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Feasibility, Acceptability, and Outcomes of a Mobile Health Tool for Radical Cystectomy Recovery. J Urol 2024; 211:266-275. [PMID: 37972245 DOI: 10.1097/ju.0000000000003787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Postoperative education and symptom tracking are essential following cystectomy to reduce readmission rates and information overload. To address these issues, an internet-based tool was developed to provide education, alerts, and symptom tracking. We aimed to evaluate the tool's feasibility, acceptability, and impact on complication and readmission rates. MATERIALS AND METHODS Thirty-three eligible patients over 18 years old scheduled for cystectomy were enrolled. Patients were asked to use the mobile health (mHealth) tool daily for the first 2 weeks, then less frequently up to 90 days after discharge. Descriptive statistics were used to summarize study variables. Feasibility was defined as at least 50% of patients using the tool once a week, and acceptability as patient satisfaction of > 75%. RESULTS Use of the mHealth tool was feasible, with 90% of patients using it 1 week after discharge, but engagement declined over time to 50%, with technological difficulties being the main reason for nonengagement. Patient and provider acceptability was high, with satisfaction > 90%. Within 90 days, 36% experienced complications after discharge and 30% were readmitted. Engagement with the mHealth application varied but was not statistically associated with readmission (P = .21). CONCLUSIONS The study showed that the electronic mobile health intervention for patients undergoing cystectomy was feasible, acceptable, and provided valuable educational content and symptom management. Future larger studies are needed to determine the tool's effectiveness in improving patient outcomes and its potential implementation into routine clinical care.
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Corrigendum to "Route of Administration for UGN-101 and Impact on Oncological and Safety Outcomes" [Eur. Urol. Focus (2023)]. Eur Urol Focus 2024; 10:211. [PMID: 37640582 DOI: 10.1016/j.euf.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
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Route of Administration for UGN-101 and Impact on Oncological and Safety Outcomes. Eur Urol Focus 2023; 9:1052-1058. [PMID: 37263827 DOI: 10.1016/j.euf.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/19/2023] [Accepted: 05/09/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND UGN-101 can be used for chemoablation of low-grade upper tract urothelial carcinoma (UTUC). The gel can be administered via a retrograde route through a ureteral catheter or an antegrade route via a nephrostomy tube. OBJECTIVE To report outcomes of UGN-101 by route of administration. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective review of 132 patients from 15 institutions who were treated with UGN-101 for low-grade UTUC via retrograde versus antegrade administration. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Survival outcomes are reported per patient. Treatment, complications, and recurrence outcomes are reported per renal unit. Statistical analysis was performed for primary endpoints of oncological response and ureteral stricture occurrence. RESULTS AND LIMITATIONS A total of 136 renal units were evaluated, comprising 78 retrograde and 58 antegrade instillations. Median follow-up was 7.4 mo. There were 120 cases (91%) of biopsy-proven low-grade UTUC. Tumors were in the renal pelvis alone in 89 cases (65%), in the ureter alone in 12 cases (9%), and in both in 35 cases (26%). Seventy-six patients (56%) had residual disease before UGN-101 treatment. Chemoablation with UGN-101 was used in 50/78 (64%) retrograde cases and 26/58 (45%) antegrade cases. A complete response according to inspection and cytology was achieved in 31 (48%) retrograde and 30 (60%) antegrade renal units (p = 0.1). Clavien grade 3 ureteral stricture occurred in 21 retrograde cases (32%) and only six (12%) antegrade cases (p < 0.01). Limitations include treatment bias, as patients in the antegrade group were more likely to undergo endoscopic mechanical ablation before UGN-101 instillation. CONCLUSIONS These preliminary results show a significantly lower rate of stricture occurrence with antegrade administration of UGN-101, with no apparent impact on oncological efficacy. PATIENT SUMMARY We compared results for two different delivery routes for the drug UGN-101 for treatment of cancer in the upper urinary tract. For the antegrade route, a tube is inserted through the skin into the kidney. For the retrograde route, a catheter is inserted past the bladder into the upper urinary tract. Our results show a lower rate of narrowing of the ureter (the tube draining urine from the kidney into the bladder) using the antegrade route, with no difference in cancer control.
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Treatment of Low-grade Intermediate-risk Nonmuscle-invasive Bladder Cancer With UGN-102 ± Transurethral Resection of Bladder Tumor Compared to Transurethral Resection of Bladder Tumor Monotherapy: A Randomized, Controlled, Phase 3 Trial (ATLAS). J Urol 2023; 210:619-629. [PMID: 37548555 DOI: 10.1097/ju.0000000000003645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE Low-grade intermediate-risk nonmuscle-invasive bladder cancer is a chronic illness commonly treated by repetitive transurethral resection of bladder tumor. We compared the efficacy and safety of intravesical chemoablation with UGN-102 (a reverse thermal gel containing mitomycin), with or without subsequent transurethral resection of bladder tumor, to transurethral resection of bladder tumor alone in patients with low-grade intermediate-risk nonmuscle-invasive bladder cancer. MATERIALS AND METHODS This prospective, randomized, phase 3 trial recruited patients with new or recurrent low-grade intermediate-risk nonmuscle-invasive bladder cancer to receive initial treatment with either UGN-102 once weekly for 6 weeks or transurethral resection of bladder tumor. Patients were followed quarterly by endoscopy, cytology, and for-cause biopsy. The primary end point was disease-free survival. All patients were followed for adverse events. RESULTS Trial enrollment was halted by the sponsor to pursue an alternative development strategy after 282 of a planned 632 patients were randomized to UGN-102 ± subsequent transurethral resection of bladder tumor (n=142) or transurethral resection of bladder tumor monotherapy (n=140), rendering the trial underpowered to perform hypothesis testing. Patients were predominantly male and ≥65 years of age. Tumor-free complete response 3 months after initial treatment was achieved by 92 patients (65%) who received UGN-102 and 89 patients (64%) treated by transurethral resection of bladder tumor. The estimated probability of disease-free survival 15 months after randomization was 72% for UGN-102 ± transurethral resection of bladder tumor and 50% for transurethral resection of bladder tumor (hazard ratio 0.45). The most common adverse events (incidence ≥10%) in the UGN-102 group were dysuria, micturition urgency, nocturia, and pollakiuria. CONCLUSIONS Primary, nonsurgical chemoablation with UGN-102 for the management of low-grade intermediate-risk nonmuscle-invasive bladder cancer offers a potential therapeutic alternative to immediate transurethral resection of bladder tumor monotherapy and warrants further investigation.
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The ablative effect of mitomycin reverse thermal gel: Expanding the role for nephron preservation therapy in low grade upper tract urothelial carcinoma. Urol Oncol 2023; 41:387.e1-387.e7. [PMID: 37246135 DOI: 10.1016/j.urolonc.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/05/2023] [Accepted: 04/09/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE Assess the real-world ablative effect of mitomycin reverse thermal gel for low-grade upper tract urothelial carcinoma (UTUC) in patients who undergo biopsy only or partial ablation and evaluate utility of complete ablation prior to UGN-101. MATERIAL AND METHODS We retrospectively reviewed low-grade UTUC patients treated with UGN-101 from 15 high-volume centers. Patients were categorized based on initial endoscopic ablation (biopsy only, partial ablation, or complete ablation) and by size of remaining tumor (complete ablation, <1cm, 1-3cm, or >3cm) prior to UGN-101. The primary outcome was rendered disease free (RDF) rate at first post-UGN-101 ureteroscopy (URS), defined as complete response or partial response with minimal mechanical ablation to endoscopically clear the upper tract of visible disease. RESULTS One hundred and sixteen patients were included for analysis after excluding those with high-grade disease. At first post-UGN-101 URS, there were no differences in RDF rates between those who at initial URS (pre-UGN-101) had complete ablation (RDF 77.0%), partial ablation (RDF 55.9%) or biopsy only (RDF 66.7%) (P = 0.14). Similarly, a complimentary analysis focusing on tumor size (completely ablated, <1cm, 1-3cm or >3cm) prior to UGN-101 induction did not demonstrate significant differences in RDF rates (P = 0.17). CONCLUSION The results of the early real-world experience suggest that UGN-101 may play a role in initial chemo-ablative cytoreduction of larger volume low-grade tumors that may not initially appear to be amenable to renal preservation. Further studies will help to better quantify the chemo-ablative effect and to identify clinical factors for patient selection.
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Efficacy and Safety of Mitomycin Gel (UGN-101) as an Adjuvant Therapy After Complete Endoscopic Management of Upper Tract Urothelial Carcinoma. J Urol 2023; 209:872-881. [PMID: 36657029 DOI: 10.1097/ju.0000000000003185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE We describe a novel application of the reverse thermal polymer gel of mitomycin C (UGN-101) as adjuvant therapy after complete endoscopic ablation of upper tract urothelial carcinoma. MATERIALS AND METHODS We retrospectively reviewed patients treated with UGN-101 from 15 high-volume centers. Adjuvant therapy was defined as treatment administered following visually complete endoscopic ablation. Response at primary endoscopic evaluation was defined as no visual tumor or negative biopsy. Ipsilateral disease-free and progression-free survival were estimated by the Kaplan-Meier method. Ureteral stenosis and other adverse events were abstracted from the medical records. Ureteral stenosis was defined as a condition requiring ureteral stent or nephrostomy, or that would typically warrant stent or nephrostomy. RESULTS Adjuvant UGN-101 after complete endoscopic ablation was used in 52 of 115 (45%) renal units in the oncologic analysis. At first endoscopic evaluation, 36/52 (69%) were without visible disease. At 6.8 months' median follow-up, the ipsilateral disease-free rate was 63%. Recurrence after adjuvant UGN-101 therapy was more likely in multifocal tumors compared to unifocal (HR 3.3, 95% CI 1.07-9.91). Compared with UGN-101 treatment for chemoablation of measurable disease, there were significantly fewer disease detections with adjuvant therapy (P < .001). Ureteral stenosis after UGN-101 was diagnosed in 10 patients (19%) undergoing adjuvant therapy compared to 17 (29%) undergoing chemoablative therapy (P = .28). CONCLUSIONS In patients being considered for UGN-101, maximal endoscopic ablation prior to UGN-101 treatment may result in fewer patients with disease at first endoscopy and possibly fewer adverse events than primary chemoablative therapy. Longer follow-up is needed to determine if UGN-101 after complete endoscopic ablation will lead to durable disease-free interval.
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Applications of 3-Dimensional Virtual Reality Models (Ceevra®) for Surgical Planning of Robotic Surgery. UROLOGY VIDEO JOURNAL 2023. [DOI: 10.1016/j.urolvj.2023.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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IL-15 Superagonist NAI in BCG-Unresponsive Non-Muscle-Invasive Bladder Cancer. NEJM EVIDENCE 2023; 2:EVIDoa2200167. [PMID: 38320011 DOI: 10.1056/evidoa2200167] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
IL-15 Superagonist NAI in BCG-Unresponsive NMIBCIn this trial, patients with BCG-unresponsive bladder CIS with or without Ta/T1 papillary disease or BCG-unresponsive high-grade Ta/T1 papillary NMIBC were treated with intravesical NAI, an IL-15 superagonist, plus BCG. Primary end points were CR at 3 or 6 months for patients with CIS disease and DFS rate at 12 months for those with high-grade Ta/T1 disease. CR rate was 71% (58 of 82 patients), and the DFS rate was 55.4%.
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PD53-08 E-CIGARETTE EXPOSURE IN MICE PROMOTES CHANGES IN DNA METHYLATION OF THE BLADDER UROTHELIUM. J Urol 2022. [DOI: 10.1097/ju.0000000000002630.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A murine MODEL of e-cigarettes exposure to evaluate the carcinogenic effects of vaping on the bladder urothelium. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
566 Background: Data evaluating the carcinogenic potential of e-cigarette (ECS) by-products on the bladder urothelium is scarce, and to date, no group has studied the direct impact of ECS on the urothelium at the genomic and epigenetic level. While it has been published that ECS exposure causes bladder hyperplasia in mice, no bladder tumors formed and the field is therefore lacking appropriate preclinical models to be able to study ECS related bladder cancer. Importantly, whole organ mapping studies of tumor bearing human bladders have identified DNA methylation field changes in “adjacent normal” urothelium as early events in bladder carcinogenesis. Whether ECS exposure results in early field alterations of DNA methylation in the urothelium is unknown. Methods: Mice (4 females, 4 males; 35 weeks old) were exposed to 12% nicotine (120mg/ml) in 1:1 polyethylene glycol: vegetable glycerol (PG/VG) or vehicle (PG/VG) daily: 3 hr sessions, 3 sec vape duration, 10 min interval between vapes. Nicotine and cotinine serum concentrations were measured at 3 hrs, and then at 5 days using LC-MS. Bladders were harvested after 4 weeks. DNA was extracted from microdissected urothelial layer. Reduced representation bisulfite sequencing (RRBS) was performed (Zymo Research) using 100ng of DNA input and paired-end chemistry. Alignment was performed using Bismark. Number of loci covered by each sample was determined and data was filtered to only include loci with > 10 reads. Differentially methylated loci were determined. Adjusted p-value < 0.01 was used as threshold to generate heatmaps. Gene Set Enrichment Analysis was performed to contextualize the DNA methylation changes. Results: Acute and repeated exposure resulted in significantly higher levels of nicotine and cotinine serum concentration in the nicotine group vs. the vehicle group without significant adverse events. No tumors were observed on gross visualization at the time of urothelium harvest. The number of loci in the RRBS libraries with > 10 reads ranged from 130,000 to 250,000. 53 loci were differentially methylated between nicotine and vehicle. These loci did not correspond to the top hyper/hypo methylated genes in premalignant bladder tissue from recently reported whole-cystectomy mapping. Conclusions: We established an effective and safe murine model of ECS exposure closely resembling the human experience of vaping. Significant changes of DNA methylation were observed in mice exposed to ECS vapor vs. a vehicle control after four weeks of daily exposure. Ongoing experiments include longer vaping exposures as well as comparison of RRBS to a recently developed commercial mouse methylarray. Understanding epigenetic and genomic changes as a result of ECS exposure in preclinical models can serve as a foundation for studies developing assays to identify ECS users whose bladders contain early field defects that may place them at higher risk for bladder cancer.
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MP38-08 BIOMARKERS OF EXPOSURE ASSOCIATED WITH BLADDER CANCER RISK PRODUCED BY HEAT-NOT-BURN DEVICES COMPARED TO COMBUSTIBLE CIGARETTES. J Urol 2021. [DOI: 10.1097/ju.0000000000002053.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Phase II study of gemcitabine and split-dose cisplatin plus pembrolizumab as neoadjuvant therapy prior to radical cystectomy (RC) in patients with muscle-invasive bladder cancer (MIBC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
396 Background: Cisplatin-based neoadjuvant chemotherapy is standard of care in MIBC with improved pathologic response and overall survival (OS) compared to RC alone. Pembrolizumab (pembro) is active in high-risk non-muscle invasive and metastatic bladder cancer and is generally well tolerated. This phase II trial evaluated the safety and efficacy of gemcitabine and split-dose cisplatin (GC) + pembro as neoadjuvant therapy prior to RC (NCT02690558). Methods: Patients with clinical T2-4a N0/X M0 urothelial carcinoma of the bladder eligible for RC were enrolled. Patients received pembro 200mg on day 1 with cisplatin 35mg/m2 and gemcitabine 1000mg/m2 on days 1 and 8 every 3 weeks for 4 cycles, followed by RC within 4-8 weeks. The first 6 patients received full-dose cisplatin (70mg/m2 on day 1) and a lead-in pembro dose; this schedule was discontinued for excess toxicity. Primary endpoint was pathologic downstaging rate ( < pT2) with the null and alternative hypothesis rates = 35% and 55%, respectively. Secondary endpoints were toxicity, pT0 rate, event free survival, and OS. Exploratory objectives include association of response with molecular subtype and post-treatment changes in immune microenvironment (predicted neoantigens, immune gene expression, and T cell receptor repertoire). Results: Between May 2016 and July 2020, 39 patients were enrolled (72% cT2, 23% cT3, 5% cT4a) with a median age of 66 and 82% male. Patients received a median of 4 cycles of therapy. All patients underwent RC except one who declined but is included in intention to treat analysis. Rate of < pT2N0 was 56% (22/39) and pT0N0 rate was 36% (14/39). Most common adverse events (AEs) of any grade were thrombocytopenia (29/39; 74%), anemia (27/39; 69%), neutropenia (26/39; 67%), and hypomagnesemia (26/39; 67%). Most common grade 3/4 AEs were neutropenia (16/39; 41%), thrombocytopenia (13/39; 33%), febrile neutropenia (5/39; 13%), and anemia (4/39; 10%). One patient had new onset type 1 diabetes mellitus with ketoacidosis related to pembrolizumab and no patients required steroids for immune-related AEs. Nine patients (23%) discontinued GC + pembro due to AEs, including 4 of the 6 patients who received full-dose cisplatin with pembro lead-in. Survival data are not yet mature and correlative studies are ongoing. Conclusions: Neoadjuvant GC + pembro was generally safe and met its primary endpoint for improved pathologic downstaging. Correlative analyses are ongoing. Additional investigation of this combination is warranted. Clinical trial information: NCT02690558.
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The association of malnutrition and sarcopenia with geriatric assessment impairment and outcomes in patients with bladder cancer undergoing cystectomy. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
423 Background: Malnutrition and sarcopenia are linked to decreased functional status in older adults with malignancy, but their effect on geriatric assessment (GA) impairment in patients with bladder cancer (BC) undergoing radical cystectomy (RC) is unknown. We investigated the association between malnutrition and sarcopenia with GA impairment and postoperative outcomes. Methods: Patients with BC undergoing RC between 2012 – 2019 were enrolled in a prospective cohort study of GA before RC. Malnutrition was evaluated by a dietitian pre-RC per the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition diagnostic criteria. Sarcopenia, defined by a skeletal muscle index of < 52.4 cm2/m2 in males and < 38.5 cm2/m2 in females, was determined using SliceOmatic software to analyze pre-RC CT images at the L3 vertebra. Patients with vs without malnutrition and those with vs without sarcopenia were compared using Fisher’s exact and Wilcoxon rank sum tests. Results: Of 73 patients, 59 had GA + nutrition evaluation and 51 had GA + sarcopenia assessment (overall median age 68 [IQR 62-74], 76% male). The prevalence of malnutrition was 7% and sarcopenia was 63%. A numerically greater proportion of patients with malnutrition or sarcopenia were impaired on ≥ 1 GA measure compared to those without malnutrition (100% vs 78%, p=0.57) or sarcopenia (78% vs 68%, p=0.52), although this was not statistically significant (Table). Median hospital length of stay (LOS) was increased for patients with vs without sarcopenia (4 vs 5 days, p=0.005). Post-RC complication rate was similar for patients with vs without malnutrition (100% vs 75%, p=0.56) and patients with vs without sarcopenia (81% vs 74%, p=0.73), but malnourished patients were more likely to have Clavien-Dindo grade 3+ complications than those without malnutrition (100% vs 27%, p = 0.009). Conclusions: In our cohort of patients with BC undergoing RC, those with malnutrition or sarcopenia may have an increased rate of impairment on GA compared to those without malnutrition or sarcopenia. Sarcopenia was associated with increased LOS while malnutrition was associated with increased major complications. Our results are limited by small sample size, and future work is needed to elucidate whether addressing these modifiable factors improves functional status and postoperative outcomes. Research Sponsor: U.S. National Institutes of Health[Table: see text]
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A national cross-sectional survey of financial toxicity among bladder cancer patients. Urol Oncol 2021; 39:76.e1-76.e7. [DOI: 10.1016/j.urolonc.2020.09.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 09/09/2020] [Accepted: 09/29/2020] [Indexed: 11/28/2022]
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Does Lesion Location Impact Prostate Cancer Detection by MRI Ultrasound Fusion Guided Prostate Biopsy? J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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PD02-01 IMPACT OF TRAUMA CENTER DESIGNATION ON RENAL TRAUMA OUTCOMES: EVIDENCE FOR UNIVERSAL MANAGEMENT. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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MP18-19 IMPACT OF MALNUTRITION ON RADICAL NEPHROURETERECTOMY MORBIDITY AND MORTALITY: OPPORTUNITY FOR PRE-OPERATIVE OPTIMIZATION. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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What do patients with urothelial cancer know about the association of their tumor disease with smoking habits? Results of a German survey study. Investig Clin Urol 2018. [PMID: 29520384 PMCID: PMC5840123 DOI: 10.4111/icu.2018.59.2.91] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose Smoking represents a primary risk factor for the development of urothelial carcinoma (UC) and a relevant factor impacting UC-specific prognosis. Data on the accordant knowledge of UC-patients in this regard and the significance of physicians in the education of UC-patients is limited. Materials and Methods Eighty-eight UC-patients were enrolled in a 23-items-survey-study aimed to analyse patient knowledge and awareness of their tumor disease with smoking along with physician smoking cessation counselling. Results The median age of the study patients was 69 years; 26.1% (n=23), 46.6% (n=41), and 27.3% (n=24), respectively, were non-smokers, previous, and active smokers. Exactly 50% of active smokers reported a previous communication with a physician about the association of smoking and their tumor disease; however, only 25.0% were aware of smoking as main risk factor for UC development. Merely 33% of the active smokers had been prompted directly by their physicians to quit smoking. About 42% of active smokers had received the information that maintaining smoking could result in a tumor-specific impairment of their prognosis. Closely 29% of active and about 5% of previous smokers (during the time-period of active smoking) had been offered support from physicians for smoking cessation. No association was found between smoking anamnesis (p=0.574) and pack-years (p=0.912), respectively, and tumor stage of UC. Conclusions The results of this study suggest that the medical conversation of physicians with UC-patients about the adverse significance of smoking is limited. Implementation of structured educational programs for smoking cessation may be an opportunity to further enhance comprehensive cancer care.
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MP38-13 OUTCOMES OF MRI-US FUSION-TARGETED BIOPSY IN MEN WITH NO PREVIOUS BIOPSY: OPPORTUNITY TO REDUCE BIOPSY UTILIZATION AND SECONDARY OVER-DETECTION. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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V10-01 RECONSTRUCTION OF TWO CONCURRENT IPSILATERAL URETERAL STRICTURES WITH APPENDICEAL ONLAY AND NON-TRANSECTING URETERAL REIMPLANT. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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PD61-05 OUTCOMES OF REPEAT MRI-US FUSION-TARGETED BIOPSY IN MEN WITH INITIALLY LOW RISK OR NEGATIVE FUSION BIOPSY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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MP96-14 ANALYSIS OF NATIONAL TRENDS IN HOSPITAL ACQUIRED CONDITIONS FOLLOWING MAJOR UROLOGIC SURGERY BEFORE AND AFTER IMPLEMENTATION OF THE HOSPITAL ACQUIRED CONDITION REDUCTION PROGRAM. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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MP57-13 THE EFFECT OF SMOKING ON 30-DAY MORBIDITY FOLLOWING MALIGNANCY-RELATED PROSTATECTOMY. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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PD02-12 EVALUATION OF UNPLANNED HOSPITAL READMISSIONS AFTER MAJOR UROLOGIC INPATIENT SURGERY IN THE ERA OF ACCOUNTABLE CARE. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Predictive value of negative 3T multiparametric magnetic resonance imaging of the prostate on 12-core biopsy results. BJU Int 2016; 118:515-20. [PMID: 26800439 DOI: 10.1111/bju.13427] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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PD32-05 GRADE CONCORDANCE OF TARGETED MRI-ULTRASOUND FUSION TARGETED PROSTATE BIOPSY RESULTS WITH FINAL PATHOLOGY FOLLOWING RADICAL PROSTATECTOMY. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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PD32-01 COMPARISON OF MRI-US FUSION TARGETED BIOPSY AND SYSTEMATIC PROSTATE BIOPSY: SINGLE INSTITUTION EXPERIENCE IN 604 PATIENTS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Frequency of lower urinary tract injury after gastrointestinal surgery in the nationwide inpatient sample database. Am Surg 2014; 80:1216-1221. [PMID: 25513920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Bladder and ureteral injury are serious iatrogenic complications during abdominal and pelvic surgery but are poorly investigated in the general surgery literature. The objective of this study was to examine rates, trends, and patient and surgical characteristics present in lower urinary tract injuries during gastrointestinal surgery using the Nationwide Inpatient Sample (NIS) database. The NIS database was queried from 2002 to 2010 for gastrointestinal surgery procedures including small/large bowel, rectal surgery, and procedures involving a combination of the two. These were crossreferenced with bladder and ureteral injury using International Classification of Diseases, 9th Revision, Clinical Modification codes. Multivariate regression analysis was used to calculate odds ratios for hypothesized risk factors. From 2002 to 2010, total average rates of bladder injury and ureteral injury were 0.15 and 0.06 per cent, respectively. Small/large bowel procedures had lower annual rates of ureteral (0.05 to 0.07%) and bladder (0.12 to 0.14%) injuries compared with ureteral (0.11 to 0.25%) and bladder (0.27 to 0.41%) injuries in rectal procedures. Presence of metastatic disease was associated with the greatest risk for bladder (odds ratio, 2.0; 95% confidence interval, 1.8 to 2.2) and ureteral (2.2; 1.9 to 2.5) injury in small/large bowel surgery, and for bladder (3.1; 2.5 to 3.9) and ureteral (4.0; 3.2 to 5.0) injury in combination procedures. Injury rates were significantly greater in open surgeries compared with laparoscopic procedures for both bladder injury (0.78 vs 0.26%, P < 0.0001) and ureteral injury (0.34 vs 0.06%, P < 0.0001). The incidence of genitourinary (GU) injury in gastrointestinal surgery is rare, less than 1.0 per cent, and is less than the incidence of GU injury reported in gynecologic surgery. This risk is increased by operations on the rectum and the presence of malignancy.
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Frequency of Lower Urinary Tract Injury after Gastrointestinal Surgery in the Nationwide Inpatient Sample Database. Am Surg 2014. [DOI: 10.1177/000313481408001223] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Bladder and ureteral injury are serious iatrogenic complications during abdominal and pelvic surgery but are poorly investigated in the general surgery literature. The objective of this study was to examine rates, trends, and patient and surgical characteristics present in lower urinary tract injuries during gastrointestinal surgery using the Nationwide Inpatient Sample (NIS) database. The NIS database was queried from 2002 to 2010 for gastrointestinal surgery procedures including small/large bowel, rectal surgery, and procedures involving a combination of the two. These were crossreferenced with bladder and ureteral injury using International Classification of Diseases, 9th Revision, Clinical Modification codes. Multivariate regression analysis was used to calculate odds ratios for hypothesized risk factors. From 2002 to 2010, total average rates of bladder injury and ureteral injury were 0.15 and 0.06 per cent, respectively. Small/large bowel procedures had lower annual rates of ureteral (0.05 to 0.07%) and bladder (0.12 to 0.14%) injuries compared with ureteral (0.11 to 0.25%) and bladder (0.27 to 0.41%) injuries in rectal procedures. Presence of metastatic disease was associated with the greatest risk for bladder (odds ratio, 2.0; 95% confidence interval, 1.8 to 2.2) and ureteral (2.2; 1.9 to 2.5) injury in small/large bowel surgery, and for bladder (3.1; 2.5 to 3.9) and ureteral (4.0; 3.2 to 5.0) injury in combination procedures. Injury rates were significantly greater in open surgeries compared with laparoscopic procedures for both bladder injury (0.78 vs 0.26%, P < 0.0001) and ureteral injury (0.34 vs 0.06%, P < 0.0001). The incidence of genitourinary (GU) injury in gastrointestinal surgery is rare, less than 1.0 per cent, and is less than the incidence of GU injury reported in gynecologic surgery. This risk is increased by operations on the rectum and the presence of malignancy.
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MP9-16 THE IMPACT OF SEAT BELTS AND AIRBAGS ON HIGH GRADE RENAL INJURIES AND NEPHRECTOMY RATES IN MOTOR VEHICLE COLLISIONS. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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MP48-03 TESTOSTERONE REPLACEMENT THERAPY IN PATIENTS WITH PROSTATE CANCER AFTER PROSTATECTOMY: A 5-YEAR SINGLE CENTER EXPERIENCE. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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PD15-04 RISK OF CANCER ON MRI-TARGETED AND SYSTEMATIC PROSTATE BIOPSY. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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V2-05 ROBOTIC UPPER URINARY TRACT RECONSTRUCTION USING NEAR INFRARED FLUORESCENCE IMAGING. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Racial differences in prostate cancer incidence and mortality. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e15119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15119 Background: Prostate cancer is the second leading cause of male cancer deaths in the U.S. There are significant racial differences in prostate cancer incidence and mortality. Methods: The SEER Database for 2008 was analysed for designated areas: Connecticut, Detroit, and Hawaii, assuming that these areas are surrogates for whites, blacks, and Asians, respectively. Results: Incidence and mortality (see Table). Conclusions: Assuming that the geographic SEER areas (Conn, Det, Ha) are surrogates for whites, blacks, and Oriental populations, we conclude that the incidence and mortality rates for blacks are higher than those for whites and Orientals. [Table: see text]
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55 PATIENT FACTORS AND SURGICAL CHARACTERISTICS ASSOCIATED WITH DEEP VENOUS THROMBOSIS AND PULMONARY EMBOLISM AFTER UROLOGICAL SURGERY UTILIZING THE AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP). J Urol 2012. [DOI: 10.1016/j.juro.2012.02.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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53 SURGICAL SITE INFECTIONS IN UROLOGIC SURGERY. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Effect of antisense oligonucleotides targeting bcl-2 on addition proteins that regulate prostatic apoptosis and differentiation in LNCaP cells. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e13511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Suppressed caspase-3 expression compensates for bcl-2 inhibition by antisense oligonuclotides in LNCaP cells. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e13510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12 BICYCLE RELATED GENITOURINARY INJURIES: AN ANALYSIS OF THE NATIONAL TRAUMA DATA BANK. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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1231 COMPARISON OF NONOPERATIVE MANAGEMENT WITH RENORRAPHY AND NEPHRECTOMY IN PENETRATING RENAL INJURIES. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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