Khanmammadova N, Wang J, Jiang D
… +13 more, Afyouni AS, O'Leary M, Myklak K, Hanna K, Chu TY, Gomez RKM, Gao A, Nguyen TT, Ali SN, Fung C, Nguyen C, Shahait M, Lee DI
OBJECTIVE: To prospectively assess the feasibility, safety, and cost-effectiveness of a same-day discharge (SDD) pathway for multiport (MP) robot-assisted simple prostatectomy (RASP). METHODS: Data from 48 consecutive pa...OBJECTIVE: To prospectively assess the feasibility, safety, and cost-effectiveness of a same-day discharge (SDD) pathway for multiport (MP) robot-assisted simple prostatectomy (RASP). METHODS: Data from 48 consecutive patients undergoing MP-RASP between July 2021 and August 2025 were prospectively collected. All patients followed an Enhanced Recovery After Surgery protocol. We utilized a bladder neck-sparing technique with a transperitoneal approach and robotic transversus abdominis plane block. Healthcare utilization data consisted of postoperative calls/messages and unplanned visits. We also report average institutional costs for SDD versus inpatient RASP. RESULTS: Forty of forty-eight (83%) patients were discharged same-day. Eight (17%) stayed overnight: six for patient preference and two for hematuria. Subsequent analyses included SDD patients only. The median operative time was 131 (115-147) minutes, and the median length of hospital stay was 141 (114 - 173) minutes with a median pain score at discharge of 3 (0 - 4). There were no perioperative complications. Two (5%) patients were readmitted within 30 days. During the first week, four (10%) patients visited the emergency room or clinic. Six (15%) patients contacted their care team on postoperative day 1 (three for medication-related questions, two for catheter issues, and one regarding surgery). The direct cost per case was 33% lower for SDD RASP, with a greater revenue-to-cost ratio at 149% compared to 115%. CONCLUSION: MP-RASP with SDD is safe and feasible, providing favorable outcomes with reduced hospital stay and lower costs.
Cystic fibrosis (CF) is primarily recognized for its severe systemic effects, especially in the lungs, pancreas and digestive tract. Thus, the effect of CF transmembrane conductance regulator (CFTR) dysfunction on male f...Cystic fibrosis (CF) is primarily recognized for its severe systemic effects, especially in the lungs, pancreas and digestive tract. Thus, the effect of CF transmembrane conductance regulator (CFTR) dysfunction on male fertility has been relatively overlooked despite its important roles in spermatogenesis orchestration and spermatozoa function. CFTR has physiological functions as a chloride and bicarbonate channel and a role in regulating water movement. CFTR participates in spermatogenesis, and evidence suggests its involvement in seminiferous intratubular fluid control, maintenance of the blood-testis barrier, and improvement in follicle-stimulating hormone signalling, among other functions. Emerging evidence also suggests that CFTR variant carriers, typically considered to be healthy, have reduced sperm quality. Diminished CFTR expression has been observed in spermatozoa from men with various sperm quality abnormalities (teratozoospermia, asthenozoospermia and oligozoospermia), and correlates positively with sperm motility and morphology. CFTR is thought to be involved in sperm capacitation and osmoregulation via interactions with ion and water channels. Advances in CF therapy, such as CFTR modulators, gene therapy and liposome-mediated CFTR delivery, might affect CFTR's role in sperm function and could potentially be applied to improve the fertility of individuals with CFTR dysfunction.
OBJECTIVE: To evaluate the oncologic benefit of the extent of lymphadenectomy at the time of radical cystectomy (RC) for bladder cancer. Although two randomized clinical trials have reported no difference in disease-free...OBJECTIVE: To evaluate the oncologic benefit of the extent of lymphadenectomy at the time of radical cystectomy (RC) for bladder cancer. Although two randomized clinical trials have reported no difference in disease-free or overall survival for extended LND (eLND) compared to standard LND (sLND), real-world data are lacking. We therefore emulated a pragmatic clinical trial using a large, nationwide dataset. METHODS: We used SEER-Medicare to emulate the LEA AUO AB 25/02 clinical trial. We identified adults 66-79 years diagnosed with high-grade T1 or cT2-T4a, Nany, M0 urothelial carcinoma of the bladder from 2000-2017 and treated with RC with LND. sLND and eLND were defined as removal of 4-11 and >12 lymph nodes, respectively. A propensity score (PS) was estimated for receipt of eLND. Associations of LND type with cancer-specific (CSS) and overall survival (OS) were evaluated. RESULTS: A total of 1,204 patients were included in the study cohort, of whom 794 underwent eLND and 410 underwent sLND. Pre-treatment characteristics were well-balanced after PS adjustment. Compared to sLND, eLND was not associated with a statistically significant difference in 5-year CSS (68% vs 64%; HR 0.83, 95% CI 0.64-1.06; p=0.14) or OS (56% vs 55%; HR 0.82; 95% CI 0.68-1.01; p=0.06). Results were similar when examining heterogeneity of treatment effects according to T stage, pN stage and age. CONCLUSIONS: In observational analyses designed to emulate the completed LEA AUO AB 25/02 trial, eLND was not associated with improved CSS or OS compared to sLND among patients undergoing RC.
BACKGROUND: Minimally invasive surgical therapies for benign prostatic hyperplasia (BPH) are increasingly utilized but may have limited long-term durability, leading some patients to require re-treatment. Holmium laser e...BACKGROUND: Minimally invasive surgical therapies for benign prostatic hyperplasia (BPH) are increasingly utilized but may have limited long-term durability, leading some patients to require re-treatment. Holmium laser enucleation of the prostate (HoLEP) is a size-independent option, but outcomes after prior BPH intervention remain incompletely characterized. We compared perioperative, postoperative, and functional outcomes of HoLEP in re-treatment versus treatment-naïve HoLEP. METHODS: We performed a retrospective cohort study of patients undergoing HoLEP at a tertiary center between February 2021 and August 2025. Patients with prior surgical or minimally invasive BPH interventions were propensity score-matched 1:1 to treatment-naïve patients by prostate specimen weight. Perioperative variables, postoperative outcomes, and functional measures were compared. RESULTS: We identified 418 re-treatment patients who were matched to 418 treatment-naïve controls. Re-treatment patients were older and had higher rates of prior urinary retention and urinary tract infection. Operative time, laser energy usage, and intraoperative complication rates were similar between cohorts. Overall, 90-day complication rates did not differ (6.5% vs. 5.5%, p = 0.66), though emergency department visits were more frequent in re-treatment patients (9.1% vs. 5.3%, p = 0.044). Both groups experienced comparable improvements in American Urological Association symptom and quality of life scores. Postoperative Michigan Incontinence Symptom Index severity scores were lower in the re-treatment cohort (4.9 ± 6.1 vs. 6.4 ± 6.5, p = 0.038). CONCLUSIONS: HoLEP performed after prior BPH intervention demonstrates perioperative safety and functional outcomes comparable to treatment-naïve HoLEP, supporting its role as a durable and effective treatment for recurrent or persistent BPH symptoms.
BACKGROUND: This study aimed to compare the outcomes of laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) for the treatment of multiple ipsilateral renal tumours (MIRT). The primary out...BACKGROUND: This study aimed to compare the outcomes of laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) for the treatment of multiple ipsilateral renal tumours (MIRT). The primary outcomes were perioperative results, including the rate of postoperative complications and 'Trifecta' achievement. The secondary outcomes included renal functional preservation and oncological survival. METHODS: We retrospectively analysed the data of patients with MIRT who underwent LPN or RAPN between 2010 and 2024. Propensity score matching (1:1) was performed to adjust for potential baseline confounders, resulting in a final matched cohort of 19 patients per group. Perioperative data and functional, oncological, and survival outcomes were reviewed. RESULTS: In the matched cohort, the RAPN group was associated with significantly fewer postoperative complications (10.5% vs. 47.4%, P = 0.029). Notably, 88.9% (8/9) of the complications in the LPN group were Clavien-Dindo grade I. The RAPN group also showed a higher 'Trifecta' rate (63.2% vs. 21.1%, P = 0.020) and shorter postoperative hospital stay (4 vs. 6 days; P = 0.044). At 12 months postoperatively, the RAPN group demonstrated significantly lower absolute (9.1 vs. 18.4 µmol/L, P = 0.041) and percentage changes (12.0% vs. 25.9%, P = 0.024) in serum creatinine (Scr). No significant differences were identified in disease-free survival (P = 0.386), cancer-specific survival (P = 0.678), or overall survival (P = 0.116). CONCLUSIONS: For patients with MIRT, RAPN demonstrates superior perioperative results and better preservation of renal function compared to LPN. These findings support the use of robotics as the preferred minimally invasive strategy for complex cases with two ipsilateral renal lesions, potentially enhancing surgical safety and functional outcomes.
OBJECTIVE: To identify molecular features associated with earlier progression to definitive therapy amongst patients with localized prostate cancer (PCa) managed on active surveillance (AS). METHODS: We performed a retro...OBJECTIVE: To identify molecular features associated with earlier progression to definitive therapy amongst patients with localized prostate cancer (PCa) managed on active surveillance (AS). METHODS: We performed a retrospective pilot study of seven patients with low- to intermediate-risk PCa undergoing serial multiparametric MRI (mpMRI)-targeted biopsies of the same lesion while on AS who all proceeded to definitive therapy. Time-to-treatment (TTT) was defined as years from first biopsy on AS to definitive therapy. Laser-capture microdissection was used to separate tumor epithelium, benign glands, high-grade prostatic intraepithelial neoplasia, and stroma in each biopsy specimen. DNA from tumor and matched benign tissue underwent whole-exome sequencing and RNA from all compartments underwent whole-transcriptome sequencing. Somatic mutations and copy-number alterations were compared across serial biopsies, used to reconstruct phylogenies, and quantify clonal complexity. RESULTS: Tumors exhibited substantial intratumoral heterogeneity, and in three of six paired cases, serial mpMRI-targeted biopsies showed discordant somatic profiles consistent with sampling distinct major clones over time. By contrast, no single gene-level alteration, and few large-scale chromosomal events, were associated with TTT. High clonal complexity, defined as ≥3 subclones, was associated with significantly shorter TTT than low complexity (median 1.9 vs. 7.2 years; P = 0.0082). Exploratory pathway analyses of individual tissue components suggested TTT-associated differences in inflammatory signaling and stromal-epithelial cross-talk. CONCLUSION: In this small, hypothesis-generating cohort, clonal complexity was more closely associated with earlier definitive therapy than individual genomic alterations. Larger prospective studies are needed to validate whether multiomic measures of clonal architecture can improve AS risk stratification.
OBJECTIVES: To describe injury patterns, management, and outcomes of anterior urethral injuries secondary to gunshot wounds over seven years at a Level I trauma center. METHODS: We retrospectively identified men with ant...OBJECTIVES: To describe injury patterns, management, and outcomes of anterior urethral injuries secondary to gunshot wounds over seven years at a Level I trauma center. METHODS: We retrospectively identified men with anterior urethral injuries secondary to gunshot wounds who underwent retrograde urethrogram between May 2018 and October 2025. Management and outcomes were analyzed. RESULTS: Nineteen men sustained penetrating anterior urethral injuries due to gunshot wounds. Injury locations included bulbar (11), penile (7), and both (1). Bulbar injuries were most often managed with catheterization or suprapubic drainage (75%, 9/12); 78% (7/9) healed without further intervention, while two required repairs (one planned for extensive injury and one for persistent leak). The three patients who underwent urgent bulbar reconstruction all had concomitant genitourinary injuries requiring operative management. Among penile injuries, 63% (5/8) underwent primary repair with no subsequent strictures or leaks. Of the remaining patients, two developed persistent leaks requiring prolonged catheterization, and one required planned two-stage repair. Concomitant corporal body injury occurred in 88% (7/8) of penile injuries, and scrotal trauma occurred in 42% (8/19) of all cases. Overall, delayed urethroplasty was performed in 16% (3/19). One patient reported new mild-to-moderate erectile dysfunction, and all ultimately voided spontaneously. CONCLUSIONS: This represents the largest contemporary series of anterior urethral trauma secondary to gunshot wounds. Our findings support early primary repair for penile urethral injuries, while catheter drainage with selective delayed reconstruction may be appropriate for bulbar injuries in appropriately selected patients. Associated corporal body and scrotal injuries warrant consideration during initial evaluation.
OBJECTIVE: To understand patterns in private equity (PE) acquisition of urology practices based on the Social Vulnerability Index (SVI), a composite, area-level measurement reflecting the following themes: socioeconomic...OBJECTIVE: To understand patterns in private equity (PE) acquisition of urology practices based on the Social Vulnerability Index (SVI), a composite, area-level measurement reflecting the following themes: socioeconomic status, household characteristics, racial & ethnic minority status, and housing & transportation type. METHODS: We identified PE-owned urology practices by cross-referencing multiple sources. We linked the SVI for census tracts with and surrounding a PE practice (census places). We used multilevel, multivariable logistic regression to predict the probability of PE acquisition for a census tract within a census place based on SVI and its separate themes, adjusted for urban/non-urban designation and physician office density. RESULTS: We identified 349 census tracts containing at least one PE practice and 11,868 census tracts in the same census places with no PE practices. There was no statistically significant association between the composite SVI measurement and PE acquisition (False Discovery Rate (FDR)-adjusted p=0.390). In exploratory analysis, we found that census tracts with lower socioeconomic status and more racial and ethnic minorities were associated with a significantly lower probability of PE acquisition, although to only a small degree (FDR-adjusted p=0.003 and p=0.002, respectively). CONCLUSION: Composite social vulnerability index was not associated with PE acquisition of urology practices.
PURPOSE: To investigate the factors associated with variant histology (VH) and prognostic significance of VH in urothelial carcinoma (UC) among patients undergoing radical cystectomy (RC) with ileal conduit urinary diver...PURPOSE: To investigate the factors associated with variant histology (VH) and prognostic significance of VH in urothelial carcinoma (UC) among patients undergoing radical cystectomy (RC) with ileal conduit urinary diversion. METHODS: A retrospective analysis was conducted on 317 patients who underwent RC with ileal conduit diversion between 2019 and 2025. Patients were categorized based on the presence of VH in the final pathology. Demographic, clinical, perioperative, and pathological data were compared. Logistic regression was performed to identify factors associated with VH, while Kaplan-Meier and uni-multivariable Cox regression analyses evaluated overall survival (OS) and cancer-specific survival (CSS). RESULTS: VH was detected in 139 patients (43.8%), with squamous differentiation being the most prevalent variant, observed in 80 patients of the 317 patients who underwent RC with ileal conduit urinary diversion. Presence of hydronephrosis, clinical lymph node positivity and WBC > 7695 g/dl were defined as factors associated with VH in multivariate logistic regression analysis. Kaplan-Meier survival analysis illustrated a statistically significant reduction in OS and CSS among patients harboring VH compared to those with pure UC following RC and ileal conduit urinary diversion (53.8 vs. 36.8 months for OS and 68 vs. 53 months for CSS, log-rank test, p < 0.001). Multivariable Cox regression analysis revealed that presence of variant histology was associated with reduced OS (HR = 1.624; 95% CI = 1.094-2.411; p = 0.016) and CSS (HR = 1.945; 95% CI = 1.043-3.626; p = 0.036). CONCLUSION: VH in UC is associated with advanced disease and poorer survival outcomes following RC. Certain preoperative factors-hydronephrosis, clinical lymphadenopathy, and elevated WBC-may be associated with the presence of VH. Early recognition of these features could guide individualized treatment strategies and improve prognostic assessment. However, the retrospective and single-center nature of this study may introduce selection and information bias, and the findings should be interpreted with caution until validated by prospective multicenter trials.
OBJECTIVE: To evaluate whether high-frequency ultrasound (HF-US) and ultrasound-guided core needle biopsy (CNB) can accurately detect muscle-invasive bladder cancer (MIBC) in an ex-vivo setting. METHODS: In this prospect...OBJECTIVE: To evaluate whether high-frequency ultrasound (HF-US) and ultrasound-guided core needle biopsy (CNB) can accurately detect muscle-invasive bladder cancer (MIBC) in an ex-vivo setting. METHODS: In this prospective study, patients undergoing radical cystectomy (RC) for urothelial carcinoma underwent ex-vivo HF-US of the extirpated bladder to assess depth of tumor invasion (ultrasound stage, usT). In a subset, HF-US guided CNB of the opened bladder targeted the deepest region of tumor invasion (cnbT). Ultrasound images and biopsy specimens were interpreted by a blinded GU-radiologist and pathologist, respectively and were compared with RC pathologic stage (pT). Co-primary endpoints were accuracy of HF-US and CNB in identifying MIBC. RESULTS: Among 54 patients, 47 underwent HF-US and 32 underwent CNB. HF-US demonstrated an accuracy of 89.6% for detecting MIBC, with sensitivity 95.0%, specificity 85.7%, and negative predictive value (NPV) 96.0%. CNB accuracy was 90.6%, with specificity and positive predictive value of 100%. In patients undergoing both modalities (n=25), a combined approach demonstrated 92.0% accuracy, 100% sensitivity, and 100% NPV. Conventional clinical staging had significantly lower accuracy (55.6%), particularly following neoadjuvant systemic therapy (40.0%). Diagnostic performance of HF-US and CNB remained high in patients treated with neoadjuvant systemic or intravesical therapy. CONCLUSIONS: HF-US and ultrasound-guided CNB were highly accurate in determining MIBC and specifically demonstrated excellent NPV. These findings support further investigation of in-vivo endoscopic ultrasound and CNB staging to improve risk stratification and treatment selection in bladder cancer.
OBJECTIVE: To prospectively assess the clinical outcomes and safety of microsurgical denervation of the penis (MSDP) for treatment of lifelong premature ejaculation (LPE); and to examine the impact of transitioning from...OBJECTIVE: To prospectively assess the clinical outcomes and safety of microsurgical denervation of the penis (MSDP) for treatment of lifelong premature ejaculation (LPE); and to examine the impact of transitioning from partial to more extensive denervation. METHODS: A prospective multicenter study including 60 men with LPE unresponsive to optimized medical treatment who underwent MSDP. The primary outcome was to assess changes in Intravaginal Ejaculatory Latency Time (IELT), Premature Ejaculation Profile (PEP), Patients' and Partners' Satisfaction scores at 1, 3, and 6 months after MSDP. The secondary outcome was to evaluate the effect of added-on medical treatment to patients who underwent MSDP without satisfactory results after 6 months. RESULTS: MSDP was associated with statistically significant increases in the mean± SD IELT [from 5.4±0.3 to 77±22, 127±35, and 125±37, p <0.001] and PEP scores [ from 3±0.2 to 9±2.2, 12.1±2.6, and 11.5±1.9, P<0.001] at 1, 3, and 6 months, and 33 (55%) were satisfied. Twenty-seven dissatisfied patients had received added-on medical therapy for 3 months. They showed a statistically significant increase in IELT [from 102±23 to 134±35.6, P <0.001], and PEP scores [from 10.6 ±1.8 to 13 ± 2.3, P=0.002], and 17 (63%) were satisfied. None of the patients developed permanent glans anesthesia, paresthesia, or erectile dysfunction. CONCLUSION: In selected men with LPE refractory to medical therapy, MSDP, with the protocol and technique modifications presented in the current study, appears to be a safe potential treatment option.
BACKGROUND: Primary adrenal lymphoma (PAL) is a rare and aggressive extranodal lymphoma that may radiologically mimic primary adrenal carcinoma, often leading to diagnostic uncertainty and potentially unnecessary surgica...BACKGROUND: Primary adrenal lymphoma (PAL) is a rare and aggressive extranodal lymphoma that may radiologically mimic primary adrenal carcinoma, often leading to diagnostic uncertainty and potentially unnecessary surgical intervention. Early tissue diagnosis is essential for accurate management. CASE PRESENTATION: A 71-year-old man was evaluated for persistent left upper quadrant abdominal pain and progressive fatigue. Cross-sectional imaging revealed a large, heterogeneous mass originating from the left adrenal gland with radiologic features suggestive of local invasion. Based on the initial radiologic impression, primary adrenal carcinoma was suspected, and surgical intervention was planned accordingly. However, further review by an experienced radiologist raised suspicion of a lymphoproliferative disorder. A computed tomography-guided core needle biopsy was subsequently performed, and histopathological analysis confirmed the diagnosis of high-grade B-cell lymphoma with a Ki-67 proliferation index of approximately 80%. The patient received six cycles of well-tolerated R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Post-treatment imaging revealed complete resolution of the adrenal mass. At the 24-month follow-up, the patient remained in complete remission, with no evidence of disease recurrence. CONCLUSIONS: This case underscores the importance of multidisciplinary assessment and image-guided biopsy in the evaluation of adrenal masses. Avoiding unnecessary surgery through early tissue diagnosis enabled effective systemic treatment. In selected patients, R-CHOP chemotherapy may result in long-term disease control, even in elderly individuals with large unilateral adrenal tumors.
Urolithiasis is increasingly common, with rising rates driven by obesity, diabetes and metabolic syndrome. Patients with cancer have additional, unique risks of stone formation owing to effects on fluid and electrolyte b...Urolithiasis is increasingly common, with rising rates driven by obesity, diabetes and metabolic syndrome. Patients with cancer have additional, unique risks of stone formation owing to effects on fluid and electrolyte balance, systemic cancer therapies, tumour lysis syndrome and anatomical alterations after urinary diversion or nephrectomy. Moreover, urolithiasis itself has been linked to increased rates of renal cell carcinoma, urothelial carcinoma and bladder cancer, potentially mediated by chronic inflammation, recurrent infections and shared metabolic or environmental factors. Management in this setting is complex and must be individualized. Percutaneous nephrolithotomy achieves the highest stone-free rates in patients with altered urinary tract anatomy, whereas retrograde intrarenal surgery and shock wave lithotripsy have more selective roles. Preventive strategies focus on thorough metabolic evaluation, hydration optimization and addressing cancer-specific risk factors such as hypercalcaemia, acidosis and chronic urinary stasis. Despite these insights, data on the epidemiology, mechanistic underpinnings and optimal management of urolithiasis in patients with cancer remain limited. Prospective studies are needed to clarify causal relationships, refine preventive strategies and develop evidence-based treatment algorithms for this growing and complex population.
OBJECTIVE: To evaluate the impact of Fear of Cancer Recurrence (FCR) on smoking cessation in patients diagnosed with bladder tumors. This study explores its potential role as a motivator for behavioral changes, specifica...OBJECTIVE: To evaluate the impact of Fear of Cancer Recurrence (FCR) on smoking cessation in patients diagnosed with bladder tumors. This study explores its potential role as a motivator for behavioral changes, specifically tobacco abstinence. SUBJECTS AND METHODS: A total of 79 patients undergoing surgical intervention for tumor treatment were included in this cross-sectional study. Smoking history and the specific motivation for cessation were documented. FCR was assessed using the Fear of Cancer Recurrence Inventory - Short Form (FCRI-SF). Statistical analysis was performed to compare FCRI-SF scores between patients who achieved smoking cessation due to their diagnosis and those who did not. RESULTS: The median age of the cohort was 55.4 years (IQR 48.0-65.5). Among the 35 patients (44.3%) with a smoking history, 12 (34.3%) successfully achieved smoking cessation specifically attributed to their tumor diagnosis. These patients reported significantly higher FCRI-SF scores (M=24.08, SD=4.01) compared to the non-cessation group (M=13.04, SD=7.75; p<.001). Notably, 100% of the patients who quit smoking reached the clinical threshold for FCR (≥13), compared to only 43.5% of those who continued smoking. High frequency of intrusive thoughts and elevated perceived risk of recurrence were the most significant drivers for those who quit. CONCLUSION: Higher levels of FCR are strongly associated with successful smoking cessation following a tumor diagnosis. Our findings suggest that clinical FCR may serve as a critical "teachable moment" for health behavior modification. Integrating smoking cessation programs into the psychological management of patients with high FCR could enhance long-term oncology outcomes.