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To compare the findings of multidetector computed tomography (CT) with surgical pathology and magnetic resonance imaging (MRI), to determine the accuracy of delineating the superior extent of inferior vena cava (IVC) thrombotic involvement in renal cell cancer (RCC). A prospective database was examined of 11 patients (median age 65 years, range 45–77) being assessed for suspected IVC extension of RCC tumour thrombus with both multidetector CT and MRI. All had pathology confirming RCC, and eight of those undergoing surgery had pathological confirmation of tumour thrombus extent. All images were analysed originally, then re-analysed by two independent radiologists, an experienced urologist and a urological trainee unaware of the original reports and other imaging results, with a final determination on tumour thrombus level by consensus. The multidetector CT results were completely accurate when compared with surgical specimens and were in agreement with MRI on all but one occasion, where MRI determined the renal vein to be clear when it was involved on CT and at surgery, giving MRI an accuracy of seven of eight samples. Whilst there were few patients and further studies are needed, multidetector CT was comparable with MRI in determining tumour thrombus level. More importantly, in the eight patients with surgical pathological confirmation, multidetector CT was accurate in all. Ultimately, it may replace MRI as the ‘gold standard’ for imaging to delineate the upper limit of tumour thrombosis in RCC. [ABSTRACT FROM AUTHOR]

OBJECTIVE To present our experience of percutaneous nephrolithotomy (PCNL) for treating urolithiasis in patients with spinal cord injury (SCI) using a single-stage dilator for percutaneous access. PATIENTS AND METHODS A prospective database of patients with SCI having PCNL using the single-stage dilator was assessed, analysing patient data, stone-free rates, morbidity and the follow-up outcome. RESULTS In all, 26 patients had 54 PCNLS on 32 kidneys; 20 had unilateral and six bilateral stone disease; there were many staghorn calculi (24/54). Major complications occurred in three of 54 PCNLS (6%). The complete stone- clearance rate was 87% for PCNL alone, rising to 29 of 32 kidneys (91%) or 24 of 26 patients (92%) with adjuvant procedures. A further three kidneys required no further treatment and were monitored, having residual fragments of ≤2 mm. CONCLUSIONS PCNL has a high success rate and acceptable complication rate compared to extracorporeal shock-wave lithotripsy, and remains a valid first-line treatment option for kidney stones in patients with SCI. [ABSTRACT FROM AUTHOR]

The article presents a study that determines the impact of the partnership between Urological Society of Australia and New Zealand (USANZ) and the journal. It offers overview of the method of the study which uses the Medline algorithm to elucidate the number of Australian and New Zealand publication in urology. It outlines the findings of the study which indicate the increase of publications appeared in the journal since the partnership.

Treatment decisions for both early and advanced genitourinary (GU) malignancies take into account the risk of dying from the malignancy as well as the risk of death due to other causes such as other co-morbidities. COVID-19 is a new additional and immediate risk to a patient's morbidity and mortality and there is a need for an accurate assessment as to the potential impact on of this syndrome on GU cancer patients. The aim of this work was to develop a risk tool to identify GU cancer patients at risk of diagnosis, hospitalization, intubation, and mortality from COVID-19. A retrospective case showed a series of GU cancer patients screened for COVID-19 across the Mount Sinai Health System (MSHS). Four hundred eighty-four had a GU malignancy and 149 tested positive for SARS-CoV-2. Demographic and clinical variables of >38,000 patients were available in the institutional database and were utilized to develop decision aides to predict a positive SARS-CoV-2 test, as well as COVID-19-related hospitalization, intubation, and death. A risk tool was developed using a combination of machine learning methods and utilized BMI, temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation. The risk tool for predicting a diagnosis of SARS-CoV-2 had an AUC of 0.83, predicting hospitalization for management of COVID-19 had an AUC of 0.95, predicting patients requiring intubation had an AUC of 0.97, and for predicting COVID-19-related death, the risk tool had an AUC of 0.79. The models had an acceptable calibration and provided a superior net benefit over other common strategies across the entire range of threshold probabilities. [ABSTRACT FROM AUTHOR]

Abstract: A simple technique using a fenestrated urethral catheter to assist in drainage of pericatheter urethral exudates from the anastomosis of the urethra to the bladder neck in radical prostatectomy is described. It is applicable to open and laparoscopic techniques of radical prostatectomy. [Copyright &y& Elsevier]

Foreign bodies placed into the ureter are uncommon. Unintentionally placed sutures may cause obstruction and stone formation. If not recognized, the patient may become symptomatic. A diagnosis of a suture in the ureter is best made and subsequently dealt with endoscopically. We report on laser ablation of the suture as a safe technique for its removal. [ABSTRACT FROM AUTHOR]

Transrectal ultrasound-guided biopsy of the prostate is an integral step in the investigation of patients at risk of prostate adenocarcinoma. With an increasing number of biopsies being performed, uncommon forms of prostatic pathology will be identified more frequently. Amyloidosis of the prostate and/or the seminal vesicles may be noted on transrectal ultrasound-guided biopsy of the prostate and the implications of this histological diagnosis must be understood. We present our experience of two such cases of amyloidosis and review the literature regarding their management. [ABSTRACT FROM AUTHOR]

Objective: To explore the causes of the decrease in bladder cancer survival that has occurred over the past four decades. Methods: We extracted data from the South Australian Cancer Registry. Data from the period 1 January 1977 to 31 December 2020 were extracted to explore changes in incidence and survival among a total of 8356 patients diagnosed with ≥pT1 disease. Invasive bladder cancer was defined as ≥pT1 in this study. Results: Invasive bladder cancer age‐standardized incidence decreased from 7.20 cases per 100 000 people in 1977 to 5.85 cases per 100 000 in 2020. The mean age at diagnosis increased from 68 years to 76 years. The crude incidence for patients aged 80 years and over increased by 3.3% per year (95% confidence interval [CI] 2.1 to 4.6). Overall survival decreased over the study period (hazard ratio [HR] 1.22 [95% CI 1.09 to 1.35]), however, survival increased after adjusting for age at diagnosis (HR 0.80 [95% CI 0.76 to 0.94]). Despite a decrease in non‐bladder cancer‐specific deaths in older people, there was no change in the bladder cancer‐specific death rate in older people (HR 0.94 [95% CI 0.70 to 1.26]). Male sex was associated with higher survival (HR 0.87 [95% CI 0.83 to 0.92]), whereas socioeconomic advantage was not. Conclusions: Invasive bladder cancer survival has decreased over the past 40 years, with the age structure of the population being a significant contributing factor. Patient summary: We looked at why bladder cancer survival is decreasing using a large cancer registry with information from 1977 to 2020. We found that people are now more likely to be diagnosed at an older age. Older people often live for a shorter time with bladder cancer compared to younger people. Bladder cancer survival has decreased because there are more older people with the disease than previously. [ABSTRACT FROM AUTHOR]

The article discusses whether career medical interviews have predicative ability for a candidate as they move through surgical training or the present candidates over prepare or rote learn responses as an effective means of impressing management. Topics discussed include how applicants engage in impression management (IM) strategies to improve their chances of success and reduce anxiety and whether interviews are solid selector or are influenced by IM tactics.

Objective: To compare clinical outcomes of single‐use endoscopes with those of reusable endoscopes to better define their role within urology. Methods: A systematic search of electronic databases was performed. All studies comparing the clinical outcomes of participants undergoing urological procedures with single‐use endoscopes to those of participants treated with reusable endoscopes were included. Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 statement. Results: Twenty‐one studies in 3943 participants were identified. Six different single‐use flexible ureteroscopes and two different single‐use flexible cystoscopes were assessed. There were no differences in mean postoperative infection rates (4.0% vs 4.4%; P = 0.87) or overall complication rates (11.5% vs 11.9%; P = 0.88) between single‐use and reusable endoscopes. For patients undergoing flexible ureteroscopy there were no differences in operating time (mean difference −0.05 min; P = 0.96), length of hospital stay (LOS; mean difference 0.06 days; P = 0.18) or stone‐free rate (SFR; 74% vs 74.3%; P = 0.54) between the single‐use and reusable flexible ureteroscope groups. Conclusion: This study is the largest to compare the clinical outcomes of single‐use endoscopes to those of reusable endoscopes within urology, and demonstrated no difference in LOS, complication rate or SFR, with a shorter operating time associated with single‐use flexible cystoscope use. It also highlights that the cost efficiency and environmental impact of single‐use endoscopes is largely dependent on the caseload and reprocessing facilities available within a given institution. Urologists can therefore feel confident that whether they choose to 'use' or to 'reuse' based on the financial and environmental implications, they can do so without negatively impacting patient outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the trends in management of localized renal masses surgery. It says that radical nephrectomy is considered an independent risk factor for developing chronic renal failure and its complications and patients acquiring radical nephrectomy-induced chronic renal insuffiencey are at risk of cardiac arrest and death from any cause. Meanwhile, the study from the U.S. and Australia shows that nephron-sparing surgery for small renal masses is continued to be underutilized.

In this article, the author discusses aspects of the role of positron emission tomography (PET) in urological oncology. He remarks on the progress of the imaging method in spite of the limitations to its present established role in staging and management of urological malignancies. Also investigated is the benefits of PET technology.

Discusses the medical case of a 74-year-old woman with metastatic breast cancer to the bladder. Bladder biopsy findings; Ureter obstruction by compressing metastases; Usual presentation of bladder metastasis.

Background: The COVID-19 pandemic exploits existing inequalities in the social determinants of health (SDOH) that influence disease burden and access to healthcare. The role of health behaviours and socioeconomic status in genitourinary (GU) malignancy has also been highlighted. Our aim was to evaluate predictors of patient-level and neighbourhood-level factors contributing to disparities in COVID-19 outcomes in GU cancer patients. Methods: Demographic information and co-morbidities for patients screened for COVID-19 across the Mount Sinai Health System (MSHS) up to 10 June 2020 were included. Descriptive analyses and ensemble feature selection were performed to describe the relationships between these predictors and the outcomes of positive SARS-CoV-2 RT-PCR test, COVID-19-related hospitalisation, intubation and death. Results: Out of 47,379 tested individuals, 1094 had a history of GU cancer diagnosis; of these, 192 tested positive for SARS-CoV-2. Ensemble feature selection identified social determinants including zip code, race/ethnicity, age, smoking status and English as the preferred first language—being the majority of significant predictors for each of this study's four COVID-19-related outcomes: a positive test, hospitalisation, intubation and death. Patient and neighbourhood level SDOH including zip code/ NYC borough, age, race/ethnicity, smoking status, and English as preferred language are amongst the most significant predictors of these clinically relevant outcomes for COVID-19 patients. Conclusion: Our results highlight the importance of these SDOH and the need to integrate SDOH in patient electronic medical records (EMR) with the goal to identify at-risk groups. This study's results have implications for COVID-19 research priorities, public health goals, and policy implementations. [ABSTRACT FROM AUTHOR]

Background Radical cystectomy ( RC) remains a morbid procedure. The use of Enhanced Recovery After Surgery ( ERAS) pathways has proven to reduce care time and post-operative complications after colorectal surgery. There is a high potential for reducing morbidity associated with RC by utilizing ERAS in this setting. The purpose of this review is to examine the current evidence for ERAS in preoperative, intra-operative and post-operative setting of care for RC patients and to propose ERAS evidence-based protocol for patients undergoing RC in the Australian and New Zealand environment. Preoperative Patient's medical optimization, avoidance of oral mechanical bowel preparation and emphasis on preoperative administration of high-energy carbohydrate drinks from colorectal literature has led to inclusion of these strategies in the preoperative considerations of ERAS in RC. Intra-operative Epidural analgesia has an integral role in reducing surgical stress response, improving analgesia and expediting functional recovery and should be included in ERAS RC protocols. Of relevance is 72 h maximum length of its duration. With regard to minimally invasive approach to RC, despite encouraging results from high-volume centres, high-level evidence in this field are lacking (ongoing clinical trials). Standardized anaesthetic protocols with particular emphasis on perioperative fluid management are essential components of ERAS protocols. Post-operative Avoidance of routine nasogastric tube placement, early mobilization and multifaceted approach to optimization of gut function and elimination of post-operative ileus are the cornerstones of post-operative care in the setting of ERAS in RC patients. [ABSTRACT FROM AUTHOR]

A better understanding of the immune processes in the pathogenesis and progression of prostate cancer (CaP) may point the way towards improved treatment modalities. The challenge is to amplify immune responses to combat tumour escape mechanisms. Infection and inflammation may have a role in prostate carcinogenesis, including the newly discovered xenotropic murine leukaemia virus (XMRV). These inflammatory states damage defence mechanisms and induce a high proliferative state favouring further mutation and impaired immune surveillance. With this knowledge we are able to explore the use of immunotherapy to rejuvenate the immune system in combating CaP. Recently Sipuleucel-T, an immunotherapeutic agent for metastatic androgen independent CaP, has resulted in improved survival and might be the first immunotherapeutic agent to obtain approval for CaP treatment. This short review will focus on the growing body of evidence suggesting an immunity-based link between CaP and inflammation and infection. [ABSTRACT FROM AUTHOR]

The author discusses emerging trends in the prostate cancer (PCa) literature by searching for treatment terms in the database MEDLINE from January 1992 to December 2012. Among the trends discussed include expanding journal listing, marketing and implementation of new technologies, and the inconsistent use of terminology. It also explores the significance of using standardised terms through the efforts of researchers and database administrators.

Objectives: To ascertain the potential utility of magnetic resonance imaging in providing additional clarification of those solid renal mass lesions identified at routine antenatal ultrasonography in early pregnancy and influencing the management of such lesions. Methods: We present 7 patients in whom magnetic resonance imaging was used to diagnose, stage, and monitor renal lesions detected during pregnancy. Results: Magnetic resonance imaging provided for improved imaging of renal mass lesions identified at antenatal ultrasonography, without the use of ionizing radiation, and permitted management determined by optimal radiographic assessment of such lesions without fetal irradiation. Conclusions: Magnetic resonance imaging is the most appropriate method to further investigate renal masses identified at routine antenatal ultrasonography early in pregnancy. [Copyright &y& Elsevier]

Nuclear medicine techniques continue to be important non-invasive imaging tools assisting the diagnosis, monitoring and – in some cases – treatment of prostate cancer. Bone scintigraphy was the premier modality to have an extensive role in the staging of prostate cancer and has remained an integral tool for over three decades in the assessment of newly diagnosed disease or in follow-up staging. Therapeutic treatment and palliation of disseminated disease, particularly in the skeleton, has also been successful with several radioisotopes including strontium-89 chloride. Despite advances in nuclear medicine techniques and molecular imaging technology such as positron emission tomography and radioimmunoscintigraphy, bone scintigraphy still remains the gold standard in the assessment of osseous metastatic disease in prostate cancer. Thus, it is important to continually review the modalities that have remained important over time and not just to focus on newer technologies. This article summarizes the current diagnostic and therapeutic use of radioisotopes for bony disease in prostate cancer with particular reference to radionuclide bone scintigraphy and positron emission tomography. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: A variety of irrigation systems are available during ureteroscopy. We sought to compare gravity-driven pressure bags with hand-operated irrigation pumps in terms of postoperative complications after ureteroscopy with lithotripsy. Methods: A retrospective analysis of 234 patients undergoing flexible ureteropyeloscopy with laser lithotripsy by 24 supervised trainees over 4 years at a single teaching institution. Patients were divided into those who had procedures performed by using gravity-driven pressure bags fixed at 60 to 204 cm H2O, vs those who had procedures performed by using a hand-operated irrigation pump capable of delivering 1 to 10 mL per flush. Variables including surgical duration, hypotension, fever, sepsis, and hematuria were extracted from the charts, along with the surgical techniques utilized. Statistical analyses included chi-squared tests and Student's t-tests. Results: There were no differences in gender, age, indication, or stone size in the two groups. Postoperative systemic inflammatory response syndrome was significantly greater in the hand-assisted n = 11/144 (7.6%) compared with the fixed irrigation group n = 1/90 (1.1%); p = 0.032. Emergency room presentations were greater in the hand irrigation group, n = 46/144 (32%) vs n = 12/90 (13%) in the pressure-bag irrigation, p = 0.002. Postoperative fever was also greater in the hand pump irrigation cohort compared with the continuous pressure cohort (13/144 [9%] vs 1/90 [1%], p = 0.011). No statistical difference was found between the two groups with respect to stone clearance and subsequent procedures required (p = 0.123). Conclusions: This analysis suggests that using continuous flow irrigation at a fixed maximum pressure of 150 mmHg (204 cm H2O) or less may result in decreased pain, infection, and sepsis compared with handheld pressure irrigation. [ABSTRACT FROM AUTHOR]

Ischaemia-reperfusion injury (IRI) is a major obstacle during liver transplantation and resection surgeries for cancer, with a need for effective and safe drugs to reduce IRI. Zinc preconditioning has been shown to protect against liver IRI in a partial (70%) ischaemia model. However, its efficacy against a clinically relevant Pringle manoeuvre that results in global liver ischaemia (100%) is unknown. The aim of this study was to test the efficacy of zinc preconditioning in a rat model of global liver ischaemia. Rats were preconditioned via subcutaneous injection of 10 mg/kg of ZnCl 2 , 24 h and 4 h before ischaemia. Total liver ischaemia (100%) was induced by placing a clamp across the portal triad for 30 min. Liver injury was assessed by serum alanine transaminase (ALT) and aspartate transaminase (AST) levels in blood taken before ischaemia (baseline) and at 1, 2, 4, 24, 48, 72, 96 and 120 hours after ischaemia. Animals were culled after 7 days, and the harvested livers were histologically analysed. On a two-way repeated-measures analysis of variance, there was a statistically significant (p = 0.025) difference in the mean ALT levels between saline- and ZnCl 2 -treated groups. Specifically at 24 h after ischaemia, the ALT (341 ± 99 U/L) and AST (606 ± 78 U/L) in the zinc-treated group were significantly less than the ALT (2863 ± 828 U/L) and AST (3591 ± 948 U/L) values in the saline-treated group. Zinc significantly reduced neutrophil infiltration and necrosis compared with the saline control. Zinc preconditioning reduces the overall hepatocellular damage from IRI. These results lay the foundation to assess the benefit of zinc preconditioning for clinical applications. [ABSTRACT FROM AUTHOR]

Purpose: Data assessing the effectiveness of intracavernosal injections (ICIs) for the treatment of erectile dysfunction (ED) are limited. This study evaluates intracavernosal injectable therapies for ED and reviews available guidelines that inform clinical practice. Methods: A systematic search using electronic databases (Medline, Pubmed) was performed for studies investigating injectable management strategies for ED published after 1990. Primary outcome measures were to comparatively evaluate clinical efficacy, continuation rates and adverse event profiles of each injectable agent as monotherapy or in combination. The secondary outcome measurement was to discuss available guidelines that inform clinical practice for injectable agents. Results: ICIs demonstrate clinical efficacy in 54–100% of patients, early discontinuation rates of ≤ 38% and adverse events in ≤ 26%. Discontinuation rates are typically greatest within 3–6 months of commencement. Anxiety related to the initial injection occurs in approximately 65% and anxiety levels can remain high for 4 months. Approval of intracavernosal injection agents is mainly limited to alprostadil with the recent addition of aviptadil/phentolamine combination therapy in a select few geographical regions. Although combination therapies are attractive alternative options, their formulations are variable and should be standardised before widespread acceptance is achieved. Conclusions: ICIs are associated with good clinical efficacy rates, high discontinuation rates and a moderate side-effect profile. They represent an important tool in the urological armamentarium for treating ED in patients that cannot tolerate or are refractory to oral therapies. [ABSTRACT FROM AUTHOR]

Active surveillance (AS) has become the recommended management strategy for men with low-risk prostate cancer. However, there is considerable uncertainty about the optimal follow-up schedule in terms of the tests to perform and their frequency. To assess the costs and benefits of different AS follow-up strategies compared to watchful waiting (WW) or immediate treatment. A state-transition Markov model was developed to simulate the natural history (ie, no testing or intervention) of prostate cancer for a hypothetical cohort of 50-yr-old men newly diagnosed with low-risk prostate cancer. Following diagnosis, men were hypothetically managed with immediate treatment, watchful waiting, or one of several AS strategies. AS follow-up was performed either with transrectal ultrasound-guided biopsy or magnetic resonance imaging (MRI) which was scheduled annually, biennially, every 3 yrs, according to the PRIAS protocol (yrs 1, 4, 7, and 10, and then every 5 yr) or every 5 yr. Diagnosis of higher-grade or -stage disease while on AS resulted in curative treatment. We measured discounted quality-adjusted life years (QALYs), discounted lifetime medical costs (2017 US$), and incremental cost-effectiveness ratios (ICERs). Compared to WW, MRI-based surveillance performed every 5 yr improved quality-adjusted survival by 4.47 quality-adjusted months and represented high-value health care at the Medicare reimbursement rate using standard cost-effectiveness metrics. Biopsy-based strategies were less effective and less costly than the corresponding MRI-based strategies for each testing interval. MRI-based surveillance at more frequent intervals had ICERs greater than $800 000 per QALY and would not be considered cost-effective according to standard metrics. Our results were sensitive to the diagnostic accuracy and costs of both biopsy modes in detecting clinically significant cancer. Incorporation of MRI into surveillance protocols at Medicare reimbursement rates and decreasing the intensity of repeat testing may be cost-effective options for men opting for conservative management of low-risk prostate cancer. Our study modeled outcomes for men with low-risk prostate cancer undergoing watchful waiting, immediate treatment, or active surveillance with different follow-up schedules. We found that conservative management of low-risk disease optimizes health outcomes and costs. Furthermore, we showed that decreasing the intensity of active surveillance follow-up and incorporating magnetic resonance imaging (MRI) into surveillance protocols can be cost-effective, depending on the MRI costs. Active surveillance outcomes and costs can be optimized by decreasing the intensity of follow-up testing and potentially using multiparametric magnetic resonance imaging—if the cost is similar to the Medicare reimbursement rate—to determine which patients require biopsy. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the principles that govern ureteral stent failure by digitally and mechanically characterizing their luminal reduction in response to various extrinsic compression forces. To explore the relationship between ureteral stent "material area," "luminal area," and "cross-sectional area (CSA)" for resisting extrinsic compression forces. Materials and Methods: We mechanically investigated 4.8F (n = 9), 6F (n = 9), and 7F (n = 9) ureteral stents to determine parameters that contribute to resisting radial compression forces. Digitalized images of luminal reduction values under incrementally increased reductions of stent outer diameters were obtained (0%, 25%, 50%, and 60% of original outer diameter). Forces (Newton [N]) and percentage luminal reduction that resulted in complete ureteral stent obstruction were determined. Results: Uniaxial incremental compression in the radial direction demonstrated complete luminal reduction (95%–100%) when 58% to 62% of the outer stent diameter was compressed. The 6F ureteral stents demonstrated the greatest resistance to extrinsic compression and the greatest "material area" relative to "CSA" (mm2). The force (N) required for 50% compression of outer stent diameter was 10.44, 28.13, and 25.39 N for 4.8F, 6F, and 7F ureteral stents, respectively. The "material area"/"CSA" at 50% compression of the outer stent diameter was 76%, 86%, and 78% for 4.8F, 6F, and 7F ureteral stents, respectively. Conclusions: Maintenance of intraluminal stent diameter in the presence of extrinsic compressive forces is primarily dependent on the stent's ratio of "material area" to "CSA." Urologists should be aware of these findings to decrease the risk of ureteral stent failure when treating extrinsic ureteral obstruction. [ABSTRACT FROM AUTHOR]

Abbreviations AS active surveillance NCCN National Comprehensive Cancer Network The management of low-risk prostate cancer in North America has recently seen some unexpected, surprising, and somewhat perplexing occurrences. Examples include recent imaging trials using prostate-specific membrane antigen positron emission tomography-CT to better target and provide more informed initial biopsy as found in the PRIMARY trial [4], or CONFIRM trial (Australian New Zealand Clinical Trials Registry [ACTRN]12621001648819 at https://www.anzctr.org.au) aiming to better select men for AS prior to confirmatory biopsy. This trial concluded that 'enzalutamide monotherapy was well-tolerated and demonstrated a significant treatment response in patients with low-risk or intermediate-risk localized prostate cancer', and that 'enzalutamide may provide an alternative treatment option for patients undergoing AS'. [Extracted from the article]

Purpose: Three-dimensional (3D) printing was invented in 1983 but has only just begun to influence medicine and surgery. Conversion of digital images into physical models demonstrates promise to revolutionize multiple domains of surgery. In the field of uro-oncology, researchers and clinicians have recognized the potential of this technology and are working towards making it an integral part of urological practice. We review current literature regarding 3D printing and other 3D technology in the field of urology.Method: A comprehensive assessment of contemporary literature was performed according to a modified PRISMA analysis for the purposes of this narrative review article. Medical databases that were searched included: Web of Science, EMBASE and Cochrane databases. Articles assessed were limited only to English-language peer-reviewed articles published between 1980 and 2017. The search terms used were “3D”, “3-dimensional”, “printing”, “printing technology”, “urology”, “surgery”. Acceptable articles were reviewed and incorporated for their merit and relevance with preference given for articles with high impact, original research and recent advances.Results: Thirty-five publications were included in final analysis and discussion.Conclusions: The area of 3D printing in Urology shows promising results, but further research is required and cost reduction must occur before clinicians fully embrace its use. As costs continue to decline and diversity of materials continues to expand, research and clinical utilization will increase. Recent advances have demonstrated the potential of this technology in the realms of education and surgical optimization. The generation of personalized organs using 3D printing scaffolding remains the ‘holy grail’ of this technology. [ABSTRACT FROM AUTHOR]

The purpose of this article was to review and compare the international guidelines and surveillance protocols for post-nephrectomy renal cell carcinoma ( RCC). PubMed database searches were conducted, according to the PRISMA statement for reporting systematic reviews, to identify current international surveillance guidelines and surveillance protocols for surgically treated and clinically localized RCC. A total of 17 articles were reviewed. These included three articles on urological guidelines, three on oncological guidelines and 11 on proposed strategies. Guidelines and strategies varied significantly in relation to follow-up, specifically with regard to the frequency and timing of radiological imaging. Although there is currently no consensus within the literature regarding surveillance protocols, various guidelines and strategies have been developed using both patient and tumour characteristics. [ABSTRACT FROM AUTHOR]

Objective To describe the characteristics of patients with and without positive surgical margins ( PSMs) and to analyse the impact of PSMs on secondary cancer treatment after radical prostatectomy ( RP), with short-term follow-up., Patients and Methods We analysed data from 2385 consecutive patients treated using RP, who were notified to the Prostate Cancer Registry by 37 hospitals in Victoria, Australia between August 2008 and February 2012., Independent and multivariate models were constructed to predict the likelihood of PSMs. Independent and multivariate predictors of secondary treatment after RP in the initial 12 months after diagnosis were also assessed., Results Data on PSM status were collected for 2219/2385 (93%) patients. In total 592/2175 (27.2%) RPs resulted in PSMs; 102/534 (19.1%) in the low-risk group, 317/1218 (26.0%) in the intermediate-risk group, 153/387 (39.5%) in the high-risk group, and 9/11 (81.8%) in the very-high-risk disease group of patients., Patients having surgery in a hospital where <10 RPs occur each year were significantly more likely to have a PSM (incidence rate ratio [ IRR] 1.44, 95% confidence interval [ CI] 1.07-1.93) and those in the intermediate-, high- or very-high-risk groups ( IRR 1.34, 95% CI 1.09-1.65, P = 0.007, IRR 1.96, 95% CI 1.57-2.45, P < 0.001 and IRR 3.81, 95% CI 2.60-5.60, P < 0.001, respectively) were significantly more likely to have a PSM than those in the low-risk group ( IRR 2.50, 95% CI 1.23-5.11, P = 0.012). Patients with PSMs were significantly less likely to have been treated at a private hospital than a public hospital ( IRR 0.76, 95% CI 0.63-0.93, P = 0.006) or to have undergone robot-assisted RP ( IRR 0.69, 95% CI 0.55-0.87; P = 0.002) than open RP., Of the 2182 patients who underwent RP in the initial 12 months after diagnosis, 1987 (91.1%) received no subsequent treatment, 123 (5.6%) received radiotherapy, 47 (2.1%) received androgen deprivation therapy ( ADT) and 23 (1.1%) received a combination of radiotherapy and ADT. Two patients (0.1%) received chemotherapy combined with another treatment., At a multivariate level, predictors of additional treatment after RP in the initial 12 months included having a PSM compared with a negative surgical margin (odds ratio [ OR] 5.61, 95% CI 3.82-8.22, P < 0.001); pT3 compared with pT2 disease ( OR 4.72, 95% CI 2.69-8.23, P < 0.001); and having high- or very-high-risk disease compared with low-risk disease ( OR 4.36, 95% CI 2.24-8.50, P < 0.001 and OR 4.50, 95% CI 1.34-15.17, P = 0.015, respectively). Patient age, hospital location and hospital type were not associated with secondary treatment. Patients undergoing robot-assisted RP were significantly less likely to receive additional treatment than those receiving open RP ( OR 0.59, 95% CI 0.39-0.88, P = 0.010)., Conclusions These data indicate an important association between hospital status and PSMs, with patients who underwent RP in private hospitals less likely than those in public hospitals to have a PSM. Patients treated in lower-volume hospitals were more likely to have a PSM and less likely to receive additional treatment after surgery in the initial 12 months, and robot-assisted RP was associated with fewer PSMs than was open RP in this non-randomized observational study., PSM status and pathological T3 disease are both important and independent predictors of secondary cancer treatment for patients undergoing RP. A robot-assisted RP approach appears to decrease the likelihood of subsequent treatment, when compared with the open approach. [ABSTRACT FROM AUTHOR]

Introduction We analyzed data obtained from a randomized controlled blinded study of the prostatic urethral lift ( PUL) to evaluate the sexual side effects of this novel treatment. Aims We sought to determine whether PUL, when conducted in a randomized study, significantly improved lower urinary tract symptoms ( LUTS) and urinary flow rate while preserving sexual function. Methods Men ≥50 years with prostates 30-80 cc, International Prostate Symptom Score (IPSS) >12, and peak urinary flow rate (Qmax) ≤12 ml/s were randomized 2:1 between PUL and sham. Sexual activity was not an inclusion criterion. In PUL, permanent transprostatic implants are placed to retract encroaching lateral lobes and open the prostatic fossa. Sham entailed rigid cystoscopy with sounds to mimic PUL and a blinding screen. Main Outcome Measures Blinded groups were compared at 3 months and active arm then followed to 12 months for LUTS with IPSS and for sexual function with sexual health inventory for men ( SHIM) and Male Sexual Health Questionnaire for Ejaculatory Dysfunction ( MSHQ- Ej D). Subjects were censored from primary sexual function analysis if they had baseline SHIM < 5 at enrollment. Secondary stratified analysis by erectile dysfunction ( ED) severity was conducted. Results There was no evidence of degradation in erectile or ejaculatory function after PUL. SHIM and MSHQ- Ej D scores were not different from control at 3 months but were modestly improved and statistically different from baseline at 1 year. Ejaculatory bother score was most improved with a 40% improvement over baseline. Twelve-month SHIM was significantly improved from baseline for men entering the study with severe ED, P = 0.016. IPSS and Qmax were significantly superior to both control at 3 months and baseline at 1 year. There was no instance of de novo sustained anejaculation or ED over the course of the study. Conclusions The PUL improves LUTS and urinary flow while preserving erectile and ejaculatory function. McVary KT, Gange SN, Shore ND, Bolton DM, Cowan BE, Brown BT, Te AE, Chin PT, Rukstalis DB, and Roehrborn CG on behalf of the L.I.F.T. Study Investigators. Treatment of LUTS secondary to BPH while preserving sexual function: Randomized controlled study of Prostatic Urethral Lift. J Sex Med 2014;11:279-287. [ABSTRACT FROM AUTHOR]

OBJECTIVE [ABSTRACT FROM AUTHOR]

Objectives: In tumors, hypoxia stimulates angiogenesis and correlates with treatment resistance and poor prognosis. We have previously demonstrated hypoxia in human renal cell carcinoma (RCC) via direct oxygen probe measurements. Carbonic anhydrase IX (CA IX) is a protein stimulated by hypoxia and involved in angiogenesis, and is a potential tumor target for imaging and therapies using cG250, a monoclonal antibody that recognizes CAIX. Our objectives were to characterize intratumoral hypoxia in a human RCC xenograft model using oxygen probe measurements; investigate if (124)I-cG250 targets RCC correlating uptake on noninvasive positron emission tomography-computerized tomography (PET-CT) against traditional biodistribution studies, and investigate CAIX expression in this RCC model. Methods: BALB/c nude mice had human RCC (SK-RC-52) subcutaneously xenografted with oxygen levels measured by probe. Positron emission tomography (PET/CT) and biodistribution studies ((124)I-cG250) were correlated with oxygen measurements. Immunohistochemistry and autoradiography were performed on selected tumors to confirm CAIX expression. Results: Oxygen tension in normal tissue (muscle) was 35.08 ± 2.41 mmHg (mean ± 95% CI), significantly greater compared to xenograft SK-RC-52 tumors at 5.02 ± 1.12 mmHg. Biodistribution studies of (124)I-cG250 demonstrated isotope uptake in SK-RC-52 xenografts peaking at 23.45 ± 5.07% ID/g (mean ± SD) 48 hours after antibody injection, which was maintained for a further 2 days (19.43 ± 4.31 and 10.64 ± 5.64 % ID/g, respectively). PET studies demonstrated excellent localization of (124)I-cG250 in tumor, and a significant correlation between SUVmean, SUVmax, and %/ID (124)I-cG250. CAIX expression was present in all groups studied but there was no significant correlation between it and any oxygen parameter studied. Conclusion: Intratumoral hypoxia does exist within a human RCC xenograft model using invasive oxygen probe measurements. (124)I-cG250 targets RCC with correlation between uptake on noninvasive PET-CT studies and traditional biodistribution studies opening the possibility of using PET/CT in future studies. Finally, CAIX expression was not related to hypoxia in this model, supporting the hypothesis that cell lines may subvert known hypoxia mechanisms in hypoxic environments. [ABSTRACT FROM AUTHOR]

Study Type - Therapy (RCT) Level of Evidence 1b OBJECTIVE To compare the comprehension gained by standard consent (SC) vs a unique interactive multimedia presentation (IMP), for radical prostatectomy (RP), as informed consent for RP requires that the patient understands the procedure and potential complications. PATIENTS AND METHODS Forty patients undergoing RP were prospectively randomized to SC or IMP, followed by a 26-question test on critical aspects of the surgery and its implications. The groups were crossed over and re-tested, with a subsequent statistical analysis. SC involved typical verbal interaction and consultation with physicians and nurses, whilst the IMP provided consistent and animated information on these topics, and included multiple-choice questions probing understanding of key points. Progression through the IMP only occurred with correct responses; incorrect responses prompted a review of the information before repeating the question. Telephone interviews assessed usability, overall understanding, educational level and primary language. RESULTS The patient groups had similar demographics. The IMP group (78%) had significantly higher knowledge test scores ( P < 0.001) than the SC group (57%), suggesting a better understanding of the implications of surgery. This was maintained on crossover, with the SC group scores improving by 11% compared to testing before IMP ( P < 0.001). The initial IMP group scores were unchanged on crossover and repeat testing ( P < 0.05). CONCLUSION IMP provides better patient understanding than SC for RP, by ensuring that the procedure and risks have been explained consistently, and by actively testing the patient. Such tools assist in obtaining ethical and legally informed consent, thus increasing patient knowledge whilst reducing patient anxiety and potential dissatisfaction or medico-legal consequences when less than ideal outcomes occur. [ABSTRACT FROM AUTHOR]

Background and Objective: There has been a shift toward systemic treatment intensification for men with metastatic hormone-sensitive prostate cancer (mHSPC). Recent trials have demonstrated the efficacy of triplet therapy with an androgen receptor signalling inhibitor (ARSI), docetaxel, and androgen deprivation therapy (ADT). However, ARSI treatment is expensive. The objective was to determine the cost effectiveness of current treatments strategies for men with mHSPC., Methods: We developed a Markov state-transition model to simulate outcomes for men with newly diagnosed mHSPC. For the simulation, patients were entered in the model in the mHSPC disease state before progressing to castration-resistant disease and finally dying from prostate cancer. Costs were calculated from a USA health sector perspective in 2022 US dollars. Deterministic and probabilistic sensitivity analyses were conducted to account for uncertainty in the parameter estimates. We also performed scenario analyses for costs in the UK and Australian health sectors., Key Findings and Limitations: Treatment intensification with doublet and triplet therapy resulted in an improvement in quality-adjusted survival for all strategies in comparison to ADT monotherapy. However, only docetaxel doublet therapy was cost effective at standard thresholds, with an incremental cost-effectiveness ratio of $13 647. The cost of ARSIs needed to be discounted by 47-70% before they were cost effective. Only medication costs impacted the model results. If the generic price for abiraterone acetate is used, then triplet therapy with abiraterone is the best-value option. Similar results were obtained for analyses for the UK and Australian health sectors., Conclusions and Clinical Implications: Treatment intensification with ARSIs in men with mHSPC results in better quality-adjusted survival but is not cost effective according to standard thresholds. The costs of these medications would need to be heavily discounted before they are cost effective. The cost of generic ARSIs, once available, would render these strategies cost effective., Patient Summary: This report examines whether increasing the number of systemic drugs used to treat a patient's metastatic hormone-sensitive prostate cancer is cost effective for the health care system. We found that the additional cost of triplet therapy does not justify the increase in patient benefit., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Socioeconomic status (SES), race and geographical factors are known to impact prostate cancer management and outcomes. We aimed to assess these factors with regard to access to novel imaging in prostate cancer. Using the Prostate Cancer Outcomes Registry of Victoria (PCOR-Vic) we identified 5256 men diagnosed with prostate cancer via biopsy. Following the introduction of government rebate, the access to MRI improved with respect to SES. Access to PET imaging remains poor with respect to SES and geographical location in the absence of Federal funding. Further improvements for men with low SES and regional areas to access PET staging., (© 2022. The Author(s).)

Purpose of Review: Many clinical trials are currently underway to target the epigenome of castration-resistant prostate cancer. In this review, we summarize the major epigenetic alterations that occur during prostate cancer progression, describe their biological consequences, and highlight potential of therapies that target epigenetic regulators for use in patients., Recent Findings: Epigenetic alterations frequently occur in tumour suppressor genes, DNA repair genes, and genes that regulate cell proliferation and differentiation. Unlike genetic alterations, epigenetic changes are reversible, making them promising targets for cancer therapy. Epigenetic regulators can be divided into three broad groups: writers, readers, and erasers , each with specific drug targets that are being assessed in phase I and II clinical trials for prostate cancer. CBP/p300, and BRD4 are coregulators of the androgen receptor and inhibit androgen signalling, making bromodomain extra-terminal inhibitors and CBP/p300 inhibitors attractive targets in prostate cancer. Enhancer of zeste homolog 2, a histone methyltransferase, is also a potential target in castrate-resistant prostate cancer. An emerging direction is to combine epigenetic inhibitors with other compounds to enhance their efficacy., Summary: Preclinical studies indicate that the epigenome is a potential target in prostate cancer, and clinical trials are testing multiple agents that target the epigenome in different ways. However, the process of translating these therapies into the clinic is ongoing and none have yet been approved for castrate-resistant prostate cancer., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Self-reported information may not accurately capture smoking exposure. We aimed to evaluate whether smoking-associated DNA methylation markers improve urothelial cell carcinoma (UCC) risk prediction., Methods: Conditional logistic regression was used to assess associations between blood-based methylation and UCC risk using two matched case-control samples: 404 pairs from the Melbourne Collaborative Cohort Study (MCCS) and 440 pairs from the Women's Health Initiative (WHI) cohort. Results were pooled using fixed-effects meta-analysis. We developed methylation-based predictors of UCC and evaluated their prediction accuracy on two replication data sets using the area under the curve (AUC)., Results: The meta-analysis identified associations ( P < 4.7 × 10 -5 ) for 29 of 1,061 smoking-associated methylation sites, but these were substantially attenuated after adjustment for self-reported smoking. Nominally significant associations ( P < 0.05) were found for 387 (36%) and 86 (8%) of smoking-associated markers without/with adjustment for self-reported smoking, respectively, with same direction of association as with smoking for 387 (100%) and 79 (92%) markers. A Lasso-based predictor was associated with UCC risk in one replication data set in MCCS [ N = 134; odds ratio per SD (OR) = 1.37; 95% CI, 1.00-1.90] after confounder adjustment; AUC = 0.66, compared with AUC = 0.64 without methylation information. Limited evidence of replication was found in the second testing data set in WHI ( N = 440; OR = 1.09; 95% CI, 0.91-1.30)., Conclusions: Combination of smoking-associated methylation marks may provide some improvement to UCC risk prediction. Our findings need further evaluation using larger data sets., Impact: DNA methylation may be associated with UCC risk beyond traditional smoking assessment and could contribute to some improvements in stratification of UCC risk in the general population., (©2021 American Association for Cancer Research.)

Introduction and Objectives: Renal calculi are a common medical problem with incidence rates calculated to be approximately 6%-9% in men & 3%-4% in women worldwide. Incidence appears to be increasing. This study compares emergency presentations and unplanned readmissions between extracorporeal shock wave lithotripsy (SWL) and pyeloscopic stone treatment in the population of Victoria, Australia after 1-year follow-up., Methods: This is a population study comparing all patients with renal calculi electively treated with SWL to those initially treated with flexible ureteroscopy (URS) in Victoria, Australia. We used data linkage across the state of Victoria to follow patients treated with either modality in a 12 months period (with no urological surgery in the prior 12 months). Each patient's emergency presentations and subsequent re-admissions were followed up for 1 year after their index treatment to assess for stone complications. We assessed for selection bias between the two patient groups by comparing age, gender, insurance status, geographical location, and comorbidity scores., Results: We report stone-related complications for 739 flexible URS and 1317 SWL procedures undertaken across public and private hospitals in Victoria over 12 months. Unplanned emergency presentations within 60-days of surgery were (22/739) 2.98% for flexible URS patients and (83/1317) 6.30% for SWL patients ( P  = .001); however, at 12 months, this became 16.23% (120/739) for flexible URS patients and 12.83% (169/1317) for SWL patients ( P  = .034). Flexible URS patients were more likely than SWL patients to be admitted with 71.76% of flexible URS versus 53.97% of SWL patients requiring an admission at any given emergency presentation ( P ≤ .001) within 12 months. On multivariate analysis, both flexible URS ([OR] 1.67, CI 1.23-2.26,  P  = .001) and being a public patient ([OR] 3.06, CI 2.24-4.18,  P  < .001) significantly increased the likelihood that patients required an unplanned re-admission within 12 months., Conclusions: There is work needed to reduce emergency presentations and unplanned re-admissions after both SWL and flexible URS. At 12-months follow-up, unplanned emergency visits and re-admission rates were significantly more after flexible URS. Symptoms at emergency presentation indicate that better education regarding stent management is needed, especially in the public health care system., Competing Interests: Gregory Jack, Niall Davis, Matthew Farag, Lih‐Ming Wong: None. Damien Bolton: Boston Scientific, Investigator Grant., (© 2021 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.)

Background: Detecting and isolating cases of COVID-19 are amongst the key elements listed by the WHO to reduce transmission. This approach has been reported to reduce those symptomatic with COVID-19 in the population by over 90%. Testing is part of a strategy that will save lives. Testing everyone maybe ideal, but it is not practical. A risk tool based on patient demographics and clinical parameters has the potential to help identify patients most likely to test negative for SARS-CoV-2. If effective it could be used to aide clinical decision making and reduce the testing burden. Methods: At the time of this analysis, a total of 9,516 patients with symptoms suggestive of Covid-19, were assessed and tested at Mount Sinai Institutions in New York. Patient demographics, clinical parameters and test results were collected. A robust prediction pipeline was used to develop a risk tool to predict the likelihood of a positive test for Covid-19. The risk tool was analyzed in a holdout dataset from the cohort and its discriminative ability, calibration and net benefit assessed. Results: Over 48% of those tested in this cohort, had a positive result. The derived model had an AUC of 0.77, provided reliable risk prediction, and demonstrated a superior net benefit than a strategy of testing everybody. When a risk cut-off of 70% was applied, the model had a negative predictive value of 96%. Conclusion: Such a tool could be used to help aide but not replace clinical decision making and conserve vital resources needed to effectively tackle this pandemic., Competing Interests: DR is President and Chief Operating Officer of The Mount Sinai Hospital and President of Mount Sinai Queens. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Lundon, Kelly, Nair, Bolton, Patel, Reich and Tewari.)

Objectives: To determine the best way to intervene for ureteric stones which still require treatment during the COVID-19 pandemic, with respect to infection control. In this setting, in which resources are constrained, extracorporeal shockwave lithotripsy (SWL) has prima facie advantages over ureteroscopy (URS). It is also necessary to also consider posttreatment resource consumption in regards to complications and repeat procedures., Subjects and Methods: The ideal ureteric stone treatment during a pandemic such as COVID-19 would involve minimum resource consumption and a minimum number of patient attendances. We compared all patients initially treated with SWL to those initially treated with URS for acute ureteral colic within the state of Victoria, Australia in 2017., Results: A total of 2724 ureteric stones were analyzed, a cumulative "3-month exposure and burden on the healthcare system" was calculated for each patient by their initial procedure type. The readmission rate for URS was significantly higher than for SWL, 0.92 readmissions/patient for URS versus 0.54 readmissions/patient for SWL ( P  < .001). The cumulative hospital stay per patient for these two procedures was 2.35 days for SWL versus 3.21 days for URS ( P  < .001). The number of procedures per patient was 1.52 for SWL versus 1.89 for URS ( P  = .0213)., Conclusions: Patients with ureteric stones treated initially by SWL have shorter length of stay with fewer overall attendances and procedures at 3 months than those treated with URS. During a pandemic such as COVID-19, SWL may have benefits in preserving hospital resources and limiting opportunity for virus transmission, compared to URS., Competing Interests: Dan Lenaghan, Matthew Farag, Lih‐Ming Wong: None; Damien Bolton: Boston Scientific, Investigator Grant; Gregory Jack: Boston Scientific, lecture honoraria., (© 2020 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of BJU International Company.)

Background: Clinically significant CKD following surgery for kidney cancer is associated with increased morbidity and mortality, but identifying patients at increased CKD risk remains difficult. Simple methods to stratify risk of clinically significant CKD after nephrectomy are needed., Methods: To develop a tool for stratifying patients' risk of CKD arising after surgery for kidney cancer, we tested models in a population-based cohort of 699 patients with kidney cancer in Queensland, Australia (2012-2013). We validated these models in a population-based cohort of 423 patients from Victoria, Australia, and in patient cohorts from single centers in Queensland, Scotland, and England. Eligible patients had two functioning kidneys and a preoperative eGFR ≥60 ml/min per 1.73 m 2 . The main outcome was incident eGFR <45 ml/min per 1.73 m 2 at 12 months postnephrectomy. We used prespecified predictors-age ≥65 years old, diabetes mellitus, preoperative eGFR, and nephrectomy type (partial/radical)-to fit logistic regression models and grouped patients according to degree of risk of clinically significant CKD (negligible, low, moderate, or high risk)., Results: Absolute risks of stage 3b or higher CKD were <2%, 3% to 14%, 21% to 26%, and 46% to 69% across the four strata of negligible, low, moderate, and high risk, respectively. The negative predictive value of the negligible risk category was 98.9% for clinically significant CKD. The c statistic for this score ranged from 0.84 to 0.88 across derivation and validation cohorts., Conclusions: Our simple scoring system can reproducibly stratify postnephrectomy CKD risk on the basis of readily available parameters. This clinical tool's quantitative assessment of CKD risk may be weighed against other considerations when planning management of kidney tumors and help inform shared decision making between clinicians and patients., (Copyright © 2020 by the American Society of Nephrology.)