Archive for category: Latest Articles

Abstract

Objectives

To assess whether free PSA ratio (FPSAR) at biochemical recurrence (BCR) can predict metastasis, castrate‐resistant PCa (CRPC), and cancer‐specific survival (CSS), following therapy for localized disease.

Methods

A single‐center retrospective cohort study (NCT03927287) including a discovery cohort composed of patients with an FPSAR after radical prostatectomy (RP) or radiotherapy (RT) between 2000‐2017. For validation, an independent biobank cohort of patients with biochemical recurrence (BCR) after RP was tested. Using a defined FPSAR cutoff, the metastasis‐free‐survival (MFS), CRPC‐free survival, and CSS were compared. Multivariable Cox models determined the association between posttreatment FPSAR, metastases, and CRPC.

Results

Overall, 822 patients (305 RP‐ and 363 RT‐treated patients and 154 biobank patients) were analyzed. In the RP cohort, a total of 272/305 (89.1%) and 33/305 (10.9%) had an FPSAR test incidentally and reflexively, respectively. In the RT cohort, 155/363 (42.7%) and 208/263 (57.3%) had an FPSAR test incidentally and reflexively, respectively. However, in the prospective biobank RP cohort, FPSAR testing was done on all samples of patients diagnosed with BCR. An FPSAR cutoff of 0.10 was determined using receiver‐operating characteristic‐analyses in both RP and RT cohorts. FPSAR<0.10 resulted in longer median MFS (14.8 vs. 9.3 years, and 14.8 vs. 13 years, respectively), and longer median CRPC‐free survival (median not reached vs. 9.9 years, and 20.7 vs. 13.8 years, respectively). Multivariable analyses showed that FPSAR>=0.10 was associated with increased metastasis in the RP cohort (HR 1.915 [95% CI 1.241‐2.955], and RT cohort (HR 1.754 [95% CI 1.112‐2.769]), and increased CRPC in the RP cohort (HR 2.470 [95% CI 1.493‐4.088]). Findings were validated in the biobank cohort.

Conclusions

Posttreatment FPSAR>=0.10 is associated with more aggressive disease, suggesting a potentially novel role for this biomarker.

Abstract

Objectives

To develop and validate the PREP (Preoperative Risk Evaluation for Partial Nephrectomy) score to predict the probability of major postoperative complications following partial nephrectomy (PN) based on patient comorbidities.

Patients and Methods

The Premier Healthcare Database was used to identify patients who had undergone elective PN. Through review of ICD‐9 codes, we identified patient comorbidities and major surgical complications (Clavien grade 3‐5). Multivariable logistic regression was used to identify predictors of major complications. We used half of the set as the training cohort to develop our risk score and the other half as a validation cohort.

Results

From 2003‐2015, 25,451 PN were performed. The overall rate of major complications was 4.9%. The final risk score consisted of 10 predictors: age, sex, CHF, CAD, COPD, CKD, diabetes, hypertension, obesity, smoking. In the training cohort, the area under the receiver‐operator characteristic curve (AUC) was 0.75 (95% CI 0.73‐0.78), while the AUC for the validation cohort was 0.73 (95% CI 0.70‐0.75). The predicted probabilities of major complication in the low risk (≤10 points), intermediate risk (11‐20 points), high risk (21‐30 points), and very high risk (>30 points) categories were 3% (95% CI 2.6‐3.2), 8% (95% CI 7.2‐9.2), 24% (95% CI 20.5‐27.8), and 41% (95% CI 34.5‐47.8) respectively.

Conclusions

We developed and validated the PREP score to predict the risk of complications following PN based on patient characteristics. Calculation of the PREP score can help providers select treatment options for patients with a cT1a renal mass and enhance the informed consent process for patients planning to undergo PN.

Abstract

Objective

To provide a chronological overview of evolution of continent urinary diversion over the last fifty years and to highlight important milestones.

Methods

We performed an extensive literature review and analysed different forms of urinary diversion worldwide. After the work up of surgical techniques, we assessed advantages and disadvantages of assorted continent urinary diversion based on published long‐term follow‐up data.

Results

A wide variety of surgical options for continent urinary diversion is available and feasible to date, although consensus between urologists regarding the gold standard is still lacking. Several forms of orthotopic bladder substitutes and continent cutaneous urinary reservoirs have shown to provide excellent long‐term results.

Conclusion

The last 50 years of CUD have been a constant evolution and refinement of technique but the best surgical option remains unclear and there is no “one size fits all” concept, but rather tailor‐made concepts are necessary to ensure patient satisfaction.

Abstract

To provide evidence‐based care, it is important for healthcare professionals to stay up to date with relevant medical literature. To overcome the barriers of high volume, time constraints and difficulty retaining information, some journals use social media (SoMe) sites, such as Twitter, to disseminate research. More recent strategies include creating visual abstracts and infographics, which combine images and text to graphically represent data (1). As the name suggests, visual abstracts summarise and simplify an article’s abstract and/or key messages.

Abstract

Objective

To provide a chronological overview of evolution of continent urinary diversion over the last fifty years and to highlight important milestones.

Methods

We performed an extensive literature review and analysed different forms of urinary diversion worldwide. After the work up of surgical techniques, we assessed advantages and disadvantages of assorted continent urinary diversion based on published long‐term follow‐up data.

Results

A wide variety of surgical options for continent urinary diversion is available and feasible to date, although consensus between urologists regarding the gold standard is still lacking. Several forms of orthotopic bladder substitutes and continent cutaneous urinary reservoirs have shown to provide excellent long‐term results.

Conclusion

The last 50 years of CUD have been a constant evolution and refinement of technique but the best surgical option remains unclear and there is no “one size fits all” concept, but rather tailor‐made concepts are necessary to ensure patient satisfaction.