The Canadian Journal Of Urology[JOURNAL]
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200 papers
Role of J stent as a minimally invasive treatment option for ureteropelvic junction obstruction.
Koparal MY, Elmas B, Gurocak S … +2 more , Aytekin C, Tan MO
Can J Urol · 2025 Jun · PMID 40567087 · Publisher ↗
AIM: The aim of this study was to investigate the factors affecting treatment success in children that got either pyeloplasty or J stent placement in ureteropelvic junction obstruction (UPJO). PATIENTS AND METHODS: The s...
AIM: The aim of this study was to investigate the factors affecting treatment success in children that got either pyeloplasty or J stent placement in ureteropelvic junction obstruction (UPJO). PATIENTS AND METHODS: The study comprised 126 patients who either J stent placement or pyeloplasty performed by the same physician for UPJO from 2012 to 2022. The criteria for surgical intervention adhered to the European Association of Urology (EAU) recommendations. Symptomatic patients with verified obstruction, with a split renal function (SRF) over 40%, low-grade hydronephrosis (Society of Fetal Urology grade 2), and an obstructive segment measuring less than 1 cm, had Double-J stent placement. Furthermore, in infants exhibiting poor health or development retardation, a J stent was inserted as a temporary measure to alleviate obstruction and maintain renal function, notwithstanding the recommendation for pyeloplasty. RESULTS: The treatment success rate was 43.9% in the J stent group and 88.4% in the pyeloplasty group, with a statistically significant difference (p < 0.001). The kind of procedure (pyeloplasty vs. stent) was the sole independent prognostic factor predicting treatment success (HR: 4.77, p < 0.001) in the multiple logistic regression analysis. No statistically significant change was observed in preoperative and postoperative SRF (48% vs. 48.5%, p = 0.923) among patients with stent failure, confirming a transient preservation of functional advantage. CONCLUSION: The placement of a stent may have restricted success rates in specific patients with UPJO. Preserving renal function may be advantageous until definitive surgery, particularly in cases where there are hazards associated with anesthesia and invasive procedures.
Robotic-assisted super-extended pelvic lymph node dissection for prostate cancer: safety and pathologic findings.
Daigle R, Staff I, Tortora J … +5 more , Proto TM, Pinto K, Negron R, Earle J, Wagner J
Can J Urol · 2025 Jun · PMID 40567086 · Publisher ↗
INTRODUCTION: We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy. MATERIALS AND METHODS: W...
INTRODUCTION: We examined the pathology and safety outcomes associated with the extent of pelvic lymph node dissection in patients with high-risk prostate cancer undergoing radical prostatectomy. MATERIALS AND METHODS: We retrospectively identified men with prostate cancer who underwent robot-assisted radical prostatectomy with pelvic lymph node dissection between May 2016 and September 2021. Cases were categorized using Current Procedural Terminology (CPT) codes (38571) for extended lymph node dissection and super-extended lymph node dissection (38572). Using logistic regression, we compared the groups on a number of factors, including recurrence. RESULTS: Super-extended lymph node dissection had significantly higher median prostate-specific antigen and National Comprehensive Cancer Network risk classification prior to surgery. Significant differences were observed in the pathologic T stage and pathology grade group. Time on robot was significantly longer for the super-extended group, while estimated blood loss was lower. No differences were observed in length of stay or any complication-related variable. Super-extended had significantly higher node positivity (36.1% vs. 7.6%, p < 0.001) and recurrence. 10.0% of super-extended cases had node positivity in the aortic bifurcation, the common iliac, or the pre-sacral chains that would have been missed with an extended dissection. 2.2% of patients had node positivity in these chains only. CONCLUSIONS: Super-extended lymph node dissection is safe and feasible for patients with high-risk prostate cancer. Further research is needed to better understand its clinical benefit and to further inform optimal patient selection.
Feasibility and short-term outcomes of robotic distal ureteroureterostomy for benign obstruction.
Seaman JA, Palanjian R, Fitzgerald J … +3 more , McCormick K, Funk J, Kim S
Can J Urol · 2025 Jun · PMID 40567085 · Publisher ↗
INTRODUCTION: Distal ureteral obstruction has classically been managed by ureteroneocystostomy (UNC). The feasibility and success of robotic primary ureteroureterostomy (UU) for benign obstruction appears promising with...
INTRODUCTION: Distal ureteral obstruction has classically been managed by ureteroneocystostomy (UNC). The feasibility and success of robotic primary ureteroureterostomy (UU) for benign obstruction appears promising with several benefits over UNC but is poorly studied. Robotic repair offers superior visualization and precision, allowing for minimal ureteral dissection. Here we report on our experience and short-term outcomes. MATERIALS AND METHODS: We identified patients who underwent robotic distal ureteroureterostomy for benign distal ureteral obstruction at our institution from 2020-2024. Etiology, stricture length, and post-operative outcomes were recorded. All patients had renal ultrasound (US), diuretic renography, or cross-sectional imaging within 6 months of repair. RESULTS: Seven patients underwent distal UU from 2020-2024, with one case of bilateral repair for a total of 8 anastomoses. Iatrogenic injury from hysterectomy represented 5/8 injuries. The mean time between injury and repair was 3.5 months. All defects were 1-1.5 cm in length. At follow-up imaging, there was no evidence of obstruction in any patient with a median follow-up of 10 months, including diuretic renography in 5 of 7 patients. One patient had mild hydronephrosis on their initial renal US but with normal drainage on subsequent diuretic renography. All patients reported no flank pain at follow-up. CONCLUSIONS: Robotic UU is feasible for short, benign distal ureteral obstruction in carefully selected patients. Advantages over traditional UNC include a significantly shorter catheter time, no risk of vesicoureteral reflux, no effect on bladder capacity or function, and the ability to retain the native ureteral orifice. Continued research will elucidate the long-term efficacy of this approach.
Machine learning-based comparison of transperineal vs. transrectal biopsy for prostate cancer diagnosis: evaluating procedural effectiveness.
Arafa MA, Farhat KH, Lotfy N … +7 more , Khan FK, Mokhtar A, Althunayan AM, Al-Taweel W, Al-Khateeb SS, Azhari S, Rabah DM
Can J Urol · 2025 Jun · PMID 40567084 · Publisher ↗
BACKGROUND: Transrectal (TR) and transperineal (TP) biopsies are commonly used methods for diagnosing prostate cancer. However, their comparative effectiveness in conjunction with machine learning (ML) techniques remains...
BACKGROUND: Transrectal (TR) and transperineal (TP) biopsies are commonly used methods for diagnosing prostate cancer. However, their comparative effectiveness in conjunction with machine learning (ML) techniques remains underexplored. This study aimed to evaluate the predictive accuracy of ML algorithms in detecting prostate cancer using data derived from TR and TP biopsies. METHODS: The clinical records of patients who underwent prostate biopsy at King Saud University Medical City and King Faisal Specialist Hospital and Research Centerin Riyadh, Saudi Arabia, between 2018 and 2025 were analyzed. Data were used to train and test ML models, including eXtreme Gradient Boosting (XGBoost), Decision Tree, Random Forest, and Extra Trees. RESULTS: The two datasets are comparable. The models demonstrated exceptional performance, achieving accuracies of up to 96.49% and 95.56% on TP and TR biopsy datasets, respectively. The area under the curve (AUC) values were also high, reaching 0.9988 for TP and 0.9903 for TR biopsy predictions. CONCLUSION: These findings highlight the potential of ML to enhance the diagnostic accuracy of prostate cancer detection irrespective of the biopsy method. However, TP biopsy data showed marginally higher accuracy, possibly because of the lower risk of contamination. While ML holds great promise for transforming prostate cancer care, further research is needed to address limitations. Collaboration between clinicians, data scientists, and researchers is crucial to ensure the clinical relevance and interpretability of ML models.
Long-term follow-up of metastatic renal myoepithelial carcinoma: case report and literature review.
Dave P, Yaakoubi G, Loloi J … +2 more , Shenoy N, Aboumohamed A
Can J Urol · 2025 Jun · PMID 40567083 · Publisher ↗
BACKGROUND: Primary renal myoepithelial carcinoma is an exceptionally rare malignancy with limited data on optimal treatment, particularly in metastatic settings. CASE DESCRIPTION: In 2020, Shenoy reported a dramatic res...
BACKGROUND: Primary renal myoepithelial carcinoma is an exceptionally rare malignancy with limited data on optimal treatment, particularly in metastatic settings. CASE DESCRIPTION: In 2020, Shenoy reported a dramatic response in a case of metastatic myoepithelial carcinoma with Ewing sarcoma breakpoint region 1-POU class 5 homeobox 1 (EWSR1-POU5F1) fusion arising from the left kidney using the Ewing Sarcoma vincristine, doxorubicin, cyclophosphamide/ifosfamide, etoposide (VDC/IE) chemotherapy regimen. Ten months post-treatment, the patient showed ~90% reduced disease burden on imaging. Subsequent treatment included consolidation vincristine, cyclophosphamide/ifosfamide, etoposide (VC/IE) chemotherapy, surgical resection of the remnant tumor, and follow-up imaging. CONCLUSION: The patient has been disease-free for 44 months off treatment and 5 years post-treatment initiation. To our knowledge, this is the first report of long-term disease-free survival in metastatic primary renal myoepithelial carcinoma. We also review the literature on this rare disease.
Botulinum toxin A in idiopathic overactive bladder: a narrative review of 5410 cases.
Lachkar S, Ibrahimi A, Boualaoui I … +2 more , Sayegh HE, Nouini Y
Can J Urol · 2025 Jun · PMID 40567082 · Publisher ↗
INTRODUCTION: When conservative treatments fail, botulinum toxin A (BoNT-A) is an option for refractory idiopathic overactive bladder (OAB). This review evaluates the efficacy, safety, and predictive factors for BoNT-A i...
INTRODUCTION: When conservative treatments fail, botulinum toxin A (BoNT-A) is an option for refractory idiopathic overactive bladder (OAB). This review evaluates the efficacy, safety, and predictive factors for BoNT-A in this situation. MATERIALS AND METHODS: A literature search up to January 2025 was performed using PubMed, Google Scholar, and Embase to assess efficacy, safety, and predictors of adverse events (AE) related to BoNT-A. The risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool for randomized studies and the Critical Appraisal Skills Programme (CASP) checklist for cohort studies. The quality of the review was evaluated based on the Oxford criteria, following the Strengthening the Assessment of Narrative Review Articles (SANRA) guidelines, and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews. RESULTS: 31 studies were included, involving 5410 patients. BoNT-A improves OAB symptoms even after reinjections. Higher doses do not enhance efficacy but increase AE. AE includes high post-void residual (PVR), clean intermittent self-catheterization (CISC), and Urinary Tract Infection (UTI). Predictors of CISC include age, male gender, hysterectomy, ≥3 vaginal deliveries, mixed incontinence, prior mid-urethral sling (MUS), high PVR, low Pressure at Pdet at First Micturition (PIP1) in women, low Bladder Compliance Index (BCI) in men, and high Bladder Outlet Obstruction Index (BOOI). Diabetes and heart failure increase PVR. UTIs are more frequent in women and men with benign prostatic hyperplasia, with CISC increasing the risk fivefold. Severe complications are rare. Predictors of poor response include male gender, high BOOI, low urinary flow, and diabetes. DISCUSSION: BoNT-A is effective for OAB, especially for incontinence. AE is dose-dependent and limits treatment adherence. Their link with poor response remains unclear. CONCLUSION: BoNT-A effectively treats refractory idiopathic OAB, improving symptoms and quality of life with repeated injections.
Survival outcomes with pelvic node dissection after partial cystectomy among octogenarians with muscle-invasive bladder cancer.
Avudaiappan AP, Prabhakar P, Baker H … +4 more , Roy MK, Ozambela M, Gomez C, Manoharan M
Can J Urol · 2025 Jun · PMID 40567081 · Publisher ↗
INTRODUCTION: Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma (MIBC); however, there is a growing interest in bladder preservation alternatives among the...
INTRODUCTION: Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma (MIBC); however, there is a growing interest in bladder preservation alternatives among the elderly population. Guidelines indicate that partial cystectomy (PC) combined with pelvic node dissection (LND) can be considered as an alternative in carefully selected individuals. Using the National Cancer Database, we analyzed the overall survival (OS) between PC with and without LND among octogenarians. METHODS: We identified octogenarians with localized muscle-invasive bladder carcinoma (cT2-3N0M0) and urothelial histology who underwent PC with or without LND between 2004 and 2018. Based on the number of lymph nodes removed (LNR), the LND group was further subdivided into <10 and >=10 lymph node groups. A propensity-matched Kaplan-Meier survival analysis was performed to compare OS between these groups. RESULTS: Among 2573 patients who underwent PC, 492 octogenarians met our selection criteria. 208 (42.2%) had LND, while 284 (57.8%) had no LND. Within the LND group, 53 (25.5%) had <10 LNR, and 155 (74.5%) had >=10 LNR. The median OS for the matched LND and non-LND groups was 36.9 and 33.4 months (p = 0.96), respectively. Similarly, <10 LNR and >=10 LNR had 36.9 and 43.5 months (p = 0.42), respectively. Multivariate Cox regression analysis revealed no difference in the risk of mortality. CONCLUSION: Among octogenarians who underwent PC, there was no significant difference in OS between those with or without LND, and between <10 or >=10 LNR groups. Therefore, the role and extent of LND after PC need further exploration in this subset of the population.
Comparing functional outcomes of glansectomy with or without glans reconstruction.
Murányi M, Domoszlai A, Nagy AC … +1 more , Flaskó T
Can J Urol · 2025 Apr · PMID 40331261 · Publisher ↗
INTRODUCTION: We aimed to compare the oncological and functional outcomes of glansectomy and split-thickness skin graft reconstruction (GR) with those of glansectomy alone (GA) and penile amputation (PA). MATERIALS AND M...
INTRODUCTION: We aimed to compare the oncological and functional outcomes of glansectomy and split-thickness skin graft reconstruction (GR) with those of glansectomy alone (GA) and penile amputation (PA). MATERIALS AND METHODS: This retrospective study included patients with penile carcinoma or penile intraepithelial neoplasia diagnosed between 2017 and 2022. Surgical outcomes, complications, and oncological outcomes were assessed through a chart review, and functional outcomes were assessed using a questionnaire administered to patients who underwent GR (group A), GA (group B), or PA (group C). RESULTS: Six, eight, and seven patients were enrolled in groups A, B, and C, respectively. Their complication rates were 0%, 25%, and 29%, respectively; margin positivity rates were 17%, 13%, and 0%, respectively; and local recurrence rates were 0%, 0%, and 14%, respectively. Logistic regression analysis showed that being in group A rather than C was a significant predictor of favorable erectile function (p = 0.007) and cosmetic outcomes (p = 0.030). However, being in group A rather than B was not a significant predictor of favorable erectile function (p = 0.127) or cosmetic outcomes (p = 0.638). CONCLUSION: Excellent functional results were observed after GR; however, the benefits were significant only when compared with those of amputation.
Comparison of clinical effectiveness and safety of 272 µm and 365 µm holmium lasers in retrograde intrarenal surgery.
Demir DÖ, Gökkurt Y, Bürlükkara S … +4 more , Kaçan T, Yıldız AK, Bozkurt U, Karakan T
Can J Urol · 2025 Apr · PMID 40331260 · Publisher ↗
INTRODUCTION: Surgeons typically prefer 270 µm and 272 µm laser probes in retrograde intrarenal surgery (RIRS) due to the reduced deflection capacity of flexible ureterorenoscopes when using larger probe diameters. This...
INTRODUCTION: Surgeons typically prefer 270 µm and 272 µm laser probes in retrograde intrarenal surgery (RIRS) due to the reduced deflection capacity of flexible ureterorenoscopes when using larger probe diameters. This study aims to investigate the effects of 272 and 365 µm holmium laser probes on operative time, clinical efficacy, and complication rates in RIRS. MATERIALS AND METHODS: A total of 285 patients with proximal ureteral or kidney stones who met the inclusion criteria were enrolled in the study. Patients were divided into two groups based on laser probe thickness: 272 µm and 365 µm. Stone-free rates, operative time, and complication rates were compared between the groups. Factors affecting stone-free rates were analyzed using multivariate logistic regression analysis. RESULTS: Patient and stone characteristics were similar between the two groups. No significant differences were found in stone-free or complication rates. However, operative time was significantly shorter in the 365 µm probe group. In univariate analysis, risk factors for postoperative residual stones included multi-calyceal stones, lower pole stones, high Hounsfield unit (HU) values on non-contrast computed tomography, and larger stone size. In multivariate analysis, independent prognostic factors for residual stones were identified as multi-calycal stones, lower pole stones, and high HU values. CONCLUSION: Compared to 272 µm laser probes, operative time was shorter in surgeries performed with 365 µm laser probes. The 365 µm holmium laser can be effectively and safely used in the treatment of proximal ureteral and renal stones, demonstrating high clinical efficacy and safety.
Differences at diagnosis between long-term survivors and not long-term survivors in metastatic renal cell carcinoma initially treated with TKI.
Gómez-Luque MÁ, Lendínez-Cano G, Congregado-Ruiz CB … +2 more , Osman-García I, Medina-López RA
Can J Urol · 2025 Apr · PMID 40331259 · Publisher ↗
INTRODUCTION: In recent years, significant advancements in the treatment of metastatic renal cell carcinoma (mRCC) have notably extended overall survival (OS) times, particularly with the introduction of tyrosine kinase...
INTRODUCTION: In recent years, significant advancements in the treatment of metastatic renal cell carcinoma (mRCC) have notably extended overall survival (OS) times, particularly with the introduction of tyrosine kinase inhibitors (TKIs) and combination immunotherapy. However, survival outcomes in mRCC remain highly variable. MATERIALS AND METHODS: This study retrospectively analyzed clinical and demographic factors at diagnosis in patients treated for mRCC to identify predictors of long-term survival (defined as OS ≥ 48 months). Patients were categorized into long-term survivors (LTS) and non-long-term survivors (nLTS). RESULTS: The analysis revealed that factors such as better Karnofsky Performance Status (KPS), normal baseline laboratory values (e.g., hemoglobin, calcium), and the presence of lung-only metastases were significantly associated with longer survival. Conversely, comorbid conditions like hypertension and dyslipidemia, poorer KPS, and certain adverse laboratory findings were more common in the nLTS group. CONCLUSION: These findings underscore the importance of baseline prognostic factors in predicting survival outcomes and emphasize the need for personalized treatment strategies in mRCC.
The intersection of histologies: navigating the complexity of a renal collision tumor.
Henriksson T, Mitchell K, El Naili R … +1 more , Hajiran A
Can J Urol · 2025 Apr · PMID 40331258 · Publisher ↗
Renal cell carcinoma is a heterogeneous group of renal tumors characterized by several histological subtypes. Herein, we discuss an unusual case of a 55-year-old male who presented as a consultation to our urology clinic...
Renal cell carcinoma is a heterogeneous group of renal tumors characterized by several histological subtypes. Herein, we discuss an unusual case of a 55-year-old male who presented as a consultation to our urology clinic with an incidentally found renal mass. After shared decision making patient proceeded with a Robotic Assisted Laparoscopy (RAL) left sided partial nephrectomy. Final pathology confirmed the presence of high nuclear grade mixed clear cell and papillary renal cell carcinoma (RCC) of the left kidney (pT3aN0M0). This case elucidates a very rare incidence of a patient seen to have a collision tumor, and furthermore demonstrates guideline-based treatment.
The cost and guideline adherence of direct-to-consumer telemedicine companies offering gender-affirming hormone therapy.
Sellke N, Jesse E, Dubin JM … +6 more , Medved TD, Basti NS, Ramchandra J, Brannigan RE, Halpern JA, Thirumavalavan N
Can J Urol · 2025 Apr · PMID 40331257 · Publisher ↗
INTRODUCTION: Direct-to-consumer (DTC) telemedicine has emerged as an option for transgender patients seeking gender affirming hormone therapy (GAHT). We aimed to characterize the healthcare services provided by DTC tele...
INTRODUCTION: Direct-to-consumer (DTC) telemedicine has emerged as an option for transgender patients seeking gender affirming hormone therapy (GAHT). We aimed to characterize the healthcare services provided by DTC telemedicine companies offering GAHT and to compare their costs to a tertiary care center. METHODS: We identified DTC telemedicine platforms offering GAHT via internet searches and extracted information from their websites related to evaluation, treatment, monitoring, and cost. Cost of the DTC GAHT was compared to cost for comparable services at a tertiary care center. RESULTS: Six DTC companies were identified. All platforms utilized an informed consent model without prerequisite mental health evaluation for GAHT. Platforms did not provide comprehensive mental health services. All platforms endorsed the use of regular follow up visits throughout the treatment period although interval of laboratory assessment varied. Cost estimates were comparable for uninsured patients and higher compared to those for insured patients. Cost estimates were lowest with private and public insurance at the tertiary center. CONCLUSIONS: DTC telemedicine platforms offering GAHT appear to be in line with the recently released World Professional Association for Transgender Health standards of care regarding the laboratory evaluation and monitoring, but it is unclear whether they are compliant with other recommendations. These platforms offer competitive costs for TGD patients without insurance.
Emergency room management of urolithiasis: a sex-based comparison.
Shilling M, Faber LS, Doan H … +4 more , Peckham M, Petersen TR, Ehsanian R, Alba F
Can J Urol · 2025 Apr · PMID 40331256 · Publisher ↗
INTRODUCTION: Existing literature has highlighted disparities in acute pain management across racial and sex groups in both emergency department and pre-hospital settings. This study aimed to evaluate prescribing pattern...
INTRODUCTION: Existing literature has highlighted disparities in acute pain management across racial and sex groups in both emergency department and pre-hospital settings. This study aimed to evaluate prescribing patterns among physicians and advanced practice providers for patients with upper tract urolithiasis in an academic emergency department. MATERIALS AND METHODS: Retrospective chart review of patients diagnosed with upper tract urolithiasis was performed to evaluate age, sex, race, ethnicity, stone size and location, presence of hydronephrosis, admission status, history of prior nephrolithiasis, medications administered in the emergency department (ED), requests for urology consult or referral, and discharge medications. RESULTS AND CONCLUSIONS: In this single-center, propensity-matched analysis, we found no significant sex, race, or provider level of training-based differences in prescribing patterns for patients presenting with renal colic secondary to upper urinary tract stones in our academic emergency department.
Sacrocolpopexy in urology versus gynecology: a contemporary analysis of outcomes and patient profiles.
Shah YB, Capella CE, Simhal RK … +3 more , D'Amico MJ, Smith W, Murphy AM
Can J Urol · 2025 Mar · PMID 40194938 · Publisher ↗
INTRODUCTION: With the aging population, more females will suffer from pelvic organ prolapse. Both urologists and gynecologists perform sacrocolpopexy, but there is no comparative study analyzing differences in provision...
INTRODUCTION: With the aging population, more females will suffer from pelvic organ prolapse. Both urologists and gynecologists perform sacrocolpopexy, but there is no comparative study analyzing differences in provision of care, outcomes, or patient population. We aimed to elucidate potential differences in demographics, outcomes, and minimally invasive surgery utilization for SCP performed by urology and gynecology. METHODS: In our retrospective analysis, sacrocolpopexies were identified using the American College of Surgeons National Surgical Quality Improvement Project database from 2006-2020. Pearson's chi-square test was performed to test trends in the utilization of MIS in five-year blocks. Frailty was calculated using the NSQIP modified frailty index and the revised surgical Risk Analysis Index. Univariate analysis was performed using Student's t-test and Pearson's chi-square to compare operative parameters, frailty, demographics, and outcomes. RESULTS: We identified 8944 sacrocolpopexies. Gynecology performed 81% of cases while urology performed the remaining 19% (p < 0.001). Between the specialties, there were no significant differences in outcomes, minor or major complications, or 30-day reoperations/hospital readmissions/mortality. However, urologists tended to care for patients who were older (65 vs. 61 years, p < 0.001) and frailer by both frailty indices (p < 0.001). CONCLUSION: Case distributions have remained stable, with gynecologists four-fold more sacrocolpopexies, in keeping with the larger number of practicing gynecologists vs. urologists. There was no difference in 30-day outcomes between both specialties. However, urologists operated on older, more frail patients.
Transperineal prostate biopsy without routine antibiotics demonstrates decreased infection risk.
Lichtbroun BJ, Patel M, Consalvo A … +12 more , Khizir L, Said M, Chien A, Chua K, Pfail J, Passarelli R, Packiam VT, Golombos D, Elsamra S, Jang TL, Srivastava A, Ghodoussipour S
Can J Urol · 2025 Mar · PMID 40194937 · Publisher ↗
INTRODUCTION: Infections are the most feared complication of transrectal prostate biopsies, along with growing concerns of antibiotic resistance. Our institution transitioned to a transperineal approach without use of pe...
INTRODUCTION: Infections are the most feared complication of transrectal prostate biopsies, along with growing concerns of antibiotic resistance. Our institution transitioned to a transperineal approach without use of perioperative antibiotics or bowel preparations. We aimed to compare the safety outcomes associated with transperineal and transrectal prostate biopsy techniques. MATERIALS AND METHODS: A retrospective analysis of patients who underwent transrectal and transperineal prostate biopsies at our institution from 2019-2022 was performed. RESULTS: We identified 319 patients-174 transrectal and 145 transperineal. 8 patients who had transperineal biopsy (5.5%) received peri-operative antibiotics, compared to 100% with transrectal biopsy. 35.86% of transperineal patients received a bowel preparation, compared to 100% in the transrectal group. 44.14% and 49.43% of patients received a prior prostate biopsy in the transperineal and transrectal groups, respectively. Patients in the transperineal biopsy group had zero infectious complications, 1 ER visit, and zero 30-day readmissions. This is compared to 9 infectious complications (5.17%, p = 0.005), 8 ER visits (4.60%, p = 0.036), and 7 30-day readmissions (4.02%, p = 0.015) in the transrectal group. CONCLUSIONS: In a single institution series, patients undergoing transperineal biopsy had fewer infectious complications compared to those undergoing transrectal biopsy. Despite only a small percentage of patients receiving perioperative antibiotics and a majority of patients not receiving a bowel preparation in the transperineal group, there were zero infectious complications or 30-day readmissions. With greater infectious complications with transrectal biopsy and growing antibiotic resistance, we underline the safety of transperineal prostate biopsy which can largely be done without perioperative antibiotics or a bowel preparation.
Perivascular epithelioid cell neoplasm of the bladder with peritoneal metastasis.
Arnold PJ, Spio M, Youssef R … +2 more , Dehner C, Rice K
Can J Urol · 2025 Mar · PMID 40194936 · Publisher ↗
Perivascular epithelioid cell tumors (PEComas) are a diverse group of mesenchymal neoplasms. While they have been described throughout the genitourinary system, PEComas are quite rare within the bladder. We present the c...
Perivascular epithelioid cell tumors (PEComas) are a diverse group of mesenchymal neoplasms. While they have been described throughout the genitourinary system, PEComas are quite rare within the bladder. We present the case of a 37-year-old male who presented in clot retention and was found to have a bladder PEComa. Staging images seemingly demonstrated solid tumor confinement to the bladder and pelvis. Intraoperative pathology revealed peritoneal metastasis. The patient underwent a pelvic mass excision and partial cystectomy. The patient had plans for adjuvant chemotherapy, but later returned to the hospital and passed away from acute hypoxic respiratory failure.
Diagnosis and management of a rare paratesticular venous malformation in a pediatric patient.
Leslie DC, Ramakrishnan VM, Putra J … +2 more , Paltiel HJ, Thaker H
Can J Urol · 2025 Mar · PMID 40194935 · Publisher ↗
A 14-year-old presented with an asymptomatic left testicular mass after a brief episode of pain. Examination showed a non-tender left testis that was significantly larger than the right. Ultrasound revealed a 4.5-cm avas...
A 14-year-old presented with an asymptomatic left testicular mass after a brief episode of pain. Examination showed a non-tender left testis that was significantly larger than the right. Ultrasound revealed a 4.5-cm avascular mass and an absence of normal testicular parenchyma. Tumor markers were unremarkable. A CT scan demonstrated no lymphadenopathy but identified a prominent left spermatic cord. Due to a suspicion of chronic torsion vs. malignancy, a left radical orchiectomy was performed. Pathology identified a hemorrhagic paratesticular venous malformation without signs of germ cell neoplasia, a rare entity.
Post-operative outcomes in rectourethral fistula repair using gracilis interposition flap.
Yankelevich G, Swaim J, Coate I … +5 more , Stroud M, Stallings W, George V, Tavana ML, Clarke H
Can J Urol · 2025 Mar · PMID 40194934 · Publisher ↗
OBJECTIVES: To assess outcomes of rectourethral fistula repair utilizing a gracilis flap in a largely radiated cohort. PATIENTS AND METHODS: We performed a retrospective review of all gracilis interposition flap reconstr...
OBJECTIVES: To assess outcomes of rectourethral fistula repair utilizing a gracilis flap in a largely radiated cohort. PATIENTS AND METHODS: We performed a retrospective review of all gracilis interposition flap reconstruction surgeries performed for RUF at a university hospital in South Carolina between January 2010 and June 2023. All repairs utilized a multidisciplinary approach with urology, colorectal, and plastic surgery teams. Post-operatively, patients were maximally drained with foley catheter and suprapubic tube (SPT). Initial voiding cystourethrogram (VCUG) was performed at 4 weeks post-repair. If there was a persistent leak, catheter drainage was maintained for 4 additional weeks and VCUG was repeated. Success was defined as absence of leak on VCUG within 3 months after surgery. RESULTS: 22 patients met inclusion criteria. 68% of patients had history of external beam radiation therapy (EBRT), 13.6% had brachytherapy, and 40.9% had cryotherapy. Initial post-operative VCUG was negative in 10 patients (45.5%). Of the 12 patients with a persistent fistula, 5 (42%) had no evidence of fistula on subsequent VCUG after 4 weeks. Overall, 68% of patients were successfully treated with gracilis interposition flap. There was a significant difference of repair success based on EBRT status (p < 0.05). CONCLUSIONS: We report a success rate of 68% for gracilis flap repair of RUF. Our cohort had a higher rate of prior radiation therapy compared to other studies. A clinically significant portion of patients with an initial positive VCUG will seal their fistula with prolonged catheter drainage. Gracilis interposition flap is a reasonable surgical treatment for RUF.
Safety of nadofaragene firadenovec-vncg: review of data from phase 2 and phase 3 studies.
Konety BR, Lotan Y, Myers A
Can J Urol · 2025 Mar · PMID 40194933 · Publisher ↗
INTRODUCTION: Non-muscle-invasive bladder cancer (NMIBC) is a common malignancy worldwide. While Bacillus Calmette-Guérin (BCG) is standard of care for treatment for most patients with high-risk NMIBC, many will either n...
INTRODUCTION: Non-muscle-invasive bladder cancer (NMIBC) is a common malignancy worldwide. While Bacillus Calmette-Guérin (BCG) is standard of care for treatment for most patients with high-risk NMIBC, many will either not respond to BCG initially or will eventually develop BCG-unresponsive disease. A treatment option in BCG-unresponsive disease is nadofaragene firadenovec-vncg (Adstiladrin), a nonreplicating adenoviral vector-based gene therapy approved by the US Food and Drug Administration (FDA) for the treatment of adults with high-risk BCG-unresponsive NMIBC with carcinoma in situ with or without papillary tumors. OBJECTIVE: To review safety outcomes of participants who received the FDA-approved dose of nadofaragene firadenovec (3 × 10 vp/mL) across phase 2 (NCT01687244) and phase 3 (NCT02773849) studies. METHODS: Data from the phase 2 and phase 3 studies were collected and analyzed. The findings were reported using descriptive statistics to summarize the key outcomes observed across studies. RESULTS: Common adverse events (AEs) among nadofaragene firadenovec recipients were leakage of fluid around the urinary catheter, fatigue, bladder spasm, chills, dysuria, and micturition urgency. Most study drug-related AEs were mild and localized, with no grade 4 or 5 study drug-related AEs observed in either study. Study drug-related AEs were generally transient, with most study drug-related AEs having a median duration of ≤2.0 days in the phase 3 study. Discontinuation rates due to study drug-related AEs were low, with none (0%) in the phase 2 study and three (1.9%) in the phase 3 study. No specific postmarketing surveillance was required by the FDA besides routine pharmacovigilance monitoring; no new real-world safety signals have been observed. CONCLUSION: Nadofaragene firadenovec demonstrated a favorable and tolerable safety profile across its clinical study program, allowing for broad patient selection among those with high-risk BCG-unresponsive NMIBC.
Mind matters: how anxiety and depression shape low-risk prostate cancer active surveillance adherence in a real-world population.
Taylor Z, Meyer K, Terrenzio D … +6 more , Wong R, Larson S, Kjelstrom S, Contoreggi N, Belkoff L, Zeltser I
Can J Urol · 2025 Mar · PMID 40194932 · Publisher ↗
PURPOSE: While the mental health impact of a prostate cancer diagnosis, including low-risk prostate cancer, is well-documented, the effect of pre-existing anxiety and/or depression on adherence to active surveillance pro...
PURPOSE: While the mental health impact of a prostate cancer diagnosis, including low-risk prostate cancer, is well-documented, the effect of pre-existing anxiety and/or depression on adherence to active surveillance protocols in low-risk prostate cancer patients remains unclear. This study assessed the association between prior anxiety and/or depression and active surveillance adherence in men with low-risk prostate cancer. METHODS: We conducted a retrospective, multicenter study involving 426 men diagnosed with low-risk prostate cancer who were recommended active surveillance as the primary management strategy. Active surveillance adherence was defined by completion of both a prostate-specific antigen test and a prostate biopsy within 18 months of diagnosis. Premature treatment was identified as definitive treatment, either through radiation therapy or radical prostatectomy. RESULTS: Men with a prior mental health diagnosis were significantly less likely to adhere to active surveillance than those without such a diagnosis (27.6% vs. 49.5%, p = 0.006). These individuals had lower adherence rates for prostate-specific testing (58.6% vs. 73.4%) and biopsy (27.6% vs. 50.0%) and were more likely to abandon active surveillance in favor of immediate treatment (39.7% vs. 25.0%, p = 0.005). No significant differences were observed between patients with both anxiety and depression versus those with a single diagnosis. CONCLUSIONS: Pre-existing anxiety and/or depression is associated with reduced active surveillance adherence and a greater likelihood of premature treatment in men with low-risk prostate cancer. These findings highlight the importance of addressing psychiatric factors in low-risk prostate cancer management and suggest avenues for future research.
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