OBJECTIVES:To assess rates of medication use for lower urinary tract symptoms (LUTS) over time following laser enucleation of the prostate (LEP) and to identify preoperative predictors of persistent use. METHODS:We retrospectively analyzed 864 LEP patients from an institutional tertiary-care database (11/2017-05/2023) with available 24-month follow-up on medication use. Patient-reported use of five drug classes (alpha-blockers, 5-alpha-reductase (AR)-inhibitors, anticholinergics, beta-3-agonists, and phosphodiesterase (PDE)-5-inhibitors) was recorded preoperatively and at one, three, 12, and 24 months after the procedure. Univariable and multivariable logistic regression models were fitted to identify predictors of persistent LUTS medication use. RESULTS:Preoperatively, 84.9% of patients used LUTS medication, decreasing to 12.6% within 24 months of follow-up. Alphablocker (80.9%) and 5-AR-inhibitor (13.8%) use declined to 1.8% and 0%, respectively. Anticholinergic (4.6%) and beta-3-agonist (0.3%) use showed a transient postoperative increase with peaks of 10.9% and 1.0% at 3 months, followed by a decline to 2.7% and 0.4% at 24 months, respectively. PDE-5-inhibitor use (1.8%) increased steadily to 5.4% at 24 months. Patient with persistent use exhibited worse baseline QoL and ICIQ-SF scores and higher rates of adiposity, diabetes mellitus, and ASA score III/IV. In multivariable analysis, only preoperative PDE-5-inhibitor use (adjusted OR 3.26, p = 0.002) and ASA score III/IV (adjusted OR 2.08, p = 0.016) remained independently associated with persistent LUTS medication use. CONCLUSION:LUTS medication use decreased substantially after LEP, with only a small subset requiring continued medication at 24 months. Preoperative PDE-5-inhibitor use and higher comorbidity burden emerged as independent predictors of persistent LUTS medication use. These findings can refine preoperative counseling regarding postoperative LUTS medication dependence.

To compare 24-month outcomes of Thulium fiber laser enucleation of the prostate (ThuFLEP) and Holmium laser enucleation of the prostate (HoLEP). A 24-month follow-up analysis of a prospective randomized trial including 150 patients (ThuFLEP n = 74, HoLEP n = 76) was conducted. Primary outcome was non-inferior International Prostate Symptom Score (IPSS) and quality of life (QoL) reduction. Secondary outcomes included urinary continence, medication use reduction, erectile and ejaculatory function, and late adverse events. At 24 months, non-inferiority of ThuFLEP regarding IPSS and QoL was confirmed (p = 0.03). Median IPSS improved from 21 preoperatively to 3 after ThuFLEP and from 20 to 4 after HoLEP (p < 0.001), with no significant intergroup differences at any time point (all p > 0.1). Median QoL improved from 4 to 1 in both groups (p < 0.001), likewise without significant differences at any time point (all p > 0.3). Continence rates improved from 74.0

To test for differences in outcomes of lower urinary tract symptoms (LUTS) between patients with and without preoperative indwelling catheter after laser enucleation of the prostate (LEP). In our tertiary-care database, patients undergoing LEP (11/2017–09/2023) were retrospectively analyzed, stratified by presence of preoperative catheter. Mixed linear models assessed International Prostate Symptom Score (IPSS) and quality of life (QoL) at 1, 3, 12, and 24 months after LEP. Multiple linear regression, adjusted for age and prostate volume, tested for differences in LUTS and QoL recovery. Among 518 patients, 132 (25

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP27)1 May 2024MP27-06 RESULTS FROM A MULTICENTER PROSPECTIVE STUDY ON THE IMPACT OF AGE ON FUNCTIONAL OUTCOMES AFTER IMPLANTATION OF A SECOND-GENERATION NITINOL TEMPORARY DEVICE (iTIND) FOR THE TREATMENT OF BPH-RELATED LUTS Sabrina Titti De Cillis, Daniele Amparore, Martin Schönthaler, Grégoire Robert, Francesco Cantiello, Fernando Gómez Sancha, Andreas Becker, Piero Tognoni, Cosimo De Nunzio, Gautier Muellhaupt, Nicolas Barry Delongchamps, Emanuel Della Negra, Henry Who, and Francesco Porpiglia Sabrina Titti De CillisSabrina Titti De Cillis , Daniele AmparoreDaniele Amparore , Martin SchönthalerMartin Schönthaler , Grégoire RobertGrégoire Robert , Francesco CantielloFrancesco Cantiello , Fernando Gómez SanchaFernando Gómez Sancha , Andreas BeckerAndreas Becker , Piero TognoniPiero Tognoni , Cosimo De NunzioCosimo De Nunzio , Gautier MuellhauptGautier Muellhaupt , Nicolas Barry DelongchampsNicolas Barry Delongchamps , Emanuel Della NegraEmanuel Della Negra , Henry WhoHenry Who , and Francesco PorpigliaFrancesco Porpiglia View All Author Informationhttps://doi.org/10.1097/01.JU.0001009400.86696.a2.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this European study was assessing the impact of age on postoperative micturition outcomes after second generation iTIND for the treatment of Benign Prostatic Hyperplasia (BPH)-related LUTS. METHODS: From 6/2018 to 9/2019 men with symptomatic BPH (International Prostate Symptoms Score (IPSS) ≥10, maximum flow rate (Qmax) <12 ml/s and prostate volume <120 ml) were enrolled in this single-arm, prospective multicenter study and underwent iTIND implantation. Demographics and baseline IPSS, QoL, Qmax and post voiding residue (PVR) were recorded. Follow-up was conducted via IPSS, QoL, Qmax and PVR assessed at 1, 3, 6 and 12 months post-operatively. For the purpose of the study patients were stratified into 3 age groups (group 1<50 yrs (not approved in US); group 2 50-69 yrs; group 3 70+ yrs) and the postoperative functional outcomes evaluated accordingly. RESULTS: 149 patients enrolled, 115 reached the 12 months follow up and were included in this analysis. Overall baseline mean (SD) IPSS, IPSS-QoL, Qmax and PVR were 20.8 (5.7), 4.1 (1.0), 8.1 (2.4) and 75.2 (86.5), respectively. At 12 months follow-up a statistically significant (p<0.001) improvement of micturition variables was recorded, reaching values of 10.0 (7.4) points for IPSS, 1.8 (1.5) for IPSS QoL, 11.7 (4.5) ml/s for Qmax and 46.0 (54.5) ml for PVR. After stratification based on age 22, 97 and 30 patients were included in group 1, group 2 and group 3. Demographics and baseline characteristics were comparable between the groups. Post implantation functional outcomes were significantly ameliorated from baseline in all groups at each follow-up timepoint (p<0.001). No statistically significant difference was encountered between groups in terms of IPSS, IPSS-QoL and PVR at each follow-up (p>0.05). Postoperative Qmax values of group 3 were lower than those reported by groups 1 and 2 at all time intervals (Figure 1), although even this difference was not statistically significant (p>0.05). CONCLUSIONS: Implantation of iTind is an effective treatment for BPH-related LUTS in patients of all age groups. Although significantly improved compared to baseline, lower Qmax values should be expected in patients aged >70 years compared to their younger counterparts. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e425 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Sabrina Titti De Cillis More articles by this author Daniele Amparore More articles by this author Martin Schönthaler More articles by this author Grégoire Robert More articles by this author Francesco Cantiello More articles by this author Fernando Gómez Sancha More articles by this author Andreas Becker More articles by this author Piero Tognoni More articles by this author Cosimo De Nunzio More articles by this author Gautier Muellhaupt More articles by this author Nicolas Barry Delongchamps More articles by this author Emanuel Della Negra More articles by this author Henry Who More articles by this author Francesco Porpiglia More articles by this author Expand All Advertisement PDF downloadLoading ...

ObjectiveTo test for differences in recovery of lower urinary tract symptoms (LUTS) between patients with storage‐positive vs ‐negative symptoms after laser enucleation of the prostate (LEP).Patients and methodsConsecutive storage‐positive (severe storage symptoms, International Prostate Symptom Score [IPSS] storage subscore >8) vs storage‐negative patients treated with LEP (November 2017–September 2022) within our tertiary‐care database were identified. Mixed linear models tested for changes in IPSS and quality of life (QoL) at 1, 3 and 12 months after LEP. Multiple linear regression models tested for LUTS and QoL recovery risk factors at 1, 3 and 12 months.ResultsOf 291 study patients, 180 (62%) had storage‐positive symptoms. There were no differences between storage‐positive and ‐negative patients in mean adjusted total IPSS, IPSS‐storage, IPSS‐voiding and QoL at 12 months after LEP. In multiple linear regression models, storage‐positive status was identified as a risk factor for higher IPSS at 1 month (β coefficient 2.98, P = 0.004) and 3 months (β coefficient 2.24, P = 0.04), as well as for more unfavourable QoL at 1 month (β coefficient 0.74, P = 0.006) and 3 months (β coefficient 0.73, P = 0.004) after LEP. Conversely, at 12 months there were no differences between storage‐positive vs ‐negative patients.ConclusionStorage‐positive patients appear to experience similar long‐term benefits from LEP compared to storage‐negative patients. However, significant storage symptoms are associated with higher total IPSS and less favourable QoL at 1 and 3 months after LEP. These findings advocate for the consideration of LEP also in storage‐positive cases with the need for thorough patient education especially in the initial post‐LEP period.

Purpose: To quantify differences in five-year overall survival (OS) between clear cell metastatic renal cell carcinoma (ccmRCC) patients and age-and sex-matched population-based controls, especially when race/ethnicity is considered. Methods: We relied on the Surveillance, Epidemiology and End Results database (2006-2016) to iden-tify newly diagnosed (2006-2011) ccmRCC patients of either Caucasian, Hispanic, African American, or Asian/Pacific Islander race/ethnicity. For each case, we simulated an age-and sex-matched control (Monte Carlo simulation), relying on Social Security Administration Life Tables with five-year follow-up. We compared OS between ccmRCC patients and controls. Multivariable Cox regression models tested for race/ethnicity effect on OS. Results: Of 3067 ccmRCC patients, 2167 (71%) were Caucasians vs. 488 (16%) Hispanics vs. 216 (7%) African Americans and 196 (6%) Asians/Pacific Islanders. At five years, OS difference between ccmRCC patients vs. population-based controls was greatest in African Americans (11 vs. 94%, A = 84%), followed by Hispanics (16 vs. 94%, A = 77%), Caucasians (16 vs. 89%, A = 73%) and Asians/Pacific Islanders (19 vs. 88%, A = 70%). In multivariable Cox regression models, African Americans exhibited highest Hazard Ratio for death (HR 1.3, p = 0.003).

Introduction: The aim of the study was to examine cancer-specific mortality (CSM) of unconventional urethral cancers. Methods: Within the SEER (2004–2016) database, we analyzed CSM of 165 patients with unconventional urethral-cancer histology. Kaplan-Meier plots were used to test the effect of unconventional histologies in urethral cancer on CSM. Results: Of 165 eligible patients, the Mullerian type accounted for 55 (33.3%) versus melanocytic (26.7%) versus neuroendocrine 25 (15.2%) versus lymphoma 22 (13.3%) versus mesenchymal/sarcoma 15 (9.1%) versus spindle cell 4 (2.1%) patients. Median age at diagnosis was 81 years in spindle cell, 75 in melanocytic, 74 in neuroendocrine and mesenchymal/sarcoma, 67 in lymphoma, and 62 years Mullerian type (p < 0.001). Of all, 116 (70.3%) were female. The Mullerian type exhibited the highest female ratio (96.4%) versus the lowest female ratio in neuroendocrine (24.0%). The Mullerian type was most frequent in African-American females. In Caucasian females, the melanocytic type was most frequent (49.1%). In African-American (38.9%) and Caucasian males (33.3%), neuroendocrine histology was most frequent. Three-year CSM was, respectively, 27.5%, 23.1% 22.3%, 20.5%, and 16.1% for melanocytic, mesenchymal/sarcoma, Mullerian type, neuroendocrine, and lymphoma histology. Median cancer-specific survival was 106 versus 10 months for combined nonmetastatic versus metastatic nonconventional histologies. Conclusion: Important age, sex, racial/ethnic group distribution, and survival differences exist between each unconventional urethral-cancer histological subtypes.

You have accessJournal of UrologyCME1 Apr 2023PD41-05 SECOND GENERATION TEMPORARY IMPLANTABLE NITINOL DEVICE (iTIND) IMPACT ON SERUM PSA LEVEL: RESULTS FROM a MULTICENTER PROSPECTIVE STUDY (MT-06-STUDY) Sabrina De Cillis, Daniele Amparore, Gabriele Volpi, Juliette Meziere, Martin Schönthaler, Grégoire Robert, Francesco Cantiello, Fernando Gómez Sancha, Andreas Becker, Carlo Terrone, Martina Beverini, Stefano Parodi, Cosimo De Nunzio, Gautier Muellhaupt, Nicolas Barry Delongchamps, Emmanuel Della Negra, Henry Who, Matteo Manfredi, Cristian Fiori, and Francesco Porpiglia Sabrina De CillisSabrina De Cillis More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Gabriele VolpiGabriele Volpi More articles by this author , Juliette MeziereJuliette Meziere More articles by this author , Martin SchönthalerMartin Schönthaler More articles by this author , Grégoire RobertGrégoire Robert More articles by this author , Francesco CantielloFrancesco Cantiello More articles by this author , Fernando Gómez SanchaFernando Gómez Sancha More articles by this author , Andreas BeckerAndreas Becker More articles by this author , Carlo TerroneCarlo Terrone More articles by this author , Martina BeveriniMartina Beverini More articles by this author , Stefano ParodiStefano Parodi More articles by this author , Cosimo De NunzioCosimo De Nunzio More articles by this author , Gautier MuellhauptGautier Muellhaupt More articles by this author , Nicolas Barry DelongchampsNicolas Barry Delongchamps More articles by this author , Emmanuel Della NegraEmmanuel Della Negra More articles by this author , Henry WhoHenry Who More articles by this author , Matteo ManfrediMatteo Manfredi More articles by this author , Cristian FioriCristian Fiori More articles by this author , and Francesco PorpigliaFrancesco Porpiglia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of this report was to demonstrate the impact of he second-generation temporary implantable nitinol device (iTIND; Medi-Tate Ltd®, Israel) on serum PSA in the MT-06 study population. METHODS: From 06/2018 to 09/2019 patients with IPSS ≥10, Qmax <12 ml/s and prostate volume (PV) <120 ml were enrolled in this single-arm, prospective multicenter study (MT-06) and underwent iTIND implantation for the treatment of BPH-related LUTS. Patients included into the study had previously passed prostate cancer screening and none of them had a history of prostate cancer. Moreover, they were not washed out of BPH medication. PSA was assessed at baseline and at 1, 3, and 12 months postoperatively. Pearson correlation coejcient was used to examine the association between the baseline PSA and the PSA at 3 months follow-up. A p value <0.05 was considered statistical significant. RESULTS: 140 MT-06 study patients who had baseline serum PSA assessed were included in this analysis. The mean age was 61.16 years (IQR 54.33-68.89), with mean prostate volume of 37.27 ml (IQR 26.00-45.00 ml) and mean baseline serum PSA of 1.81 ng/ml (IQR 0.72-2.40 ng/ml). Post implantation PSA showed a peak at 4 weeks, reaching a mean of 3.00 ng/ml (IQR 1.03-3.46 ng/ml). This result is consistent with the iTIND mechanism of action, which by producing remodeling of the prostatic urethra, produces local inflammation from ischemic necrosis. Subsequently, the serum PSA decreased to a mean of 2.09 ng/ml (IQR 0.87-2.47 ng/ml), 1.90 ng/ml (IQR 0.64-2.81 ng/ml) at 3, and 12 months, respectively, (p values were all >0.05, respectively compared to baseline; Figure 1a). Change in PSA levels from baseline showed a linear correlation throughout the follow up, with a Pearson correlation coefficient at 3 months follow up of R=0.944 (p>0.0001) (Figure 1b). CONCLUSIONS: The implantation of iTIND for the treatment of BPH-related symptoms showed to have only a transient impact on serum PSA levels. This data suggests that the iTIND procedure is likely to not affect PSA monitoring in patients undergoing screening for prostate cancer or be on active surveillance protocols who would receive treatment for symptomatic BPH. Source of Funding: Olympus Corporation funded this study © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1060 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sabrina De Cillis More articles by this author Daniele Amparore More articles by this author Gabriele Volpi More articles by this author Juliette Meziere More articles by this author Martin Schönthaler More articles by this author Grégoire Robert More articles by this author Francesco Cantiello More articles by this author Fernando Gómez Sancha More articles by this author Andreas Becker More articles by this author Carlo Terrone More articles by this author Martina Beverini More articles by this author Stefano Parodi More articles by this author Cosimo De Nunzio More articles by this author Gautier Muellhaupt More articles by this author Nicolas Barry Delongchamps More articles by this author Emmanuel Della Negra More articles by this author Henry Who More articles by this author Matteo Manfredi More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Expand All Advertisement PDF downloadLoading ...

Objectives: To test for regional differences in total hospital costs (THC) across the United States in bladder cancer patients treated with open radical cystectomy (ORC) or robotic-assisted radical cystectomy (RARC). Materials: We relied on the National Inpatient Sample (NIS) database (2016-2019) and stratified RC patients according to census region (Midwest, Northeast, South, West). Primary statistical analyses consisted of THC-trend analyses and multivariable log-link linear regression models, after adjustment for hospital clustering (Generalized Estimating Equation function) and discharge disposition weighting. Finally, sensitivity analysis, relying on most favorable patient cohort, was performed. Results: Of 5280 eligible patients, 1441 (27%), 1031 (20%), 1854 (35%) and 954 (18%) underwent RC in the Midwest, Northeast, South and West, respectively. Median THC was 28,915$ and differed significantly between regions (Midwest: 28,105$; Northeast: 28,886$; South: 26,096$; West: 38,809$; p < 0.001). After stratification between ORC and RARC, highest THC was invariably recorded in the West: ORC 36,137$ vs 23,941-28,850$ and RARC 43,119$ vs 28,425-29,952$ (both p < 0.05). In multivariable log-link linear regression models, surgery in the West was independently associated with higher THC: ORC (Exponent beta (Exp(beta]]: 1.39; 95%-CI: 1.32-1.47; p < 0.001) and RARC (Exp(beta]: 1.46; 95%-CI: 1.38-1.55; p < 0.001). Results remained unchanged when analyses were refitted in most favorable patient subgroup. Conclusions: Important regional differences in ORC and RARC THC distinguish the West from other United States regions. The THC discrepancy clearly requires closer examination to identify underlying processes that contribute to inflated costs in the West.

Purpose: Apart from the existing level-one evidence, few centers have reported on long-term outcomes after Holmium Laser Enucleation of the Prostate (HoLEP). Against this backdrop we aimed to report on our treatment experience and identify predictors of persistent/recurrent lower urinary tract symptoms (LUTS) after the procedure.Materials and Methods: From 2006 to 2017, 2566 men underwent HoLEP at our institution. Only patients with available, cross-sectional follow-up (F/u) >= 6 months were included. Perioperative and F/u characteristics were compared by duration of F/u in months (quartiles). Multivariable logistic regression models (MVAs) were used to identify predictors of persistent/recurring symptoms, defined as International Prostate Symptom Score (IPSS) >7 at F/u.Results: A total of 774 patients with a median age of 70 years (interquartile range [IQR] = 66-75), prostate volume of 80 mL (IQR = 60-105), American Society of Anesthesiologists score 2 (IQR = 2-3), IPSS of 19 (IQR = 14-24), and quality of life (QoL) of 4 (3-5) at the time of operation were analyzed. Median F/u was 52 months (IQR = 32-77), overall current median prostate-specific antigen was 0.91 mg/dL (0.5-1.8), median IPSS and QoL were 3 (IQR = 1-7) and 1 (IQR 0-2), respectively. LUTS medication was present in 20 patients (2.6%), 15 (2%) patients required reoperation, and permanent urinary incontinence was present in 17 (2.2%) patients. On MVA age at operation (odds ratio [OR] = 1.04; 95% confidence interval [CI], 1.01-1.1; p = 0.013), prostate volume (OR = 0.99 [95% CI, 0.98-0.99;], p = 0.003), body mass index (OR = 1.06 [95% CI, 1.0-1.1], p = 0.043), presence of indwelling catheter (OR = 0.51 [95% CI, 0.32-0.81], p = 0.004), and anticholinergics before procedure (OR = 1.74 [95% CI, 1.01-3.0], p = 0.046) were predictors of persistent/recurring symptoms.Conclusions: Our HoLEP experience confirms durable and profound symptom relief in the vast majority men. A small fraction of patients complained about subjective persistent/recurring LUTS stressing the need for proper patient selection and timing of surgical intervention.

Objective: The aim of the study was to compare procedural efficacy, early and late functional outcomes in holmium laser enucleation of the prostate (HoLEP) under spinal anesthesia (SA) versus general anesthesia (GA). Methods: We retrospectively reviewed patients undergoing HoLEP at our institution between 2012 and 2017. Standard pre-, peri-, and postoperative characteristics were compared according to anesthetic technique. Multivariable logistic regression analyses (MVAs) were employed to study the impact of SA on procedural efficacy and postoperative complications. Results: Our study cohort consisted of 1,159 patients, of whom 374 (32%) underwent HoLEP under SA. While a medical history of any anticoagulation/antiplatelet therapy except low-dose acetylsalicylic acid was significantly more common among patients undergoing GA (16% vs. 10%, p = 0.001), no other significant differences in preoperative characteristics were noted including age, body mass index, American Society of Anesthesiologists Classification (ASA), prostate size, or International Prostate Symptom Score (IPSS), and quality of life scores. Patients under SA exhibited shorter times of enucleation 42 min (interquartile range [IQR]:27–59 vs. 45 min [IQR: 31–68], p = 0.002), and combined time of enucleation/morcellation/coagulation (57 min [IQR: 38–85] vs. 64 min [IQR: 43–93], p = 0.002), as well as fewer complications (Clavien-Dindo ≥3) (12 [3.2%] vs. 55 [7%], p = 0.013). These associations were confirmed in MVA. Patients did not differ significantly with regard to early micturition including post-void residual volume and maximum flow-rate improvement. At a median follow-up of 33 months (IQR: 32–44), patients with SA had a lower IPSS score (median 3 [IQR: 1–6] vs. 4 [IQR: 2–7], p = 0.039). However, no significant differences were observed with respect to any urinary incontinence, urge symptoms, and postoperative pain. Conclusion: In this large retrospective series, HoLEP under SA was a safe and efficacious procedure with comparable early and long-term functional outcomes.

Objective: To explore how histological subtypes impact upstaging to nonorgan confined renal cell carcinoma (>= pT3 RCC) in patients treated with partial/radical nephrectomy for cT1-2 RCC.Materials and methods: We relied on an institutional tertiary-care database to identify RCC patients treated with partial/radical nephrectomy between January 2002 and December 2021. Patients were stratified according to histological subtype of RCC. Upstaging was defined as any cT1-2 tumor classified as >= pT3 at final pathology. Uni- and multivariable logistic regression models were fitted to predict upstaging.Results: Of overall 1,020 surgically treated RCC patients, 743 harbored clear-cell (72.8%) vs. 193 (18.9%) papillary vs. 49 (4.8%) chromophobe vs. each 4 (0.4%) collecting duct and sarcomatoid vs. 27 (2.6%) other/mixed pathology of RCC. Median tumor size ranged from 3.0 cm (mixed RCC) to 7.7 cm (sarcomatoid RCC). In total, upstaging rate to >= pT3 was 22% and ranged from 6.1% (chromophobe RCC) to 75% (collecting duct RCC). In univariable logistic regression models, chromophobe and papillary histological subtypes were significantly associated with lower upstaging of all cT1-2 RCC tumors. After controlling for patient and tumor characteristics in multivariable logistic regression models, papillary RCC independently lowers the risk of upstaging, even in sensitivity analyses for cT1 RCC only.Conclusion: Important differences between histological subtypes of RCC exist regarding characteristics such as stage and tumor size at presentation, as well as upstaging to >= pT3 at final pathology. Specifically, papillary RCC is significantly associated with lower chance of upstaging even after controlling for confounding parameters. The study is limited by missing central pathological/radiographic review and lack of survival analyses.(c) 2023 Elsevier Inc. All rights reserved.

Background Partial nephrectomy (PN) is the gold standard surgical treatment for resectable renal cell carcinoma (RCC) tumors. However, the decision whether a robotic (RAPN) or open PN (OPN) approach is chosen is often based on the surgeon’s individual experience and preference. To overcome the inherent selection bias when comparing peri- and postoperative outcomes of RAPN vs. OPN, a strict statistical methodology is needed. Materials and methods We relied on an institutional tertiary-care database to identify RCC patients treated with RAPN and OPN between January 2003 and January 2021. Study endpoints were estimated blood loss (EBL), length of stay (LOS), rate of intraoperative and postoperative complications, and trifecta. In the first step of analyses, descriptive statistics and multivariable regression models (MVA) were applied. In the second step of analyses, to validate initial findings, MVA were applied after 2:1 propensity-score matching (PSM). Results Of 615 RCC patients, 481 (78%) underwent OPN vs 134 (22%) RAPN. RAPN patients were younger and presented with a smaller tumor diameter and lower RENAL-Score sum, respectively. Median EBL was comparable, whereas LOS was shorter in RAPN vs. OPN. Both intraoperative (27 vs 6%) and Clavien-Dindo > 2 complications (11 vs 3%) were higher in OPN (both < 0.05), whereas achievement of trifecta was higher in RAPN (65 vs 54%; p = 0.028). In MVA, RAPN was a significant predictor for shorter LOS, lower rates of intraoperative and postoperative complications as well as higher trifecta rates. After 2:1 PSM with subsequent MVA, RAPN remained a statistical and clinical predictor for lower rates of intraoperative and postoperative complications and higher rates of trifecta achievement but not LOS. Conclusions Differences in baseline and outcome characteristics exist between RAPN vs. OPN, probably due to selection bias. However, after applying two sets of statistical analyses, RAPN seems to be associated with more favorable outcomes regarding complications and trifecta rates.

BackgroundTo test the effect of race/ethnicity on cancer-specific mortality (CSM) after salvage radical prostatectomy (SRP).Material and methodsWe relied on the Surveillance, Epidemiology and End Results database (SEER, 2004–2016) to identify SRP patients of all race/ethnicity background. Univariate and multivariate Cox regression models addressed CSM according to race/ethnicity.ResultsOf 426 assessable SRP patients, Caucasians accounted for 299 (69.9%) vs. 68 (15.9%) African-Americans vs. 39 (9.1%) Hispanics vs. 20 (4.7%) Asians. At diagnosis, African-Americans (64 years) were younger than Caucasians (66 years), but not younger than Hispanics (66 years) and Asians (67 years). PSA at diagnosis was significantly higher in African-Americans (13.2 ng/ml), Hispanics (13.0 ng/ml), and Asians (12.2 ng/ml) than in Caucasians (7.8 ng/ml, p = 0.01). Moreover, the distribution of African-Americans (10.3%–36.6%) and Hispanics (0%–15.8%) varied according to SEER region. The 10-year CSM was 46.5% in African-Americans vs. 22.4% in Caucasians vs. 15.4% in Hispanics vs. 15.0% in Asians. After multivariate adjustment (for age, clinical T stage, lymph node dissection status), African-American race/ethnicity was an independent predictor of higher CSM (HR: 2.2, p < 0.01), but not Hispanic or Asian race/ethnicity. The independent effect of African-American race/ethnicity did not persist after further adjustment for PSA.ConclusionAfrican-Americans treated with SRP are at higher risk of CSM than other racial/ethnic groups and also exhibited the highest baseline PSA. The independent effect of African-American race/ethnicity on higher CSM no longer applies after PSA adjustment since higher PSA represents a distinguishing feature in African-American patients.

BACKGROUND:We aimed to determine the concordance between the radiologic stage (rT), using multiparametric magnetic resonance imaging (mpMRI), and pathologic stage (pT) in patients with high-risk prostate cancer and its influence on nerve-sparing surgery compared to the use of the intraoperative frozen section technique (IFST).METHODS:The concordance between rT and pT and the rates of nerve-sparing surgery and positive surgical margin were assessed for patients with high-risk prostate cancer who underwent radical prostatectomy.RESULTS:The concordance between the rT and pT stages was shown in 66.4% (n = 77) of patients with clinical high-risk prostate cancer. The detection of patients with extraprostatic disease (≥pT3) by preoperative mpMRI showed a sensitivity, negative predictive value and accuracy of 65.1%, 51.7% and 67.5%. In addition to the suspicion of extraprostatic disease in mpMRI (≥rT3), 84.5% (n = 56) of patients with ≥rT3 underwent primary nerve-sparing surgery with IFST, resulting in 94.7% (n = 54) of men with at least unilateral nerve-sparing surgery after secondary resection with a positive surgical margin rate related to an IFST of 1.8% (n = 1).CONCLUSION:Patients with rT3 should not be immediately excluded from nerve-sparing surgery, as by using IFST some of these patients can safely undergo nerve-sparing surgery.

The survival benefit of primary external beam radiation therapy (EBRT) has never been formally tested in elderly men who were newly diagnosed with metastatic prostate cancer (mPCa). We hypothesized that elderly patients may not benefit of EBRT to the extent as younger newly diagnosed mPCa patients, due to shorter life expectancy.

OBJECTIVE:To test 1) contemporary pelvic lymph node dissection (PLND) trends at radical cystectomy (RC) in variant histology bladder cancer (VHBC) patients and urothelial carcinoma of the urinary bladder (UCUB), as well as 2) to test the effect of PLND extent on cancer specific mortality (CSM) after RC.METHODS:Within the Surveillance, Epidemiology and End Results Registry (SEER, 2004-2016), we identified non-metastatic stage T1-2 or T3-4 VHBC and UCUB patients, who underwent RC. CSM and lymph node invasion (LNI) rates were stratified according to PLND extent, as well as coded continuously in multivariate Cox and logistic regression models.RESULTS:Of 19,020 patients, 1736 (9.1%) were coded as having VHBC (46.9% squamous cell carcinoma, 22.5% adenocarcinoma, 18.9% neuroendocrine carcinoma, 11.7% not otherwise specified) vs 17,284 (90.9%) UCUB. PLND was performed in 80.1 of VHBC vs. 83.5% UCUB patients. In both histological groups, PLND rates increased over time (70.9-89.6% and 76.2%-90.1%, both P < .01). PLND extent did not significantly affect CSM in stage T1-2 or T3-4 VHBC patients. Conversely, PLND extent was associated with lower CSM in T1-2, as well as in T3-4 UCUB patients, which was confirmed in multivariate Cox analyses (Hazard ratio [HR] 0.99, P < .001). Rates of LNI increased with extent of PLND in logistic regression analyses in stage T3-4 VHBC (Odds ratio [OR] 1.01, P = .001), stage T1-2 UCUB (OR 1.01, P < .001) and T3-4 UCUB (OR 1.01, P < .001), but not in stage T1-2 VHBC (OR 1.01, P = .3).CONCLUSION:PLND rates do not differ between VHBC and UCUB patients. A potential survival benefit related to more extensive PLND is operational in UCUB patients, but not in VHBC patients.

Background: To investigate perioperative complication rates at radical nephrectomy (RN) according to inferior vena cava thrombectomy (IVC-T) status and stage (metastatic vs non-metastatic) within kidney cancer patients. Materials and methods: We ascertained perioperative complication rates within the National Inpatient Sample database (2016-2019). First, log-link linear Generalized Estimating Equation function (GEE) regression models (adjusted for hospital clustering and weighted for discharge disposition) tested complication rates in IVC-T patients, according to metastatic stage. Subsequently, a subgroup analysis relied on RN patients with or without IVC-T. Here, multivariable logistic regression models tested complication rates in RN patients according to IVC-T status, after propensity score matching including metastatic stage. Results: Of 26,299 RN patients, 461 (2%) patients underwent IVC-T. Of those, 252 (55%) were non-metastatic vs 209 (45%) were metastatic. Rates of acute kidney injury (AKI), transfusion, cardiac, thromboembolic and other medical complications in non-metastatic vs metastatic patients were 40 vs 40%, 25 vs 22%, 21 vs 23%, 19 vs 14% and 38 vs 40%, respectively (all p >= 0.2). Metastatic stage in IVC-T patients did not predict differences in complications in log-link linear GEE regression models (all p > 0.1). However, in logistic regression models with propensity score matching, relying on the overall cohort of RN patients, IVC-T status was associated with higher complication rates (all p < 0.001): AKI (Odds ratio [OR]:2.60; 95%-CI [95%-Confidence interval: 1.97-3.44), transfusions (OR:2.40; 95%-CI: 1.72-3.36), cardiac (OR:2.27; 95%-CI: 1.49-3.47), thromboembolic (OR:9.07; 95%-CI: 5.21-16.58) and other medical complications (OR:2.01; 95%-CI: 1.52-2.66).Conclusions: The current analyses indicate that presence of concomitant IVC-T is associated with higher complication rate at RN. Conversely, metastatic stage has no effect on recorded complication rates.