQR) 60-73), with a median follow up of 20 months (IQR 6-47). Thirty-seven percent received neoadjuvant chemotherapy and 5% had pN+ disease. Seven percent of patients experienced disease relapse; 3% had local and 5% had distant recurrence. Most common sites of local and distant recurrences were pelvis (1%) and lungs (2%). Five-year RFS, DSS, and OS were 88%, 93%, and 79%, respectively. Age (hazards ratio [HR] 1.05, 95% confidence interval [CI] 1.01-1.09, P = 0.02), pN+ve (HR 11.48, 95% CI 4.47-29.49, P < .01), and reoperations within 30 days (HR 5.53, 95% CI 2.08-14.64, P < .01) were associated with RFS. Chronic kidney disease (HR 3.24, 95% CI 1.45-7.23, P < .01), neoadjuvant chemotherapy (HR 0.41, 95% CI 0.18-0.92, P = .03), pN+ve (HR 4.37, 95% CI 1.46-13.06, P < .01), and reoperations within 30 days (HR 2.64, 95% CI, 1.08-6.43, P = .03) were associated with OS.Conclusions: Despite pT0 status at RARC, 5% had pN+ disease and 7% of patients relapsed. Node status was the variable strongest associated with RFS and OS in pT0. [ABSTRACT FROM AUTHOR]