Guidelines for Meta-analyses and Systematic Reviews in Urology.

Our guideline comprises points addressing the conduct and interpretation of systematic reviews and meta-analyses in urology. Application of the guideline would lead to a more considered interpretation of a smaller number of systematic reviews and meta-analyses, and could thus help in translating evidence into better decision-making for doctors and patients.

Bedtime sliding scale insulin is unnecessary for hospitalized patients with bedtime glucose < 300 mg/dL: A nudge-based quasi-experiment.

Aims: Bedtime rapid-acting insulin is commonly given to hospitalized patients with moderate hyperglycemia. Its effectiveness has been evaluated in one randomized controlled trial (RCT), the results of which might not generalize to specific populations such as cancer patients.

Methods: An order set encouraging use of rapid-acting bedtime insulin was replaced with one defaulting to rapid-acting bedtime insulin only for glucoses ≥300 mg/dL, deployed over a two-month period in which approximately half of providers were arbitrarily assigned to the new order set.

Evaluating Benefits of Peristomal Mesh Placement at the Time of Radical Cystectomy and Ileal Conduit Formation: A Phase 3, Randomized Controlled Trial.

Purpose: Stomal complications following ileal conduit (IC) urinary diversion are challenging and can negatively impact quality of life after radical cystectomy. Parastomal hernias (PH) develop in up to half of patients; 30%-75% are symptomatic, and up to 1/3 require surgical repair. Recurrence rates after local tissue repair are high, and relocation of the stoma requires closure of the original defect, placing both sites at risk for hernias.

Quantification of prostate cancer Gleason pattern 4 to predict oncological outcome.

Objectives: To determine if quantifying Gleason pattern 4 (GP4) is superior to Grade Group (GG) in predicting any and distant metastatic recurrence after radical prostatectomy (RP) for prostate cancer, and compare various GP4 quantification methods for predicting metastatic recurrence using preoperative targeted biopsy and magnetic resonance imaging (MRI) data.

Patients And Methods: We conducted a retrospective study of patients who underwent MRI-guided biopsies and RP from 2009 to 2018. Patients with GG 2-4 without GP5 disease on biopsy and/or RP specimen were included.

"Neoadjuvant Chemotherapy with Transurethral Resection for Bladder Preservation: 15-year follow-up of the retained bladder".

Purpose: Bladder preservation is a desired goal for most patients with muscle invasive bladder cancer (MIBC), although select few are ideal candidates based on established criteria. Heterogenous cohorts with short follow-up hinder assessment of true risks/benefits for ideal candidates. We describe long-term outcomes in patients with MIBC, meeting established ideal criteria for bladder preservation, treated initially with systemic therapy and transurethral resection (TUR).

Protection against reinfection with extends across heterologous Mtb lineages.

Immunological memory elicited either through previous or ongoing (Mtb) infection provides a critical mechanism by which hosts protect against re-infection and disease progression upon Mtb re-exposure. Conversely, the uneven competition between distinct Mtb strains suggest certain bacterial clades have enhanced ability to spread across communities and circulate globally, potentially by evading memory responses gained by prior infection with genomically different strains. To address whether memory responses induced by one strain can protect against a genetically distinct strain, we conducted a heterologous reinfection study in cynomolgus macaques involving primary infection by a Lineage 4 Erdman Mtb strain and subsequent re-challenge by a Lineage 2 strain, HT-L2.

Patterns of Outpatient Urinalysis Testing and the Detection of Microscopic Hematuria.

Objective: To evaluate urinalysis testing patterns within the Veterans Health Administration (VHA), estimate the proportion and likelihood of patients who completed a urinalysis to have microscopic hematuria (MH), and explore how urinalysis testing patterns may influence MH detection.

Methods: This was a retrospective cross-sectional study using VHA data. We identified adult patients without a known urologic cancer history who had at least 1 outpatient visit at any VHA site and at least 1 interpretable urinalysis performed in 2015.

Rizedisben in Minimally Invasive Surgery: A Nonrandomized Clinical Trial.

Importance: Fluorescence-guided surgery aims to improve intraoperative identification of vital structures. Rizedisben is a myelin-binding fluorophore that fluoresces in the blue light (370-425 nm) spectrum to improve intraoperative nerve identification.

Objective: To determine the optimal safe and clinically effective dose of rizedisben for sustained intraoperative fluorescence of nerve structures.

Local anesthesia for transperineal prostate biopsy performed under sedation: effects on intraoperative and postoperative narcotic use.

Purpose: To investigate whether patients undergoing sedated prostate biopsies benefit from administration of local anesthetic.

Materials And Methods: 880 transperineal prostate biopsies were done under sedation at our institution between November 2022 and December 2023. We assessed the effect of bupivacaine on pain severity during post-anesthesia care unit (PACU) stay, use of narcotics in PACU, length of PACU stay, and urinary retention.

Prospective health-related quality of life in women undergoing radical cystectomy and urinary diversion.

Objectives: To assess health-related quality of life (HRQoL) in women undergoing radical cystectomy (RC) for bladder cancer, focusing on identifying the pattern of recovery among women and any gender-specific differences.

Patients And Methods: We analysed a prospective study of HRQoL in 411 participants undergoing RC (88 females), including 14 patient-reported outcome measures over 2 years of follow-up. Generalised estimating equation models were used to estimate recovery in domain scores among women and analyse baseline HRQoL (among women based on diversion type and then comparing outcomes to males).

Quality of Informed Consent via Telemedicine Compared With In-Person for Clinical Cancer Research.

Purpose: Telemedicine is increasingly used in oncology research including informed consent discussions, but data evaluating the potential impact of telemedicine on the quality of informed consent are scarce.

Methods: Consecutive patients with genitourinary malignancies who underwent informed consent discussions for biomarker (next-generation sequencing) or therapeutic (phase I to III) clinical studies at the Memorial Sloan Kettering Cancer Center were asked to complete modified versions of the validated Quality of Informed Consent (QuIC) questionnaire evaluating objective (QuIC A) and subjective (QuIC B) understanding. The method used for the informed consent discussion (in-person or telemedicine) was at the physician's discretion.

Refined selection of individuals for preventive cardiovascular disease treatment with a transformer-based risk model.

Background: Although statistical models have been commonly used to identify patients at risk of cardiovascular disease for preventive therapy, these models tend to over-recommend therapy. Moreover, in populations with pre-existing diseases, the current approach is to indiscriminately treat all, as modelling in this context is currently inadequate. This study aimed to develop and validate the Transformer-based Risk assessment survival (TRisk) model, a novel deep learning model, for predicting 10-year risk of cardiovascular disease in both the primary prevention population and individuals with diabetes.

Antibody-Fab and -Fc features promote Mycobacterium tuberculosis restriction.

Mycobacterium tuberculosis, the causative agent of tuberculosis (TB), a leading cause of death by an infectious disease globally, has no efficacious vaccine. Antibodies are implicated in M. tuberculosis control, but the mechanisms of action remain poorly understood.

Magnetic resonance imaging for long-term active surveillance biopsy decision-making.

Objectives: To evaluate whether long-term magnetic resonance imaging (MRI) findings, alone or in combination with prostate-specific antigen (PSA) density or the result of prior surveillance biopsies, could be used to omit biopsies occurring after patients have been on active surveillance (AS) for ≥5 years.

Patients And Methods: Analysis of a single-institution AS cohort of patients with Grade Group (GG) 1 prostate cancer who underwent a scheduled 6-year MRI and biopsy. Multivariable logistic regression was used to test the association between the Prostate Imaging-Reporting and Data System (PI-RADS) score, PSA density, status of prior AS biopsy, and reclassification to GG ≥2.

Effect of Age on Robotic-Assisted Radical Prostatectomy Outcomes: A Multi-center Analysis.

Objective: To evaluate the association between age and risk of perioperative complications and whether age-related increases in complication risk are of clinical significance in the era of robotic-assisted radical prostatectomies.

Methods: We pooled prostatectomy outcomes during 2012-2022 from Cornell (n = 585), Georgetown (n = 319), and Memorial Sloan Kettering (n = 6419) to assess the primary outcome of any major complication (Clavien-Dindo grade ≥3) within 30 days of surgery. We used multivariable regression to determine the relationship between age and complications, adjusting for surgeon volume and oncologic risk (prostate specific antigen, surgery grade group, extracapsular extension, seminal vesical invasion, lymph node involvement, and surgical margin status).

Variation in Prostate Magnetic Resonance Imaging Performance: Data from the Prostate Biopsy Collaborative Group.

Background And Objective: The quality and reporting of prostate magnetic resonance imaging (MRI) are operator dependent, leading to variations in estimates such as positive predictive value across sites. This impacts patient counseling, risk modeling, and risk calculators. This study assessed variation in Prostate Imaging Reporting and Data System (PI-RADS) score classification and subsequent probability of grade group (GG) ≥2 + prostate cancer.

Surgical Performance Metrics for 1-Year Patient-Reported Outcomes After Radical Prostatectomy.

Importance: There is a dearth of surgical performance measures that accurately predict long-term patient outcomes.

Objective: To develop surgical performance measures collected at the time of surgery that accurately predict future outcomes.

Design, Setting, And Participants: In this cohort study, surgical video of 157 patients undergoing robotic-assisted radical prostatectomy by 28 surgeons from 4 tertiary referral hospitals across the US and 1 hospital in Germany was analyzed.

Implementation of Recovery Tracker: A Postdischarge Electronic Remote Symptom-Monitoring Survey Tool After Major Urologic Oncology Surgeries.

Purpose: Remote symptom monitoring shows promise in promoting postdischarge contact between patients and clinicians. Unique strategies may be needed to tailor reach and engagement to specific patient populations. We aimed to assess implementation and effectiveness outcomes of a patient-reported symptom assessment tool (Recovery Tracker [RT]) after major urologic operations.

Drop the "M": Minimally Important Difference and Change Are Not Independent Properties of an Instrument and Cannot Be Determined as a Single Value Using Statistical Methods.

Objectives: Patient-reported outcome (PRO) instruments typically give a score on a scale, making it difficult to know whether a given difference between an experimental treatment and control in a clinical trial is large enough to warrant use of that treatment. The minimally important difference (MID) is used for designing and interpreting clinical research. We aim to explore the rationale and statistical underpinnings of the idea that MID can be defined as an inherent property of a particular PRO instrument.

An inflammatory biomarker signature of response to CAR-T cell therapy in non-Hodgkin lymphoma.

Disease progression is a substantial challenge in patients with non-Hodgkin lymphoma (NHL) undergoing chimeric antigen receptor T cell (CAR-T) therapy. Here we present InflaMix (INFLAmmation MIXture Model), an unsupervised quantitative model integrating 14 pre-CAR-T infusion laboratory and cytokine measures capturing inflammation and end-organ function. Developed using a cohort of 149 patients with NHL, InflaMix revealed an inflammatory signature associated with a high risk of CAR-T treatment failure, including increased hazard of death or relapse (hazard ratio, 2.