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Background Telemedicine gained wide acceptance during the COVID-19 pandemic, as it was deemed critical for patient care when lockdowns were implemented worldwide. While there is evidence to suggest that urology patients were receptive to telemedicine, no systematic review has been done to date on andrology patients and their perception of telemedicine. Methods Three electronic databases, PubMed, Scopus, and Web of Science, were searched from their inception until June 2022 for relevant articles. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. A meta-analysis was completed in line with PRISMA 2020 and AMSTAR Guidelines. For our study, we limited telemedicine to communication through videoconferencing or telephone encounters between patients and medical professionals. Positive response to telemedicine was defined as patients “wishing for telemedicine consultation”, “preferring telemedicine over in person”, “accepting the current telemedicine arrangement”, “having needs addressed with teleconsultation”, or “willingness to do a teleconsultation”. Results Of the 1128 retrieved abstracts, 56 underwent full-text review and 12 were included in the final analysis, comprising a total cohort of >4021 cases. Video visits were evaluated in 5 studies, telephone encounters were analyzed in 2 studies, and both methods were examined in 1 randomized control study. Three studies showed that andrology and sexual medicine are compatible with telemedicine, with few 30- and 90-day in-person revisit rates. Telemedicine was shown to save an average cost of US$149-$252 per patient, and 8 studies that directly assessed andrology patient perceptions of telemedicine showed that most patients had a “positive perception.” Pooled analyses of the positive responses to telemedicine were 68.7% (95% CI, 49.4%-83.1%, P = 0.057), and those of patients who recommended telemedicine were 65.1% (95% CI, 18.4%-93.9%, P = 0.577). While the percentage of patients recommending telemedicine was high among studies using videoconferencing, the percentage dropped in studies using telephone visits only. The difference between recommending video and telephone practices was statistically significant, with 84.6% pooled proportion for recommending video practice compared to 38.9% pooled proportion for recommending telephone practice, P = 0.035. In the telephone-only encounters, up to 27.1% of patients preferred in-person visits, as security and privacy of any mode of telecommunication were of concern. Conclusions Most patients have a positive perception of telemedicine, particularly with videoconferencing and less so with telephone visits. These results suggest that telemedicine will likely continue to play a pivotal role in andrology and sexual medicine practices.

Objective: To report on the outcomes of magnetic resonance imaging (MRI)/ultrasonography (US)-fusion transperineal prostate (TP) biopsy at a tertiary medical centre in the Middle East including detection rate of clinically significant prostate cancer (csPCa), complications, and tolerability of the procedure. Patients and methods: Between May 2019 and June 2020, 98 MRI/US-fusion TP biopsies were performed in the US suite using light sedation. All patients had pre-biopsy 3-T multiparametric MRI. Data on patient characteristics, PCa detection rate and complication rates were collected retrospectively. A Gleason score ≥3 + 4 was defined as csPCa. Results There were 98 patients, with a mean (SD) age of 65 (9.1) years, and a median (SD) prostate-specific antigen level prior to biopsy of 7.53 (12.97) ng/mL and prostate volume of 51 (31.1) mL. PCa was detected in 54 (55%) patients, with csPCa detected in 43 (44%). A total of 124 Prostate Imaging-Reporting and Data System (PI-RADS) 3–5 lesions were targeted. Grade Group ≥2 PCa was found in 35.5% of the targeted lesions. Random biopsies detected one csPCa Gleason score 3 + 4 in one patient with a negative target. None of the patients had post-biopsy haematuria or retention. Only one patient developed acute prostatitis requiring in-patient intravenous antibiotics. Conclusions MRI/US-fusion TP biopsy has an adequate detection rate of csPCa with minimal complications and low infection rates after biopsy. This is one of the first TP biopsy series in the Middle East paving the way for wider adoption in the region. Abbreviations AS: active surveillance; AUR: acute urinary retention; GG: Grade Group; IQR: interquartile range; mpMRI: multiparametric MRI; (cs)PCa: (clinically significant) prostate cancer; PI-RADS: Prostate Imaging-Reporting and Data System; TP: transperineal; US: ultrasonography; TRUS: transrectal Ultrasound guided.

Introduction: Recent studies have shown that software-generated 3D stone volume calculations are better predictors of stone burden than measured maximal axial stone diameter. However, no studies have assessed the role of formula estimated stone volume, a more practical and cheaper alternative to software calculations, to predict spontaneous stone passage (SSP). Methods: We retrospectively included patients discharged from our emergency department on conservative treatment for ureteral stone (≤10 mm). We collected patient demographics, comorbidities, and laboratory tests. Using non-contrast computed tomography (CT) reports, stone width, length, and depth (w, l, d, respectively) were used to estimate stone volumes using the ellipsoid formula: V=π*l*w*d*0.167. Using a backward conditional regression, two models were developed incorporating either estimated stone volume or maximal axial stone diameter. A receiver operator characteristic (ROC) curve was constructed and the area under the curve (AUC) was computed and compared to the other model. Results: We included 450 patients; 243 patients (54%) had SSP and 207 patients (46%) failed SSP. The median calculated stone volume was significantly smaller among patients with SSP: 25 (14–60) mm3 vs. 113 (66–180) mm3 (p75 (OR 4.83, 95% CI 2.12–11.00), and proximal stone (OR 2.11, 95% CI 1.16–3.83). For every 1 mm3 increase in stone volume, the risk of SSP failure increased by 2.5%. The model explained 89.4% (0.864–0.923) of the variability in the outcome. This model was superior to the model including maximal axial diameter (0.881, 0.847–0.909, p=0.04). Conclusions: We present a nomogram incorporating stone volume to better predict SSP. Stone volume estimated using an ellipsoid formula can predict SSP better than maximal axial diameter.

Radiation-based therapy (RT) has emerged as a suitable alternative to radical cystectomy (RC) and pelvic lymph node dissection for muscle-invasive bladder cancer (MIBC) patients. Routine biopsy after RT to rule out residual disease remains inconsistent across guidelines. Our objective was to review the significance of a bladder biopsy in terms of assessment of response post-RT and its potential impact on survival.This was a single-center retrospective study on patients with MIBC (cT2-4aN0-2M0) treated with curative intent RT. A total of 169 patients with primary urothelial carcinoma were analyzed. Patients' demographic, clinical and pathological variables, imaging, cystoscopy, urine cytology, and biopsy reports after RT were collected and compiled. Whenever urine cytology was positive or cystoscopy showed any malignant-appearing lesion, the first assessment post-RT was considered suspicious for residual disease. A descriptive population analysis was reported. Cox regression multivariable analysis was performed to identify independent variables associated with survival outcomes.Median age was 75 years (interquartile range 66-82) and clinical staging was cT2 in 152 (90%) patients. Cytology and cystoscopy were normal in 140 (83%) after RT. Of patients with a control biopsy, residual MIBC was present in 3 (5%) and non-MIBC in another 6 (11%). On the contrary, a for-cause biopsy due to a suspicious assessment post-RT did not yield residual cancer in 45% of patients. Multivariable analysis showed that age (hazard ratio [HR] 1.04, P0.001), lymphovascular invasion (HR 1.68, P = 0.03) and a suspicious assessment after RT (HR 3.21; P0.001) were significantly associated with worse OS. This study was limited by its retrospective design.A routine biopsy after RT may be warranted to assess treatment response. This might be particularly important for patients who may benefit from early surgical intervention for residual MIBC. Further prospective studies are needed to confirm our findings.

Author(s): Shahait, Mohammed; Majali, Fawaz Al; Dobbs, Ryan W; Sandberg, Alex; El-Achkar, Adnan; El-Fahmawi, Ayah; Mucksavage, Philip; Lee, David I | Abstract: ObjectiveManagement of prostate cancer in kidney transplant recipients presents a unique surgical challenge due to the risk of direct or indirect injury to the transplanted kidney. Herein, we report the largest single center study of Robot-assisted Radical prostatectomy (RARP) in kidney transplant recipients.MethodsBetween Jan 2014-2019, 14 kidney transplant recipients with prostate cancer underwent RARP. Clinical and pathological features, perioperative and postoperative complications were retrospectively evaluated. Continence was defined as by patient utilization of zero urinary pads postoperatively.ResultsThe median (IQR) age at RARP was 60.2 (57.8-61.3) years, the interval between kidney transplant and RARP was 8.1 ± 7.5 years. The median (IQR) PSA was 6.9 (4-8.6); 10 of 14 patients had intermediate or high-risk prostate cancer. The median ASA score was 3, the mean (SD) operative time was 129.7 (26.3) minutes, and mean (SD) blood loss was 110 (44.6) ml. All cases were completed robotically, there was no graft loss or injury to transplanted ureter, and the mean length of stay was 1 (0.26) day.Final pathology demonstrated that 42.8% (6/14) of the patients had nonorgan confined disease (pT3a/T3b). 50% (7/14) of the patients were upgraded to higher risk Gleason disease on final surgical pathology. Post-RARP continence rate at 3 months, and 12 months were 45.5% (5/11) and 87.5% (7/8), respectively.ConclusionRARP following kidney transplantation represents a safe and feasible operation which does not appear to compromise oncological or transplant outcomes.

This review targets the latest literature on bladder preservation therapy with emphasis on trimodal therapy (TMT), highlighting its role in the management of muscle invasive bladder cancer (MIBC) and outlining future directions in bladder preservation research. TMT is the most promising bladder preservation treatment modality. Comparable results to contemporary radical cystectomy series are seen in properly selected patients. A multidisciplinary team approach is critical in the management of these patients. Future research is directed at the integration of immunotherapy into the treatment protocol. TMT, involving maximal transurethral resection followed by chemoradiation, is an attractive alternative to radical cystectomy with urinary diversion in carefully selected patients with muscle invasive disease. In the absence of randomized trial (RCT), comparison between TMT and cystectomy, based on retrospective data from large centers, suggests comparable oncological outcomes, with a favorable impact on quality of life.

Objectifs La therapie trimodale (TMT), associant resection transuretrale etendue (RTUVe) et chimioradiotherapie, est une alternative de preservation vesicale pour les cancers de vessie infiltrant le muscle (TVIM) chez les patients refusant ou medicalement contre-indique a la cystectomie totale. L’objectif etait d’analyser les resultats oncologiques de la TMT chez les patients atteints d’une TVIM. Methodes Etude retrospective monocentrique incluant tous les patients atteints d’une TVIM (cT2-4aN0-2M0) traites par TMT a dose curative entre 2001 et 2017. Les resultats demographiques, pathologiques, d’imagerie et des cystoscopies ont ete collectes. Les patients ont beneficies d’une RTUVe, d’une radiotherapie a dose curative (> 45 Gy) associe a une chimiotherapie concomitante. Un suivi regulier par imagerie, cystoscopie et anatomopathologie etait realise. Les analyses statistiques etaient realisees par analyse de Kaplan–Meier et modele de Cox. Resultats Au total, 158 patients atteints d’une TVIM ont ete inclus dont 142 (90 %) cT2 patients, 12 (8 %) cT3, et 4 (2 %) cT4a. L’âge median etait de 75 ans [IQR 43–91]. Chez 60 (38 %) patients la chirurgie etait contre-indiquee et 30 (19 %) ont beneficies d’une chimiotherapie neoadjuvante. Les radio-sensibilisants majoritairement utilises etaient la gemcitabine (68 %) ou le cisplatine (23 %). La mediane de suivi etait de 43 mois [IQR 5–191]. Cinquante-deux patients (33 %) ont presente une recidive, la mediane avant recidive etait de 10 mois [IQR 5,7–20,2]. Durant la periode l’etude, 76 (48 %) patients sont decedes. Les probabilites de survie a 2 et 5 ans etaient de 0,71 (IC95 % : 0,64–0,79) et 0,52 (IC95 % : 0,48–0,66) respectivement. En analyse multivariee, l’âge (HR = 1,06 ; p = 0,026) et une cystoscopie suspecte ou une cytologie urinaire positive (HR = 3,10 ; p = 0,008) etaient predictifs d’une survie globale plus faible ( Fig. 1 , Fig. 2 ). Conclusion La TMT est associee a des resultats oncologiques satisfaisant et est une alternative valide a la cystectomie totale pour les patients atteints d’une TVIM ne pouvant ou ne souhaitant pas de chirurgie invasive. Nos resultats doivent etre valides par des etudes prospectives.