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).

Health-Related Quality of Life Across the Spectrum of Bladder Cancer: A Current Review.

Purpose Of Review: The purpose of this review is to highlight the health-related quality of life (HRQOL) burden of bladder cancer due to the disease itself and its treatments.

Recent Findings: Large database studies have provided evidence that patients with bladder cancer have worse HRQOL than the general population. While transurethral resections and intravesical therapy are known to cause urinary symptoms, a large impact on HRQOL otherwise has not been demonstrated.

Low-intensity shockwave therapy improves baseline erectile function: a randomized sham-controlled crossover trial.

Background: Low-intensity shockwave therapy for erectile dysfunction is emerging as a promising treatment option.

Aim: This randomized sham-controlled crossover trial assessed the efficacy of low-intensity shockwave therapy in the treatment of erectile dysfunction.

Methods: Thirty-three participants with organic erectile dysfunction were enrolled and randomized to shockwave therapy (n = 17) or sham (n = 16).

Microwave ablation of the T1a small renal mass: expanding beyond 3 cm.

Purpose: To compare the oncological and renal function outcomes for patients receiving microwave ablation (MWA) in tumors < 3 and 3-4 cm.

Methods: Retrospective analysis of a prospectively maintained database identified patients with < 3 or 3-4 cm renal cancers undergoing MWA. Radiographic follow-up occurred at approximately 6 months post-procedure and annually thereafter.

Health-related Quality of Life After Robotic-assisted vs Open Radical Cystectomy: Analysis of a Randomized Trial.

Purpose: We compare health-related quality of life using a broad range of validated measures in patients randomized to robotic-assisted radical cystectomy vs open radical cystectomy.

Methods: We retrospectively analyzed patients that had enrolled in both a randomized controlled trial comparing robotic-assisted laparoscopic radical cystectomy vs open radical cystectomy and a separate prospective study of health-related quality of life. The prospective health-related quality of life study collected 14 patient-reported outcomes measures preoperatively and at 3, 6, 12, 18, and 24 months postoperatively.

Assessing Quality and Safety of an Advanced Practice Provider-led Active Surveillance Clinic for Men with Prostate Cancer.

Purpose: We implemented an advanced practice provider (APP)-led clinic to aid in managing the growing population of men on active surveillance (AS) for prostate cancer. Our objective was to evaluate the quality and safety of an established APP-led AS clinic by comparing outcomes with urologist-led biopsies, defined in terms of adherence to scheduled visits and biopsy complications.

Materials And Methods: We performed a retrospective review of 2341 consecutive patients treated in an AS clinic at a high-volume referral center between 2000-2019.

How to present quality of life outcomes after focal therapy: using validated instruments and novel statistical methods.

Purpose Of Review: To provide an up-to-date summary of widely used patient-reported measures for focal therapy quality of life outcomes and review contemporary analytic methods and recommendations for data visualization.

Recent Findings: Measures such as pad-use, or preferably validated instruments such as the International Consultation on Incontinence Questionnaire, MSKCC Prostate Quality of Life Survey, or Expanded Prostate Cancer Index (EPIC) should be used for urinary function assessment. Sexual Function can be assessed with the International Index of Erectile Function or EPIC, but researchers must be careful to account for patients that are not currently sexually active when analyzing outcomes.

Defining the Impact of Family History on Detection of High-grade Prostate Cancer in a Large Multi-institutional Cohort.

Background: The risk of high-grade prostate cancer, given a family history of cancer, has been described in the general population, but not among men selected for prostate biopsy in an international cohort.

Objective: To estimate the risk of high-grade prostate cancer on biopsy based on a family history of cancer.

Design, Setting, And Participants: This is a multicenter study of men undergoing prostate biopsy from 2006 to 2019, including 12 sites in North America and Europe.

Have urinary function outcomes after radical prostatectomy improved over the past decade?

Background: Changes in surgical technique and postoperative care that target improvements in functional outcomes are widespread in the literature. Radical prostatectomy (RP) is one such procedure that has seen multiple advances over the past decade. The objective of this study was to leverage RP as an index case to determine whether practice changes over time produced observable improvements in patient-reported outcomes.

Health-related Quality of Life for Patients Undergoing Radical Cystectomy: Results of a Large Prospective Cohort.

Background: Radical cystectomy (RC) has the potential for profound changes to health-related quality of life (HRQOL).

Objective: To evaluate a broad range of HRQOL outcomes in a large RC cohort.

Design, Setting, And Participants: A single-center prospective study enrolled RC patients from 2008 to 2014.

Characterization of Symptoms after Radical Prostatectomy and Their Relation to Postoperative Complications.

Purpose: Many patients will experience symptoms in the initial days after radical prostatectomy (RP), but early patient-reported symptoms have not been well characterized. Our objective was to illustrate the pattern of symptoms experienced after RP and the relation of severe symptoms to postoperative complications.

Materials And Methods: In 2016, electronic patient-reported symptom monitoring began at our institution's ambulatory surgery center.

Provider Scheduling to Maximize Patient Access.

Introduction: We describe and demonstrate an efficient method for assigning clinic days to urology providers in academic and large urology group practices given their numerous scheduling constraints including evaluation and management visits, office or operating room procedures/surgeries, teaching, trainee mentorship, committee work and outreach activities.

Methods: We propose an integer programming model for scheduling providers for clinic shifts in order to maximize patient access to appointments considering the aforementioned scheduling constraints. We present results for a case study with an academic urology clinic and lessons learned from implementing the model generated schedule.

Prostate Cancer Characteristics in the US Preventive Services Task Force Grade D Era: A Single-Center Study and Meta-Analysis.

Background: In May 2012, the US Preventive Services Task Force assigned prostate-specific antigen-based screening a grade D recommendation, advising against screening at any age. Our objective was to compare prostate cancer characteristics pre- and post-recommendation with an adjusted analysis of our data and a pooled analysis including other primary data sources.

Methods: We identified all incident prostate cancer diagnoses at our institution from 2007 to 2016.

Has the use of preoperative urodynamics for stress urinary incontinence surgery changed following the VALUE study?

Aims: To assess whether routine urodynamic testing (UDT) in women undergoing slings for uncomplicated stress urinary incontinence (SUI) has decreased following publication of the landmark VALUE study, which recommended against routine UDT in uncomplicated SUI.

Methods: We identified women in the Virginia All Payers Claims Database diagnosed with SUI between 2011 and 2016 using International Classification of Disease (ICD) codes (N39.3, 625.

Does renal mass biopsy influence multidisciplinary treatment recommendations?

To examine how a multidisciplinary team approach incorporating renal mass biopsy (RMB) into decision making changes the management strategy. A multidisciplinary team comprised of a radiology proceduralist, a pathologist and urologists convened monthly for renal mass conference with a structured presentation of patient demographics, co-mborbidities, tumor pathology, laboratory and radiographic features. Biopsy protocol was standardized to an 18-gauge core needle biopsy using a sheathed apparatus under renal ultrasound guidance.

Robotic-Assisted Surgery for Upper Tract Urothelial Carcinoma: A Comparative Survival Analysis.

Background: We performed a comparative survival analysis of patients undergoing robotic-assisted versus laparoscopic or open surgery for upper tract urothelial carcinoma (UTUC).

Materials And Methods: Patients diagnosed with non-metastatic UTUC undergoing removal of the kidney and/or ureter were identified using Medicare-linked Surveillance, Epidemiology, and End Results Program data (2004-2013). Patients aged 65-85 years were categorized based on surgical approach (open, laparoscopic, or robotic-assisted).

Creation of a Novel Digital Rectal Examination Evaluation Instrument to Teach and Assess Prostate Examination Proficiency.

Objective: To create a validated tool to measure digital rectal examination proficiency and aid with teaching of the examination.

Design: The Digital Rectal Examination Clinical Tool was created using a modified Delphi method with 5 urologists and 5 radiation oncologists. The instrument was then validated in a population of preclinical medical students examining male urological teaching associates, and clinical trainees (third- and fourth-year medical students and urology resident physicians) examining prospectively enrolled subjects.

Erdheim-Chester Disease Presenting as a Solid Renal Mass.

Erdheim-Chester disease is a rare, systemic histiocytic disorder, usually presenting due to bone manifestations. The most commonly seen urologic manifestation is retroperitoneal fibrosis, leading to ureteral obstruction. We describe a patient with a solid right renal mass, initially concerning for renal cell carcinoma, in addition to diffuse retroperitoneal fibrosis and a chronically obstructed left kidney.

Evaluation of Laparoscopic Curricula in American Urology Residency Training: A 5-Year Update.

Introduction/purpose: Medical simulation offers the advantage of improving resident skill and comfort without impacting patient care. Five years ago, we identified trends in the use of robotic and laparoscopic simulation in 2008 and 2009 at American urology residency training programs. We seek to identify the changes in the use of simulators and the presence of formal curricula in the wake of technological advances and changes in graduate medical education.

Prenatal diagnosis of cloacal exstrophy: a case report and review of the literature.

Cloacal exstrophy (CE) is a rare congenital disorder with a number of significant associated anomalies. Fetal ultrasound has been used to identify CE; however, accurate diagnosis is challenging. Recently, magnetic resonance imaging has been reported to improve prenatal diagnosis and better characterize the associated defects.

Colovesical fistula caused by an ingested chicken bone.

Colovesical fistula involving the sigmoid colon is the most common fistulous communication between the gastrointestinal tract and the urinary bladder. These tracts are most commonly associated with diverticulitis but might arise secondary to a neoplasm, inflammatory bowel disease, iatrogenic injuries, radiation therapy, trauma, or foreign bodies. We describe a patient who developed a fistula between the sigmoid colon and bladder secondary to an ingested chicken bone that lodged in a colonic diverticulum.