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Objectives: Patients with histologic subtype bladder cancer (HSBC) suffer worse outcomes than those with conventional urothelial carcinoma (UC). We sought to characterize the use of adjuvant chemotherapy (AC) in HSBC after radical cystectomy (RC) using the National Cancer Database (NCDB)., Materials and Methods: We retrospectively queried the NCDB (2006-2019) for patients with non-metastatic bladder cancer (BC) who underwent RC (N = 45,797). Patients were stratified by histologic subtype and receipt of AC. Multivariable logistic regression determined associations of demographic and clinicopathologic features with receipt of AC. Multivariable Cox regression evaluated associations between receipt of any AC and overall survival (OS)., Results: We identified 4,469 patients with HSBC classified as squamous, adenocarcinoma, small cell, sarcomatoid, micropapillary, or plasmacytoid. Squamous comprised 31% of the HSBC cohort, followed by small cells and micropapillary. Black patients were presented with a higher prevalence of adenocarcinoma (119/322, 37.0%). Use of AC was highest in plasmacytoid and small cell (30% each) and lowest in squamous (11%). Neuroendocrine histology was independently associated with greater odds of receiving AC (HR 1.6, 95% CI 1.37-1.87), while squamous cell histology was associated with lower odds (HR 0.61, 95% CI 0.53-0.71). On multivariable Cox regression analysis, treatment with AC was associated with significantly longer OS (HR 0.69, 95% CI 0.59-0.81) and for squamous, sarcomatoid, and micropapillary cohorts after stratified by subtype., Conclusions: AC was variably used among patients with HSBC and was associated with OS benefit in such patients., Competing Interests: Disclosure Elizabeth L. Koehne: no conflicts to disclose. Dimitra R. Bakaloudi: no conflicts to disclose. Fady Ghali: no conflicts to disclose. Yaw Nyame: no conflicts to disclose. George R. Schade: Advisor for ImmunityBio and Consultant for EDAP TMS. Petros Grivas: consulting for 4D Pharma, Abbvie, Aadi Bioscience, Asieris Pharmaceuticals, Astellas, AstraZeneca, BostonGene, Bristol Myers Squibb, CG Oncology, Dyania Health, Exelixis, Fresenius Kabi, G1 Therapeutics, Genentech, Gilead Sciences, Guardant Health, ImmunityBio, Infinity Pharmaceuticals, Janssen, Lucence, Merck KGaA, Mirati Therapeutics, MSD, Pfizer, PureTech, QED Therapeutics, Regeneron, Roche, Seattle Genetics, Silverback Therapeutics, Strata Oncology, UroGen Pharma; institutional research funding from ALX Oncology, Acrivon Therapeutics, Bavarian Nordic, Bristol Myers Squibb, Clovis Oncology, Debiopharm Group, G1 Therapeutics, Gilead Sciences, GSK, Merck KGaA, Mirati Therapeutics, MSD, Pfizer, QED Therapeutics. Todd A. Yezefski: no conflicts to disclose. Jessica E. Hawley: paid consultant to Seagen, Daiichi Sankyo, and ImmunityBio and has received sponsored research funding to her institution from Astra Zeneca, Bristol Meyers Squibb, Crescendo Biologics, Macrogenics, Janssen, and Vaccitech. Evan Y. Yu: consulting for Bayer, Janssen, Merck, AAA Novartis, Aadi Bioscience, Oncternal, Bristol Myers Squibb, Loxo. Institutional research support from Bayer, Daiichi-Sankyo, Dendreon, Merck, Taiho, Seattle Genetics, Blue Earth, Lantheus, Surface, and Tyra. Andrew C. Hsieh: no conflicts to disclose. R Bruce Montgomery: Research Funding—AstraZeneca, Janssen Oncology, Clovis Oncology, Astellas Pharma, Beigene. Sarah P. Psutka: Research funding—NIA, BCAN, Janssen (Global PI SunRise 4), Steba Bio Tech (Site PI: ENLIGHTED Trial); Advisory Board—ImmunityBio, Janssen. John L. Gore: Advisor, Seagen Pharmaceuticals, Inc.; Advisor, ImmunityBio. Jonathan L. Wright: Royalites—UpToDate; Clinical Trials—Merck, Nucleix, Janssen, Pacific Edge, Seagen, Veracyte; Consulting—ImmunityBio, Pacific Edge., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: American Indian and Alaska Native (AIAN) health issues are understudied despite documentation of lower-than-average life expectancy. Urgent surgery is associated with higher rates of postsurgical complications and postoperative death. We assess whether American Indian and Alaska Native (AIAN) patients in Washington State are at greater risk of requiring urgent rather than elective surgery compared with non-Hispanic Whites (NHW)., Methods: We accessed data for the period 2009-2014 from the Washington State Comprehensive Hospital Abstract Reporting System (CHARS) database, which captures all statewide hospital admissions, to examine three common surgeries that are performed both urgently and electively: hip replacements, aortic valve replacements, and spinal fusions. We extracted patient race, age, insurance status, comorbidity, admission type, and procedures performed. We then constructed multivariable logistic regression models to identify factors associated with use of urgent surgical care., Results: AIAN patients had lower mean age at surgery for all three surgeries compared with NHW patients. AIAN patients were at higher risk for urgent surgery for hip replacements (OR = 1.49, 95% CI 1.19-1.88), spinal fusions (OR = 1.39, 95% CI 1.04-1.87), and aortic valve replacements (OR = 2.06, 95% CI 1.12-3.80)., Conclusion: AIAN patients were more likely to undergo urgent hip replacement, spinal fusion, and aortic valve replacement than NHW patients. AIAN patients underwent urgent surgery at younger ages. Medicaid insurance conferred higher risks for urgent surgery across all surgeries studied. Further research is warranted to more clearly identify the factors contributing to disparities among AIAN patients undergoing urgent surgery., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Objective: To describe our surgical technique for robotic partial nephrectomy, 1 focusing on specific technical hints for vascular clamping on patients with renal masses and endovascular stent (ES) in the renal artery., Methods: We reviewed the records of 3 patients that underwent robotic partial nephrectomy in our institution with precise clamping of renal arteries due to previous placement of ES. Perioperative outcomes were recorded. In our video, we present the case of 73-year-old Caucasian with a 10-cm left renal neoplasm and associated fenestrated endograft due to endovascular aorta repair. After preoperative imaging was reviewed, a robotic approach was planned., Results: Key hints for outcomes optimization during nephron sparing surgery on patients with ES on the renal arteries: (1) preoperative computed tomography scan is crucial for surgical planning on dissection of the renal pedicle, 2 (2) an additional multiplanar volume rendering of the computed tomography scan may allow better 3-dimensional visualization and orientation of the renal vasculature and anatomy, (3) precise renal artery clamping distal from the renal artery stent is required to avoid renal stent occlusion, (4) extensive and meticulous dissection of the renal pedicle is mandatory to dictate correct clamping, and (5) an intraoperative Doppler ultrasound after clamping release confirms the blood flow through the renal arteries. 3 From the patients analyzed, median age was 69.6 years, median body mass index was 31.3, and mean estimated glomerular filtration rate was 36.6 mL/min. No cases were converted to open procedures. Perioperative outcomes are described in Table 1., Conclusion: Partial nephrectomy in patients with renal artery stents requires distal dissection of the renal artery beyond the stent. Our described technique provides feasible, reproducible, and valuable surgical suggestions for outcomes optimization during nephron-sparing surgery on patients with endovascular graft stents., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To test the classic teaching that isolated right varicoceles are associated with significantly high rates of occult malignancies., Methods: Retrospective chart review included all men diagnosed with varicocele at the Cleveland Clinic from 2000 to 2015. Charts were queried for demographics, varicocele laterality, cross-sectional imaging, and subsequent diagnosis of abdominal malignancy or vascular anomaly. Descriptive statistics are presented as means ± standard deviation. Comparative statistics include analyses of variance with Tukey-Kramer pairwise comparisons or chi-square tests as indicated. All P <.05 are considered significant., Results: Varicocele was diagnosed in 4060 men (3258 left, 337 right, and 465 bilateral). Men with right varicoceles were significantly older (43.6 ± 17.1) than left (33.4 ± 14.9, P <.0001) or bilateral (34.9 ± 15.3, P <.0001), and had higher body mass indices (right 28.9 ± 5.7; left 26.4 ± 5.5, P <.0001 and; bilateral 26.5 ± 5.5, P <.0001). Laterality of varicocele was not significantly associated with cancer diagnosis (P = .313), with cancer diagnosed in 2.67% of right, 1.63% of left, and 2.15% of bilateral varicoceles. Rates of abdominal computed tomography imaging differed significantly (P <.0001) by laterality: 30.3% of right, 8.7% of left, and 11.2% of bilateral varicoceles were scanned. Vascular anomalies did not significantly differ by varicocele laterality., Conclusion: Men with right varicoceles were older, heavier, and underwent more computed tomography scans than those with left or bilateral varicoceles but did not have higher rates of cancer diagnosis., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to assess the relationship of total prostate volume (TPV) and oncologic outcomes following focal prostate cryoablation., Materials and Methods: A query of the Cryo On-Line Database (COLD) registry for men who underwent primary focal prostate cryoablation revealed 829 patients with complete data. The impact of TPV on oncologic outcomes including progression-free survival (PFS) and post-cryoablation biopsy outcome was assessed using Kaplan-Meier curves and Cox and logistic regression models., Results: The median follow-up time was 25.2 months (interquartile range [IQR], 12.7-48.2 months). The median age at time of treatment was 68 years (IQR, 63-74 years) with median prostate-specific antigen (PSA) 5.6 ng/mL (IQR, 4.4-7.5 ng/mL), and median TPV 35 mL (IQR, 26.5-46 mL). PFS was achieved in 83.2%, with positive post-cryoablation biopsy detected in 81 (35.7%) of 228 patients. Higher TPV was associated with higher biochemical progression (BP) using the Phoenix definition (39 vs. 34.5 mL; P = .003) and was an independent predictor of BP (hazard ratio, 1.01; P = .02). Conversely, men who had a positive post-cryoablation biopsy had significantly smaller median TPV on univariate and multivariate analyses (31 vs. 39 mL; P < .001), (odds ratio, 0.97; P = .001), respectively. Higher median pretreatment PSA density was associated with higher BP (0.18 vs. 0.16; P = .005) and positive post-cryoablation biopsy rates (0.2 vs. 0.16; P = .003)., Conclusion: Prostate volume has contradictory effects on BP and post-cryoablation biopsy outcome in men who underwent primary focal prostate cryoablation. Remnant viable tissue in larger prostates continues to produce more PSA over time, which may impact BP. This may raise the need to develop a new definition for oncologic success following focal gland therapy rather than the American Society for Radiation Oncology (ASTRO) and Phoenix definitions., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To develop a clinically relevant men's health phenotype and investigate the correlation between severity of urologic symptoms and systemic health conditions METHODS: Retrospective chart review was performed for men seeking care for benign prostatic hypertrophy, erectile dysfunction or chronic prostatitis or chronic pelvic pain syndrome. Urologic symptoms were assessed with the International Prostate Symptom Score, Sexual Health Inventory for Men, and National Institute of Health Chronic Prostatitis Symptom Score. Each was graded as absent or mild (0), moderate (1), or severe (2) and totaled for a urologic score (US). Seven comorbidities with known impact on urologic symptoms were similarly graded (0-2 for each) and totaled for a systemic score (SS). These domains were anxiety, cardiovascular, testosterone deficiency, insulin (diabetes), obesity, neurologic, and sleep apnea., Results: The study included 415 men with median age of 53.8 (range 19-92). Mean total US was 2.1 (range 0-6) and mean SS was 4.1 (0-12). There was a strong correlation between US and SS (Spearman Rho = 0.37, P < .00001) which was consistent regardless of age. The hierarchy of systemic condition impact on US was cardiovascular> neurologic> diabetes> anxiety> sleep apnea> obesity> testosterone. By cluster analysis the tightest correlations were age with cardiovascular, anxiety with CPPS, and diabetes with erectile dysfunction., Conclusion: Systemic health conditions correlate strongly with urologic symptoms in men who present for urologic care. Phenotyping with ACTIONS (anxiety, cardiovascular, testosterone deficiency, insulin, obesity, neurologic, sleep apnea) can identify modifiable conditions that may impact urologic symptoms and outcome of interventions. Future validation in the general population is needed., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Robotic surgery in the treatment in certain urological diseases has become a mainstay. With the increasing use of the robotic platform, some surgeries which were historically performed open have transitioned to a minimally invasive technique. Recently, the robotic approach has become more utilized for ureteral reconstruction. In this article, the authors review the surgical techniques for a number of major ureteral reconstuctive surgeries and briefly discuss the outcomes reported in the literature., Competing Interests: There are no conflicts of interest.

Purpose: We assessed the pathological outcomes after radical prostatectomy in men with favorable risk prostate cancer diagnosed on first/initial biopsy compared to those of men who were diagnosed on a subsequent/repeat prostate biopsy., Materials and Methods: We identified 422 patients who met National Comprehensive Cancer Network® very low (199) and low risk (223) prostate cancer definitions who instead underwent radical prostatectomy. In each risk category we compared adverse pathological outcomes, defined as Gleason score upgrading, extraprostatic extension, seminal vesicle invasion and positive surgical margins, between men diagnosed on initial prostate biopsy vs repeat/subsequent prostate biopsy after a negative biopsy(-ies)., Results: There were no significant differences in the baseline clinical and demographic characteristics between the groups. However, men who were diagnosed on initial prostate biopsy demonstrated a higher median maximum cancer percent per single core (p <0.001) and higher median percent of positive cores (p <0.001). Compared to repeat/subsequent prostate biopsy, men diagnosed on initial prostate biopsy had a higher Gleason score upgrade (7 or greater) (57.7% vs 42.1%, p=0.005) and extraprostatic extension (14.1% vs 5.4%, p=0.01). On stratified analysis comparing initial prostate biopsy to repeat/subsequent prostate biopsy, very low risk disease was associated with Gleason score upgrade (49.3% vs 31.8%, p=0.02) and low risk disease demonstrated higher rates of extraprostatic extension (19.9% vs 6.0%, p=0.02)., Conclusions: The likelihood of adverse pathological outcomes at radical prostatectomy is lower in men diagnosed with favorable risk prostate cancer on repeat/subsequent prostate biopsy than in men diagnosed on initial prostate biopsy, and may represent an important consideration in risk stratifying cases of favorable risk prostate cancer., (Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: Although the 2007 AUA (American Urological Association) guidelines established it as first line therapy for ureteral stones less than 10 mm, widespread adoption of medical expulsive therapy has been low. We determined the current penetrance of medical expulsive therapy guideline recommendations and the efficacy of medical expulsive therapy in reducing the requirement for urological procedures after emergency department visits for ureteral stones., Materials and Methods: In a retrospective analysis of patients seen in the emergency department we included 2,105 emergency department visits associated with an ICD-9 diagnosis of urolithiasis in which computerized tomography abdomen/pelvis scan was performed. Outcomes were reviewed for spontaneous passage or required urological procedure., Results: Ureteral stones were found in 48.8% of patients, including 50.0% in whom medical expulsive therapy was prescribed. There was no significant difference between patients who did and did not receive medical expulsive therapy. Within 12 weeks of the initial emergency department visit there was no difference in the rate of urological procedures performed in those who received medical expulsive therapy or in the rate of return to the emergency department. Patients treated with medical expulsive therapy experienced a shorter time to spontaneous expulsion (7.1 vs 12.8 days, p = 0.048)., Conclusions: Medical expulsive therapy for renal colic in the emergency setting remains underused. Half of the patients who met criteria for medical expulsive therapy in this study did not receive the standard of care. Patients treated with medical expulsive therapy achieved spontaneous passage more quickly but there was no difference in the requirement for a urological procedure. These results highlight the need for personnel at emergency departments to better standardize care for patients with ureteral stones., (Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Background: HIV-infected (HIV(+)) men face cancer treatment disparities that impact outcome. Prostate cancer treatment and treatment appropriateness in HIV(+) men are unknown., Methods: We used electronic chart review to conduct a retrospective cohort study of 43 HIV(+) cases with prostate cancer and 86 age- and race-matched HIV-uninfected (HIV(-)) controls with prostate cancer, ages 40 to 79 years, from 2001 to 2012. We defined treatment appropriateness using National Comprehensive Cancer Network guidelines and the Charlson comorbidity index (CCI) to estimate life expectancy., Results: Median age was 59.5 years at prostate cancer diagnosis. Median CD4(+) T-cell count was 459.5 cells/mm(3), 95.3% received antiretroviral therapy, and 87.1% were virally suppressed. Radical prostatectomy was the primary treatment for 39.5% of HIV(+) and 71.0% of HIV(-) men (P = 0.004). Only 16.3% of HIV(+) versus 57.0% of HIV(-) men received open radical prostatectomy (P < 0.001). HIV(+) men received more radiotherapy (25.6% vs. 16.3%, P = 0.13). HIV was negatively associated with open radical prostatectomy (OR = 0.03, P = 0.007), adjusting for insurance and CCI. No men were undertreated. Fewer HIV(+) men received appropriate treatment (89.2% vs. 100%, P = 0.003), due to four overtreated HIV(+) men. Excluding AIDS from the CCI still resulted in fewer HIV(+) men receiving appropriate treatment (94.6% vs. 100%, P = 0.03)., Conclusion: Prostate cancer in HIV(+) men is largely appropriately treated. Under- or overtreatment may occur from difficulties in life expectancy estimation. HIV(+) men may receive more radiotherapy and fewer radical prostatectomies, specifically open radical prostatectomies., Impact: Research on HIV/AIDS survival indices and etiologies and outcomes of this prostate cancer treatment disparity in HIV(+) men are needed., (©2014 American Association for Cancer Research.)

Purpose: The association between vitamin D and prostate biopsy outcomes has not been evaluated. We examine serum vitamin D levels with prostate biopsy results in men with an abnormal prostate-specific antigen and/or digital rectal examination., Experimental Design: Serum 25-hydroxyvitamin D (25-OH D) was obtained from 667 men, ages 40 to 79 years, prospectively enrolled from Chicago urology clinics undergoing first prostate biopsy. Logistic regression was used to evaluate the associations between 25-OH D status and incident prostate cancer, Gleason score, and tumor stage., Results: Among European American (EA) men, there was an association of 25-OH D <12 ng/mL with higher Gleason score ≥ 4+4 [OR, 3.66; 95% confidence interval (CI), 1.41-9.50; P = 0.008] and tumor stage [stage ≥ cT2b vs. ≤ cT2a, OR, 2.42 (1.14-5.10); P = 0.008]. In African American (AA) men, we find increased odds of prostate cancer diagnosis on biopsy with 25-OH D < 20 ng/mL [OR, 2.43 (1.20-4.94); P = 0.01]. AA men demonstrated an association between 25-OH D < 12 ng/mL and Gleason ≥ 4+4 [OR, 4.89 (1.59-15.07); P = 0.006]. There was an association with tumor stage ≥ cT2b vs. ≤ cT2a [OR, 4.22 (1.52-11.74); P = 0.003]., Conclusions: In AA men, vitamin D deficiency was associated with increased odds of prostate cancer diagnosis on biopsy. In both EA and AA men, severe deficiency was positively associated with higher Gleason grade and tumor stage., (©2014 AACR.)

In multistep reactions, stability of intermediates is critical to the rate of product formation and a significant factor in generating kinetic traps. The capsid protein of cowpea chlorotic mottle virus (CCMV) can be induced to assemble into spherical particles of 30, 60, and 90 dimers. Based on examining assembly kinetics and reaction end points, we find that formation of uniform, ordered structures is not always a result of reactions that reach equilibrium. Equilibration or, alternatively, kinetic trapping can be identified by a straightforward analysis. Altering the assembly path of "spherical" particles is a means of controlling the distribution of products, which has broad applicability to self-assembly reactions.