Evaluation of intraoperative blood pressure and intrinsic tumor features as predictors of pseudoaneurysm formation after partial nephrectomy: A case-control study.

Introduction: Renal artery pseudoaneurysm (RAP) is a life-threatening complication of partial nephrectomy (PN) with reported rates of 1% to 2%. No studies have reported on the association between intraoperative blood pressure (BP) and RAP.

Methods: We identified all PN patients in our system between 2010 and 2024 and identified those with RAP (cases).

Risk stratification of chest pain in the emergency department using artificial intelligence applied to electrocardiograms.

Background: Despite standardised approaches, subjective assessment and inconsistent diagnostic testing for chest pain in the emergency department (ED) drive costs, disparities and adverse outcomes. Artificial intelligence offers potential to automate and improve risk stratification.

Methods And Results: Using a retrospective cohort of 15 048 patients presenting to the ED of a tertiary care hospital, we trained a neural network classifier ('Chest Pain-AI' or 'CP-AI') to predict a 7-day composite endpoint of major cardiovascular diagnoses including myocardial infarction, pulmonary embolism, aortic dissection and all-cause mortality.

Utility of circulating tumor DNA in management of diverse renal malignancies: Insights from a case series in adjuvant and recurrent/metastatic settings.

Background: Circulating tumor DNA (ctDNA) monitoring offers a minimally invasive method for detecting molecular residual disease and assessing treatment response. While increasingly adopted in several cancers, its clinical utility in renal malignancies remains underexplored, primarily due to low ctDNA shedding in kidney cancers.

Methods: We present a case series of six patients with diverse renal malignancies (clear cell renal cell carcinoma [ccRCC], papillary RCC, translocation RCC, malignant angiomyolipoma, and squamous cell carcinoma of the renal pelvis) managed in both adjuvant and recurrent/metastatic settings.

Lung Transplantation in Men With High-Risk Prostate Cancer.

Introduction: Transplantation in patients with active malignancies is controversial due to concerns about immunosuppression accelerating cancer progression and ethical allocation of donor organs. Prostate adenocarcinoma has a non-immunogenic profile and can respond to temporizing non-chemotherapeutic treatments such as androgen deprivation therapy (ADT). We examine two cases of lung transplantation (LT) in patients with high-risk prostate cancer (PCa) diagnosed during pretransplant evaluation, in whom transplantation was prioritized before definitive cancer treatment.

Genomic Signatures Correlating With Adverse Pathologic Features in Men Eligible for Active Surveillance.

Background: Genomic biomarkers offer opportunities to improve risk stratification for patients with prostate cancer. We performed a transcriptomic profile of active surveillance (AS)-eligible patients who underwent radical prostatectomy (RP) to understand genomic associations with adverse pathologic features (APF) at RP.

Methods: Patients considered AS-eligible (NCCN low-favorable intermediate risk) but proceeded to RP from February 2012 to September 2024 were identified from our prospective institutional database.

PSMA PET/CT findings in high-risk biochemical recurrence after local treatment of prostate cancer.

Objectives: To describe PSMA PET/CT characteristics of patients with high-risk BCR.

Subjects/patients And Methods: This was a retrospective analysis of patients with high-risk BCR prostate cancer (PSA ≥ 2 ng/ml above nadir after radiation therapy [RT] or ≥1 ng/ml after radical prostatectomy [RP] +/- RT) who underwent PET/CT from July 2021-March 2023. Patients with prior cytotoxic chemotherapy, androgen deprivation therapy (ADT) initiated >3 months prior to PET/CT or positive conventional imaging within 3 months of PET/CT were excluded.

Prevalence of Potential Candidates for Targeted Therapies According to Treatment-related Transcriptomic Signatures Among 140 548 Patients with Nonmetastatic Prostate Cancer.

Background And Objective: Systemic therapies that have shown a benefit in advanced prostate cancer are being evaluated in earlier disease stages. We sought to determine the prevalence of transcriptomic changes in signatures related to treatment susceptibilities in patients with nonmetastatic prostate cancer.

Methods: Patients with nonmetastatic prostate cancer with Decipher genomic classifier and whole-transcriptome profiling data for biopsy specimens from October 2016 to February 2024 were included (n = 140 548).

Active Surveillance vs Primary Intervention for Clinical T1a Kidney Tumors: 12-Year Experience of the Delayed Intervention and Surveillance for Small Renal Masses Prospective Comparative Study.

Purpose: Active surveillance (AS) is an alternative to primary intervention (PI) in the management of small renal masses (SRMs; clinical stage T1a). However, AS remains underutilized due to a lack of strong, prospective data. We herein report mature outcomes after a 12-year experience with the Delayed Intervention and Surveillance for Small Renal Masses Registry.

Characteristic Findings in Aborted Robot-Assisted Radical Prostatectomies.

In rare instances, patients deemed operative candidates for robot-assisted radical prostatectomy (RARP) have their procedure aborted intraoperatively. Understanding the incidence and factors associated with aborted RARP cases can improve preoperative counseling and intraoperative decision-making. We performed a retrospective analysis of RARP cases performed by high-volume surgeons across our multihospital medical system to characterize the incidence and causes of aborted procedures.

Detection of MRI-Invisible Disease Using PSMA PET/CT in a Patient Considering Focal Therapy.

Patient selection for focal therapy (FT) of prostate cancer requires the assessment of MRI and biopsy results. However, there is currently little guidance for the utility of PSMA PET/CT in FT planning. We describe the case of a man originally considered an ideal candidate for FT based on biopsy and MRI who was found to have a contralateral lesion-harboring cancer detected only on PSMA PET/CT.

Clear-Cell Renal Cell Carcinoma Molecular Subtypes Differ by African and European Genetic Similarity.

Abstract: Self-reported Black (B) individuals remain underrepresented in molecular studies of clear-cell renal cell carcinoma (ccRCC) relative to White (W) individuals. We performed whole-exome and transcriptome sequencing on paired tumor and normal samples from 59 matched B and W patients undergoing nephrectomy for localized ccRCC, comparing molecular differences by estimated genetic similarity to African (AFR) and European (EUR) 1000 Genomes groups. We validated our findings with a propensity-matched subset of The Cancer Genome Atlas, yielding a final cohort of 254 patients (79 AFR and 175 EUR) with similar baseline clinical variables.

Assessing ChatGPT Responses to Frequently Asked Patient Questions in Reconstructive Urology.

Introduction: Artificial intelligence (such as Chat Generative Pretrained Transformer [ChatGPT]) augments patient education on medical topics, including reconstructive surgery. In this study, we assess the information, misinformation, and readability of ChatGPT responses to reconstructive urology questions. We also evaluate prompt engineering to optimize responses.

Patient Outcomes After Penile Prosthesis Placement with Concomitant Non-Reconstructive Urologic Procedures.

Purpose: There is substantial literature demonstrating minimal to no increased risk of three-piece penile prosthesis (PP) complications for patients undergoing placement with concomitant reconstructive urologic procedures. However, there is a paucity of research investigating outcomes for patients suffering from erectile dysfunction (ED) who undergo concomitant non-reconstructive urologic procedures at the time of PP placement.

Materials And Methods: We performed a retrospective review of patients undergoing PP placement and a second non-reconstructive urologic procedure performed concomitantly at our institution between January 2007 and July 2021.

Artificial intelligence for hemodynamic monitoring with a wearable electrocardiogram monitor.

Background: The ability to non-invasively measure left atrial pressure would facilitate the identification of patients at risk of pulmonary congestion and guide proactive heart failure care. Wearable cardiac monitors, which record single-lead electrocardiogram data, provide information that can be leveraged to infer left atrial pressures.

Methods: We developed a deep neural network using single-lead electrocardiogram data to determine when the left atrial pressure is elevated.

Safety and Effectiveness of Urologist-Directed Extracorporeal Shock Wave Lithotripsy for Pancreatolithiasis.

Extracorporeal shock wave lithotripsy (SWL) can be used in conjunction with endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of large (≥5 mm) or impacted pancreatolithiasis. We report our experience demonstrating the safety and effectiveness of urologist-directed SWL for pancreatolithiasis. We performed a retrospective review of all patients undergoing SWL for pancreatolithiasis at our institution between 2016 and 2020.

Untethered Microgrippers for Biopsy in the Upper Urinary Tract.

Untethered microrobots offer the possibility to perform medical interventions in anatomically complex and small regions in the body. Presently, it is necessary to access the upper urinary tract to diagnose and treat Upper Tract Urothelial Carcinoma (UTUC). Diagnostic and treatment challenges include ensuring adequate tissue sampling, accurately grading the disease, achieving completeness in endoscopic treatment, and consistently delivering medications to targeted sites.

Detecting QT prolongation from a single-lead ECG with deep learning.

For a number of antiarrhythmics, drug loading requires a 3-day hospitalization with continuous monitoring for QT-prolongation. Automated QT monitoring with wearable ECG monitors would enable out-of-hospital care. We therefore develop a deep learning model that infers QT intervals from ECG Lead-I-the lead that is often available in ambulatory ECG monitors-and use this model to detect clinically meaningful QT-prolongation episodes during Dofetilide drug loading.

QTNet: Deep Learning for Estimating QT Intervals Using a Single Lead ECG.

QT prolongation often leads to fatal arrhythmia and sudden cardiac death. Antiarrhythmic drugs can increase the risk of QT prolongation and therefore require strict post-administration monitoring and dosage control. Measurement of the QT interval from the 12-lead electrocardiogram (ECG) by a trained expert, in a clinical setting, is the accepted method for tracking QT prolongation.

Clinical patterns and implications of prescription opioid use in a pediatric population for the management of urolithiasis in the emergency room.

Extrapolations from the adult population have suggested that opioids should be avoided in the management of pediatric urolithiasis, but the literature is sparse with regards to actual practice patterns and the downstream implications. We sought to investigate the rate of oral opioid administration for children presenting to the emergency room (ER) with urolithiasis and to identify associations between opioid administration and return visits and persistent opioid use. The TriNetX Research and Diamond Networks were used for retrospective exploratory and validation analyses, respectively.

Socioeconomic determinants of racial disparities in survival outcomes among patients with renal cell carcinoma.

Purpose: Racially driven outcomes in cancer are challenging to study. Studies evaluating the impact of race in renal cell carcinoma (RCC) outcomes are inconsistent and unable to disentangle socioeconomic disparities from inherent biological differences. We therefore seek to investigate socioeconomic determinants of racial disparities with respect to overall survival (OS) when comparing Black and White patients with RCC.

Clinicopathologic and Survival After Cystectomy Outcomes in Squamous Cell Carcinoma of the Bladder.

Background: Squamous cell carcinoma of the bladder (SqCC) is a rare disease with limited management data. Thus, we sought to characterize the clinicopathologic and survival outcomes amongst patients with SqCC and explore the association of squamous differentiation within urothelial carcinoma (UC w/Squam), as compared to muscle invasive pure UC.

Methods: We conducted a single-center retrospective cohort study of patients, stratified by histology, who underwent cystectomy for MIBC.

Implications of Opioid Prescriptions for Acute Renal Colic in the Emergency Setting on Return Visits and Long-Term Opioid Dependence.

We sought to examine the practice patterns of pain management in the emergency room (ER) for renal colic and the impact of opioid prescriptions on return ER visits and persistent opioid use. TriNetX is a collaborative research enterprise that collects real-time data from multiple health care organizations within the United States. The Research Network obtains data from electronic medical records and the Diamond Network provides claims data.

Evaluation of Growth Rates for Small Renal Masses in Elderly Patients Undergoing Active Surveillance.

Background: As the adoption of active surveillance (AS) for small renal masses (SRMs) grows, the number of elderly patients enrolled for a prolonged period of time will increase. However, our understanding of comparative growth rates (GRs) in aging patients with SRMs remains poor.

Objective: To examine whether particular age cutoffs are associated with an increased GR for patients undergoing AS for SRMs.

Longitudinal analysis of YouTube videos discussing post-prostatectomy erectile dysfunction.

Background: YouTube is heavily utilized by patients as an educational resource, but this content can be fraught with misinformation. We sought to characterize the quality of videos on YouTube discussing postprostatectomy erectile dysfunction and to evaluate metrics associated with retaining a top position in search results over time.

Methods: In October 2019, we watched the first 100 YouTube videos using the search query "radical prostatectomy erectile dysfunction.