The Canadian Journal Of Urology[JOURNAL]
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200 papers
PSMA PET/CT-guided pelvic lymph node dissection in patients with unfavorable intermediate- or high-risk prostate cancer.
Donck E, Verbeke S, De Visschere P … +4 more , Fonteyne V, Van Praet C, De Man K, Lumen N
Can J Urol · 2026 Feb · PMID 41800504 · Publisher ↗
OBJECTIVES: PSMA PET/CT (Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography) offers improved accuracy in detecting lymph node invasion (LNI) in prostate cancer (PC) patients, potentially...
OBJECTIVES: PSMA PET/CT (Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography) offers improved accuracy in detecting lymph node invasion (LNI) in prostate cancer (PC) patients, potentially reducing the need for extended pelvic lymph node dissection (ePLND). This study aims to evaluate a patient-tailored care pathway in which ePLND is performed only in patients with unfavorable intermediate- or high-risk PC who are deemed at risk for LNI based on PSMA PET/CT findings. METHODS: In this interventional cohort study, 81 patients were managed according to the new care pathway. ePLND was omitted in cases of negative PSMA PET/CT findings (N0M0), while those with positive PSMA PET/CT findings (N1M0) underwent ePLND. A comparator group of 81 patients was selected from a prospectively generated database for comparison. RESULTS: The intervention group experienced a 75% reduction in the number of ePLNDs performed compared to the comparator group (p < 0.001). ePLND-related complications were significantly lower in the intervention group (p = 0.008). No significant difference was observed in 3-year biochemical-recurrence free survival (BRFS) between the two groups (p = 0.958). CONCLUSION: Omitting ePLND in patients with negative PSMA PET/CT findings (N0M0) leads to a substantial reduction in the number of ePLNDs performed, resulting in a decrease in morbidity, without compromising early oncological outcomes.
Suprapubic transvesical adenoma resection of the prostate (STAR-P): step-by-step technique.
Gozzi C, Bucca B, Dalpiaz O … +4 more , Brassetti A, Gobbi LM, Basile G, Djordjevic M
Can J Urol · 2026 Feb · PMID 41800503 · Publisher ↗
OVERVIEW: Surgical management of benign prostatic hyperplasia (BPH) has evolved significantly, incorporating various minimally invasive procedures aimed at reducing morbidity and optimizing patient outcomes. Despite adva...
OVERVIEW: Surgical management of benign prostatic hyperplasia (BPH) has evolved significantly, incorporating various minimally invasive procedures aimed at reducing morbidity and optimizing patient outcomes. Despite advancements, transurethral approaches continue to pose risks such as urethral strictures and urinary incontinence due to mechanical and thermal stress. To address these limitations, the Suprapubic Transvesical Adenoma Resection of the Prostate (STAR-P) was developed, offering a direct suprapubic route that bypasses the urethra entirely. Recent studies have validated STAR-P as both feasible and safe, emphasizing advantages such as enhanced visualization of the urinary sphincter, minimized urethral trauma, effective hemostasis, and reduced operative stress. The procedure utilizes specially designed instrumentation, including a large-caliber bipolar resectoscope (42 Fr), allowing the efficient removal of substantial adenoma tissue in fewer resection passes compared to traditional methods. OBJECTIVES: This article provides a comprehensive, step-by-step description of the STAR-P technique. The primary objective is to detail patient selection criteria, preoperative assessments, procedural steps including mini-open suprapubic access, specialized instrumentation usage, resection techniques, and postoperative management protocols. Highlighting technical considerations and procedural innovations aims to inform urologists about the potential benefits of STAR-P, particularly in patients at higher risk for urethral complications or those with large prostate volumes. By documenting the procedural intricacies and outcomes clearly and thoroughly, we seek to encourage informed adoption of STAR-P as an alternative, effective surgical approach for managing benign prostatic hyperplasia, thus contributing to the evolving landscape of minimally invasive urological surgery.
Progress of the pathogenesis in varicocele: a narrative review.
Dong L, Xin J, Zhang J … +3 more , Liu Z, Li J, Yu X
Can J Urol · 2026 Feb · PMID 41800502 · Publisher ↗
Varicocele (VC) is widely recognized as a prevalent and clinically significant cause of male infertility. However, the comprehensive pathogenic mechanisms underlying VC development and progression remain incompletely und...
Varicocele (VC) is widely recognized as a prevalent and clinically significant cause of male infertility. However, the comprehensive pathogenic mechanisms underlying VC development and progression remain incompletely understood, creating an important knowledge gap in the field of andrology. This review establishes that VC pathogenesis centers on abnormal vascular remodeling and integrates multiple contributing elements, including anatomical abnormalities, biochemical disturbances, genetic factors, low body mass index (BMI), age, and specific sports habits, while secondary varicoceles are primarily induced by compressive pathologies. Through a systematic synthesis of current evidence and recent advances, this review aims to elucidate the complex pathogenic network of VC and provide valuable insights to guide future research directions and inform the development of targeted clinical applications.
A comprehensive review about sperm-oocyte interactions and key activation factors of fertilization in mammals.
Azil S, Louanjli Y, Louanjli N … +2 more , Benkhalifa M, Ghazi B
Can J Urol · 2026 Feb · PMID 41800501 · Publisher ↗
Mammalian fertilization involves the migration of spermatozoa through the female reproductive system. Early embryonic development is a consequence of several steps and signaling pathways being activated, as well as bioch...
Mammalian fertilization involves the migration of spermatozoa through the female reproductive system. Early embryonic development is a consequence of several steps and signaling pathways being activated, as well as biochemical and morphological modifications of spermatozoa that enable them to penetrate the membrane of mature oocytes. There are some crucial steps known to clearly explain the process of fertilization, starting with hyperactivation of spermatozoa, mutual recognition, and binding of gametes mediated by receptors located on the surface membranes of both gametes. The final step is followed by oocyte activation, which is primarily triggered via sperm-derived factors, inducing a sharp increase in intracellular calcium levels, eventually leading to polyspermy block. This review integrates current knowledge of the molecular and physiological events governing fertilization, emphasizing how ion regulation and signaling pathways converge to enable sperm function and oocyte activation. Special attention is given to sperm-derived factors such as phospholipase C zeta (PLCζ) and post-acrosomal sheath WW domain-binding protein (PAWP), which play essential roles in triggering calcium release and supporting early embryonic development.
Artificial intelligence in urological malignancy diagnosis and prognosis: current status and future prospects.
Zhan M, Zhou Z, Zhang J … +10 more , Wang X, Li C, Pan B, Luo Z, Shi W, Wang Y, Li M, Wang W, Shi R, Zhu J
Can J Urol · 2026 Feb · PMID 41800500 · Publisher ↗
Artificial intelligence (AI) is transforming the diagnostic landscape of malignant tumors in the urinary system, including prostate cancer, bladder cancer, and renal cell carcinoma (RCC). By integrating imaging, patholog...
Artificial intelligence (AI) is transforming the diagnostic landscape of malignant tumors in the urinary system, including prostate cancer, bladder cancer, and renal cell carcinoma (RCC). By integrating imaging, pathology, and molecular data, AI enhances the precision and reproducibility of tumor detection, grading, and risk stratification. In prostate cancer, AI-assisted multiparametric Magnetic resonance imaging (MRI) and digital pathology systems improve lesion localization and Gleason scoring. For bladder cancer, deep learning-based cystoscopy and radiomics models from Computed tomography/magnetic resonance imaging (CT/MRI) enable real-time lesion segmentation and non-invasive biomarker prediction, such as Programmed Cell Death-Ligand 1 (PD-L1) expression. In RCC, AI, combined with CT/MRI and multi-omics data, aids in subtype classification and prognostic prediction, supporting personalized therapy. However, despite these promising advances, challenges such as data standardization, model generalizability, interpretability, and regulatory compliance hinder AI's clinical translation. This review outlines the current state of AI in urological cancer diagnosis and prognosis, its technological innovations, and the clinical challenges and opportunities that lie ahead.
Prostate specific membrane antigen (PSMA) as a biomarker in early and localized advanced prostate cancer: a narrative review.
Carll J, Bonaddio J, Woon D … +3 more , Perera M, Lawrentschuk N, Chengodu T
Can J Urol · 2026 Feb · PMID 41800499 · Publisher ↗
Prostate-specific membrane antigen (PSMA) is a surface membrane antigen that is highly overexpressed in prostate cancer, with heterogenous expression throughout the natural history of the disease. This has generated sign...
Prostate-specific membrane antigen (PSMA) is a surface membrane antigen that is highly overexpressed in prostate cancer, with heterogenous expression throughout the natural history of the disease. This has generated significant interest as a potential biomarker for use in early diagnosis and treatment of prostate cancer. We reviewed the literature surrounding PSMA and its current clinical applications in diagnosing and managing early prostate cancer that is confined to the prostate and local lymph nodes. A search on PubMed, Medline, and Web of Science was performed using the following keywords: "PSMA", "Prostate Specific Membrane Antigen", "Prostate cancer", "Biomarker", "Diagnosis". We considered all available articles relevant to the topic of PSMA as a biomarker in early prostate cancer when developing this narrative review. Key articles assessing the biology of PSMA, as well as its use as a potential diagnostic and therapeutic target in early prostate cancer, were assessed. The role of PSMA PET as a potential diagnostic and risk stratification tool was assessed. The current use of antibody-drug conjugates and radioligand therapy targeting PSMA was assessed, along with any current evidence to support their use in early prostate cancer. PSMA is heavily expressed throughout the early stages of prostate cancer, and this has significant therapeutic implications. There is a growing body of evidence that shows PSMA PET can play a role in the diagnosis, risk stratification, and prognostication of localised prostate cancer. PSMA-targeted therapies such as Lu-177 currently do not have any proven benefit in treating early prostate cancer; however, this remains an area of ongoing research.
Association between periodontal disease and prostatic disease: a systematic review and meta-analysis of observational studies.
Li Q, Wu L, Zhang Y … +5 more , Huang D, Ou-Yang S, Yang JY, Li BH, Zeng XT
Can J Urol · 2026 Feb · PMID 41800498 · Publisher ↗
OBJECTIVE: Current research highlights periodontal disease as a systemic inflammatory condition that may influence extra-oral diseases such as prostatic diseases, which prompted us to explore the potential association. T...
OBJECTIVE: Current research highlights periodontal disease as a systemic inflammatory condition that may influence extra-oral diseases such as prostatic diseases, which prompted us to explore the potential association. To evaluate whether periodontal disease is associated with an increased risk of prostatic disease, including prostate cancer, benign prostatic hyperplasia (BPH), and prostatitis. METHODS: A systematic search of observational studies concerning the relationship between periodontal disease and prostatic disease was performed in online databases PubMed, Embase, Web of Science, Scopus, CENTRAL, CNKI, and WanFang. Searches were conducted from database inception to 31 July 2025. Pooled hazard ratio (HR) or odds ratio (OR) with 95% confidence intervals (CIs) were synthesized. Subgroup analysis was used to detect the origin of heterogeneity, sensitivity analysis was employed to evaluate the robustness of the results, and publication bias analyses were also performed. R software was used to perform statistical analyses. RESULTS: Sixteen studies that met the preset criteria were included in this study. In the pooled analysis, periodontal disease was associated with increased risk of prostate cancer (HR = 1.23, 95%CI: 1.16-1.29, p < 0.001) or BPH (OR = 1.55, 95%CI: 1.41-1.70, p < 0.001). Sensitivity analysis confirmed the robustness of the results. No obvious publication bias was found in the meta-analysis. Only one cohort study reported that chronic periodontitis increases the risk of prostatitis (HR = 2.521, 95%CI: 1.685-4.005, p < 0.001). The effect of periodontal treatment on prostatic disease is still unclear. CONCLUSIONS: The systematic review and meta-analysis identified an observational association between periodontal disease and increased risks of prostate cancer and BPH. Because all included studies were observational, these results indicate association rather than causation, and further prospective and mechanistic studies are required to clarify temporality and causality.
Brunn's cyst causing lower urinary tract symptoms in a young adult: A case report with brief review of literature.
Singh H, Vasudeva P, Aravind TK
Can J Urol · 2025 Dec · PMID 41496548 · Publisher ↗
BACKGROUND: Brunn's cyst is a seldom encountered etiology in a wide spectrum of causative pathologies producing lower urinary tract symptoms (LUTS) in a young male, causing voiding symptoms, with prompt symptom resolutio...
BACKGROUND: Brunn's cyst is a seldom encountered etiology in a wide spectrum of causative pathologies producing lower urinary tract symptoms (LUTS) in a young male, causing voiding symptoms, with prompt symptom resolution following surgical management. A diagnostic dilemma may arise, as other bladder neck cystic lesions differ in anatomical location, etiology, and the nature of associated LUTS. CASE DESCRIPTION: We report a middle-aged male patient with Brunn's cyst with a brief description of our management strategies and a review of available literature. CONCLUSIONS: Brunn's cyst is a rare but treatable cause of bladder outlet obstruction in young males, with excellent outcomes following transurethral deroofing.
Understanding self-inflicted penile strangulation: a case series analysis of clinical management and psychological considerations.
Saxena S, Panwar VK, Mittal A … +3 more , Mujahid MT, Agarwal M, Srivastav NK
Can J Urol · 2025 Dec · PMID 41496547 · Publisher ↗
BACKGROUND: Injuries to the penis resulting from self-inflicted strangulation with various objects are uncommon, yet these injuries are more frequently observed in young adults. Medical literature has identified items su...
BACKGROUND: Injuries to the penis resulting from self-inflicted strangulation with various objects are uncommon, yet these injuries are more frequently observed in young adults. Medical literature has identified items such as hair, thread, rubber bands, metallic rings, and vacuum erection devices as tools used for this purpose. These constrictive items impede venous return from the penis, potentially leading to severe complications such as ischemia or necrosis. This case series aims to analyse the clinical presentation, management strategies, and psychological dimensions of self-inflicted penile strangulation through a case series. CASE PRESENTATION: We conducted a retrospective analysis of three cases of penile strangulation treated at All India Institute of Medical Sciences, Rishikesh between 2022 and 2023. Cases were classified using a modified Bhat et al. grading system. Management techniques, complications, and psychological assessments were documented with a follow-up of 2 years. Individual consent was obtained from the patients for this case series. This article has been prepared according to the PROCESS guidelines. The cases represented a spectrum of clinical severity (Grades I-IV) with diverse constricting devices (metallic ring, plumbing fixtures, hair fibres) and presentation times (6 h to several days). Device-specific removal techniques were employed with successful outcomes. Psychiatric evaluation revealed distinct patterns: sexual experimentation in younger patients (35 and 32 years old) and major depressive disorder with paraphilic tendencies resulting in chronic self-harm (53-year-old), which eventually required partial penectomy. CONCLUSION: This study underscores the critical need for healthcare providers to recognize and understand the complexities surrounding self-inflicted penile strangulation injuries. By increasing awareness, providers can better address the psychological dimensions and surgical management strategies associated with these cases. Furthermore, involving the family in the patient's care is essential; counselling and education can play a pivotal role in preventing future recurrences of major depressive disorder.
Successful treatment of rare vaso-vesical fistula with minimally invasive measures despite prior history of radiotherapy: a case report.
Mendelson JL, Kassab J, Westbrook P … +2 more , Yang K, Corcoran A
Can J Urol · 2025 Dec · PMID 41496546 · Publisher ↗
Stereotactic body radiotherapy (SBRT) for prostate cancer is a generally well-tolerated treatment but can rarely lead to complications such as fistula formation. We report a 69-year-old male on maintenance ibrutinib for...
Stereotactic body radiotherapy (SBRT) for prostate cancer is a generally well-tolerated treatment but can rarely lead to complications such as fistula formation. We report a 69-year-old male on maintenance ibrutinib for chronic lymphocytic leukemia who developed a fistula between his bladder and vas deferens in the setting of ascending scrotal infection. Despite his prior history of SBRT, the fistula was successfully treated with minimally invasive measures. A combination of abscess debridement, urinary diversion, and broad-spectrum antibiotics helped to achieve fistula resolution. The unique presentation described herein highlights the importance of early aggressive intervention for source control and infection management in patients with complex pelvic infections post-SBRT.
Pseudoaneurysm after prostate biopsy: case report.
Daly W, Pelzman D, Ogagan PD … +1 more , Jackman SV
Can J Urol · 2025 Dec · PMID 41496545 · Publisher ↗
BACKGROUND: Minor bleeding after prostate biopsy is a relatively common complication, but clinically significant hemorrhage happens rarely. Management of prostatic artery pseudoaneurysm has not been described in the lite...
BACKGROUND: Minor bleeding after prostate biopsy is a relatively common complication, but clinically significant hemorrhage happens rarely. Management of prostatic artery pseudoaneurysm has not been described in the literature. CASE DESCRIPTION: In this case, an 84-year-old man presented after prostate biopsy with rectal bleeding and required a massive transfusion. Ultimately, he was found to have a prostatic artery pseudoaneurysm, which to our knowledge is heretofore undescribed after prostate biopsy. Bleeding ultimately stopped spontaneously as the patient deferred angioembolization. He had not recurrent bleeding on follow up but is still deciding on treatment course for newly diagnosed prostate cancer. CONCLUSIONS: Bleeding from prostatic artery pseudoaneurysm is a rare complication of prostate biopsy and can be managed with aggressive resuscitation and IR embolization if needed.
Gastrointestinal resection is associated with urolithiasis severity among inflammatory bowel disease patients.
Durbhakula V, Savin Z, Savin-Shalom E … +6 more , Gold SL, Gupta K, Frangopoulos E, Gallante B, Atallah WM, Gupta M
Can J Urol · 2025 Dec · PMID 41496544 · Publisher ↗
BACKGROUND: A well-established correlation exists between Inflammatory Bowel Disease (IBD) and urolithiasis. However, the influence of surgical history on the severity of urolithiasis in IBD patients remains underexplore...
BACKGROUND: A well-established correlation exists between Inflammatory Bowel Disease (IBD) and urolithiasis. However, the influence of surgical history on the severity of urolithiasis in IBD patients remains underexplored. This study aims to investigate the association between gastrointestinal (GI) bowel resection and urolithiasis severity in patients with IBD. METHODS: This retrospective cohort study analyzed 42 patients diagnosed with both IBD and urolithiasis between 2016 and 2024. Patients were categorized based on their history of bowel resection. Primary outcomes included maximal stone burden, need for urolithiasis surgery, and stone recurrence. Secondary outcomes were stone-related clinical events, multiple urolithiasis surgeries, and having a percutaneous nephrolithotomy. Associations between bowel resections and outcomes were assessed using univariate and multivariate regression analyses. RESULTS: The median age was 55 years (range 45-68), with 76% having Crohn's disease and 24% ulcerative colitis. Of the cohort, 48% had a history of a bowel resection (14 small bowel, 9 ileocolic resection (ICR), 10 subtotal/total colectomy), with 31% having multiple resections. The median interval between bowel resection and urolithiasis diagnosis was 8 years (5-22). Patients with prior bowel resections had significantly higher stone burden (p < 0.001), greater need for urolithiasis surgery (p = 0.03), and increased stone recurrence rates (p = 0.006). On multivariate analysis, bowel resections independently predicted adverse urolithiasis outcomes, with small bowel resections and ICR showing stronger associations than colectomies. CONCLUSION: Bowel resections are linked to increased urolithiasis severity in IBD patients. These findings highlight the need for proactive preventative therapies and stricter surveillance protocols for IBD patients undergoing bowel resection.
Stenting severely obstructed ureters: a useful method for a common challenge.
Avidor Y, Lidawi G, Majdoub M … +2 more , Asali M, Rub R
Can J Urol · 2025 Dec · PMID 41496543 · Publisher ↗
In this paper we describe a surgical technique for achieving safe ureteral stent placement in cases of severe obstruction. Although retrograde endoscopic stenting is often the preferred method for ureteral drainage, the...
In this paper we describe a surgical technique for achieving safe ureteral stent placement in cases of severe obstruction. Although retrograde endoscopic stenting is often the preferred method for ureteral drainage, the existing literature offers limited insight into innovative surgical methods made possible by recent technological advancements. In this report, we present a method that employs a ureteral dilator as an anchor to facilitate precise and effective stent insertion. The technique involves positioning a ureteral dilator in close contact with the tip of the obstructing stone. In this position, the dilator not only functions to dilate the ureter but also serves as a stable anchor point, facilitating the passage of the ureteral stent. We successfully employed this method in 23 patients in whom initial attempts at safe stent placement were unsuccessful due to severe obstruction. In all cases, ureteral drainage was achieved, thus avoiding percutaneous nephrostomy. Our findings suggest that the tensile strength of the ureteral dilator provides reliable anchorage, supporting the advancement of the stent. This technique may offer a safe and effective alternative for ureteral stenting in cases of severe obstruction, potentially reducing the need for percutaneous nephrostomy.
Current and perceived optimal use of point-of-care ultrasound in urology.
Schlaepfer CH, Shetty Z, Packiam VT … +4 more , Tracy CR, Takacs EB, Korets R, Steinberg RL
Can J Urol · 2025 Dec · PMID 41496542 · Publisher ↗
INTRODUCTION: Point-of-care ultrasound (POCUS) is a valuable tool for clinicians, but little data exists regarding the perceptions of ideal POCUS utilization, as compared to actual use, amongst urologists. We aim to asse...
INTRODUCTION: Point-of-care ultrasound (POCUS) is a valuable tool for clinicians, but little data exists regarding the perceptions of ideal POCUS utilization, as compared to actual use, amongst urologists. We aim to assess how perceptions align or diverge with actual practice. METHODS: An institutional review board (IRB)-approved survey was developed and disseminated by email to 6 of 8 American Urologic Association Sections, program directors via the Society of Academic Urologists, and to 2 residency programs. The primary outcome was to assess differences in current and perceived optimal use. Data was collected via the University of Iowa RedCap system. Descriptive statistics and Chi-squared analyses were performed. RESULTS: 184 non-trainees and 41 trainees completed the survey. Rates of current POCUS use were significantly lower than perceived optimal usage for renal (58% to 88%, p < 0.001), testis (37% to 74%, p < 0.001), and penile (19% to 37%, p < 0.001) application amongst the urologic organs. Current use was also lower than perceived optimal use with regard to utilization in the emergency room (16% to 39%, p < 0.001) and for diagnostic purposes (53% to 81%, p < 0.001), regardless of organ focus. Sub-analysis found that trainees, compared to non-trainees, identified the inpatient unit (54% to 18%, p < 0.001) and emergency room (81% to 35%, p < 0.001) as optimal locations for use. CONCLUSIONS: Perceptions of POCUS use differ between trainees and non-trainees, especially the location of use. These results help identify areas for which training could be focused, as well as highlight the need for further research on generational variation in desired POCUS use.
Donor-gifted nephrolithiasis: case-based analysis and comparative study.
Sandberg M, Xu M, Bissette R … +7 more , Malakismail J, East N, Nguyen R, Nowatzke J, Stratta R, Assimos D, Kleinguetl C
Can J Urol · 2025 Dec · PMID 41496541 · Publisher ↗
OBJECTIVES: Donor-gifted nephrolithiasis-the presence of a stone in a donor kidney at the time of transplantation-is rare. Research is limited, and no consensus high-quality evidence guidelines exist, leaving selection c...
OBJECTIVES: Donor-gifted nephrolithiasis-the presence of a stone in a donor kidney at the time of transplantation-is rare. Research is limited, and no consensus high-quality evidence guidelines exist, leaving selection criteria and management to individual provider discretion. We aimed to estimate the frequency and analyze patient and graft outcomes of deceased donor (DD) transplant recipients with stones in their kidneys at Wake Forest Baptist Medical Center. METHODS: All DD renal transplants or patients receiving most of their care postoperatively after DD renal transplantation at our institution from 1979 to 2025 were reviewed. Stones were considered donor-gifted if discovered during transplantation or on imaging within two weeks of the transplant date. Patient, stone, and graft outcomes were followed over time. Stone size on imaging was compared between patients who were treated versus surveyed for their donor-gifted stones using an independent samples t-test. RESULTS: Of 4723 patients who underwent DD renal transplant, eight were found to have a graft with stones at transplant (0.2%). The median stone size was 8 mm. Three (38%) patients underwent treatment for stones, and five (62%) underwent surveillance. Two (25%) patients experienced graft failure, and one of these patients received stone treatment. CONCLUSIONS: The frequency of donor-gifted nephrolithiasis is extremely low in DD transplant patients. Despite a small sample set, these results demonstrate favorable outcomes and provide support for the feasibility of intentionally performing DD renal transplantation in grafts with known stones.
Treatment patterns for genitourinary syndrome of menopause: a TriNetX analysis.
Ghosh A, D'Amico MJ, Shah YB … +4 more , Smith WR, Shah MS, Lallas CD, Murphy AM
Can J Urol · 2025 Dec · PMID 41496540 · Publisher ↗
BACKGROUND: Genitourinary syndrome of menopause (GSM) is a highly prevalent, underdiagnosed condition that can significantly impair quality of life (QoL). This study evaluates real-world treatment trends for GSM to bette...
BACKGROUND: Genitourinary syndrome of menopause (GSM) is a highly prevalent, underdiagnosed condition that can significantly impair quality of life (QoL). This study evaluates real-world treatment trends for GSM to better understand current management practices and highlight ongoing gaps in care. The background is in a different font than the rest of the abstract. METHODS: We queried the TriNetX database for patients with a diagnosis of postmenopausal atrophic vaginitis (ICD N95.2) and treatment information from 2004-2024. A combination of RxNorm and International Classification of Diseases-10 (ICD) codes was used to classify disease and treatment type, including topical estrogen (RxNorm 4083, 4099), Ospemifene (RxNorm 1370971), Prasterone (RxNorm 3143), and hormone replacement therapy (HRT, ICD Z79.890). Demographic information about the patients' age and sex was collected. RESULTS: Overall, there were 2,867,232 cases of GSM identified. 71.22% (n = 2,042,024) of the cohort did not receive any treatment. Of patients undergoing treatment, the majority underwent a single intervention (n = 740,922, 89.79%). Of single medical therapy cases, topical estrogen (n = 656,825; 88.64%) was most common, followed by HRT (n = 78,855; 10.64%), Prasterone (n = 3691; 0.50%), and lastly Ospemifene (n = 1551; 0.21%). Very few patients underwent multiple interventions (n = 31,339; 9.1%), the majority of which were prescribed topical estrogen with HRT (n = 70,392; 83.52%). CONCLUSIONS: Most women diagnosed with GSM did not receive treatment. Among those treated, topical estrogen was the predominant therapy. Newer therapies were underutilized, though it is unclear whether this is due to provider familiarity, patient preference, or access. Further research is warranted to elucidate the underlying reasons for undertreatment in this population.
Implementation of opioid-reduced protocols after penile prosthesis surgery.
O'Connor LP, Henry AJ, Novicoff WM … +3 more , Ali M, Baumgarten AS, Ortiz NM
Can J Urol · 2025 Dec · PMID 41496539 · Publisher ↗
BACKGROUND: Postoperative pain management after penile prosthesis (PP) has traditionally required opioid medication. Recently, urologic prosthetic surgeons have sought to establish opioid-free protocols (OFP) and/or opio...
BACKGROUND: Postoperative pain management after penile prosthesis (PP) has traditionally required opioid medication. Recently, urologic prosthetic surgeons have sought to establish opioid-free protocols (OFP) and/or opioid-reduced protocols (ORP) for PP postoperative pain management. We sought to investigate the adoption patterns of OFP/ORP among surgeons who perform PP surgery and identify barriers to implementation. METHODS: A 13-question confidential survey was sent to members of the Sexual Medicine Society of North America (SMSNA) and the Society of Urologic Prosthetic Surgeons (SUPS) via email. The survey was administered via Qualtrics. A t-test was used to analyze survey responses. RESULTS: The survey was fully completed by 53 respondents. Approximately 51% (27/53) of respondents performed more than 30 implants annually. OFPs were used at least some of the time by 43% (23/53) of respondents, with 9.5% (5/53) exclusively using OFPs. In comparison, 83% (44/53) of respondents used an ORP at least some of the time, and 32% (17/53) exclusively used ORP. Of the non-opioid medications/techniques used, acetaminophen was the most common (96%, 51/53), followed by nonsteroidal anti-inflammatory drugs (NSAIDs) (92%, 49/53) and dorsal penile block (77%, 41/53). At the time of discharge, 75% (40/53) of respondents prescribed fewer than 10 doses of opioid medication, and 15% (8/53) did not prescribe any opioids. The majority of respondents using ORP/OFP were extremely satisfied (70%, 33/47), and none of the respondents were either somewhat or extremely dissatisfied. CONCLUSION: Our study demonstrates that opioid-reduced/opioid-free regimens are widely adopted among the prosthetic urologic community. These protocols limit narcotic exposure to protect patients from adverse events related to opioids.
Adult urologic sarcomas: a single institution experience over 25 years.
Arham AB, Rieth JM, O'Donnell MA
Can J Urol · 2025 Dec · PMID 41496538 · Publisher ↗
BACKGROUND: Genitourinary (GU) sarcomas are rare soft tissue malignancies, comprising around 2% of all GU cancers. Due to their rarity, limited data exist on optimal management and long-term outcomes. This study presents...
BACKGROUND: Genitourinary (GU) sarcomas are rare soft tissue malignancies, comprising around 2% of all GU cancers. Due to their rarity, limited data exist on optimal management and long-term outcomes. This study presents a 25-year single-institution experience, evaluating clinical presentation, treatment strategies, and survival outcomes, aims to identify trends over time and potential predictors of prognosis. METHODS: A retrospective review was conducted of patients aged ≥18 years diagnosed with GU sarcomas at the University of Iowa Hospitals and Clinics (1998-2023). Data on tumor subtype, staging, histopathology, treatment modalities, and survival outcomes were analyzed. Kaplan-Meier analysis estimated recurrence-free survival (RFS) and overall survival (OS). RESULTS: Among 33 cases, the most common presentations in order of frequency were liposarcoma (LPS) (n = 15), leiomyosarcoma (LMS) (n = 12), rhabdomyosarcoma (RMS) (n = 5), and angiosarcoma (n = 1). Paratesticular tumors (n = 23) were most frequent, followed by bladder (n = 5), prostate (n = 2), and kidney (n = 2). The median age was 51 for LMS, 60 for LPS, and 24 for RMS. LMS had higher stage (66.67%), grade (83.33%), recurrence (25.00%), and mortality (41.67%) rates compared to LPS (recurrence: 13.33%, mortality: 20.00%). At 36 months, RFS was 63% (95% CI: 39%-79%), and OS was 81% (95% CI: 57%-92%) for the entire cohort. Follow-up duration was 19.9 months for LMS and 33.8 months for LPS. CONCLUSION: Surgical resection remains the mainstay of treatment for GU sarcomas. Margin status, tumor grade, and size are key prognostic factors. LMS carries the highest recurrence risk, and RMS exhibits aggressive progression. Further investigation into targeted therapies is warranted to improve outcomes.
Unbuckling: an answer to address cuff-related challenges in urethral instrumentation with an artificial urinary sphincter.
Jhaveri H, Martinez-Rivera M, Nose B … +2 more , Foreman J, Lentz AC
Can J Urol · 2025 Dec · PMID 41496537 · Publisher ↗
OBJECTIVES: There is limited in vivo data on the maximum safe instrument size that can be passed through an artificial urinary sphincter (AUS) cuff. While 21 French instruments are generally safe with the commonly used 4...
OBJECTIVES: There is limited in vivo data on the maximum safe instrument size that can be passed through an artificial urinary sphincter (AUS) cuff. While 21 French instruments are generally safe with the commonly used 4.5 cm cuff, larger instruments or smaller cuffs may require unbuckling to avoid urethral erosion. This study aimed to identify if artificial urinary sphincter cuff 'unbuckling' affects device longevity and risk of erosion. METHODS: A retrospective study of patients at a quaternary health system who underwent unbuckling was conducted. Using the Epic Clarity database and Duke Enterprise Data Unified Content Explorer (DEDUCE), we identified patients with artificial urinary sphincter (AUS) who were unbuckled during endoscopic procedures. Descriptive statistics were used to analyze patient demographics, device age at unbuckling, complications, and history of erosion, removal, or replacement. RESULTS: Eight patients were identified with a prior history of AUS unbuckling. The average age was 68 years. 75% of patients had a history of pelvic radiation. The average number of unbuckling procedures per patient was 1.62. The median device age at first unbuckling was 2.60 years. Average time to reactivation was 22.25 days, and 6 of 8 patients had their device reactivated. Two patients developed erosions requiring device removal. Neither erosion occurred within 90 days of unbuckling. The mean age of devices at the time of removal was 6.85 years. CONCLUSIONS: AUS cuff unbuckling may serve as an alternative strategy when large-caliber urethral instrumentation is required. Studies with larger patient cohorts are required to further investigate the efficacy and ideal utilization of unbuckling.
Low utilization of intracavernosal injection and penile Doppler ultrasound in the evaluation of erectile dysfunction and Peyronie's disease.
Leong JY, Gaines T, Prebay ZJ … +2 more , Ebbott D, Chung PH
Can J Urol · 2025 Dec · PMID 41496536 · Publisher ↗
INTRODUCTION: Despite the diagnostic value of intracavernosal injections (ICI) and penile Doppler ultrasound (PDUS), there remain barriers to widespread clinical adaptation of these methods. The study aimed to evaluate t...
INTRODUCTION: Despite the diagnostic value of intracavernosal injections (ICI) and penile Doppler ultrasound (PDUS), there remain barriers to widespread clinical adaptation of these methods. The study aimed to evaluate the practice patterns of utilization of ICI and PDUS in the assessment of erectile dysfunction (ED) and Peyronie's disease (PD). METHODS: Using the TriNetX database (Cambridge, MA, USA), adult (≥18 years) male patients with a diagnosis of ED on oral phosphodiesterase-5 (PDE5) inhibitors were identified. Current Procedural Terminology codes were utilized to identify patients who underwent further evaluation with ICI or PDUS, as well as penile prosthesis placement after PDUS. A second cohort was analyzed, identifying patients with a diagnosis of PD who underwent ICI or PDUS, and those who subsequently underwent PD treatment. RESULTS: Among 104 healthcare organizations, 52,227,262 adult males were screened for ED and PD. 1,689,907 (3.2%) patients had ED and 66,390 (0.1%) patients had PD. Among ED patients, there were 6508 (0.4%) who subsequently went on to receive penile prosthesis. Amongst ED patients, only 23,836 (1.4%) and 8548 (0.5%) patients underwent workup with ICI or PDUS. The number of patients who subsequently received a prosthesis after ICI and PDUS workup was 4680 (19.6%) and 868 (10.1%), respectively. Amongst PD patients, 2960 (4.5%) and 4972 (7.4%) underwent workup with ICI and PDUS, respectively. CONCLUSION: We recognize that ED and PD are challenging disease processes with complicated diagnostic workup involved. We recommend that providers be knowledgeable about counseling patients and even consider referring motivated patients to high-volume referral centers for definitive treatment.
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