AbstractObjectivesThe objective of this study is to investigate the association between the use of beta‐adrenergic antagonist atenolol and risk of pathologic upgrade in patients on active surveillance, considering growing literature implicating adrenergic innervation with disease progression mediated through beta‐adrenergic signalling.Patients and MethodsMen with low‐risk or favourable intermediate‐risk prostate cancer who were placed on an active surveillance protocol between 2006 and 2020 across three diverse urban hospitals were included. Exposure was duration of atenolol use, and outcome was pathologic grade group upgrading (to GG ≥ 3) on final prostate biopsy. Cox proportional hazard regression models were used to determine the associations between atenolol use and risk of upgrading with time, on a per‐examination basis.ResultsA total of 467 men with initial GG ≤ 2 were included. Postdiagnosis atenolol use was associated with a decreased risk of pathologic upgrade to GG ≥ 3 on final repeat biopsy (HR 0.81, 95% CI 0.39–0.98). Longer duration of postdiagnosis atenolol use (>2 years) and greater cumulative atenolol dose (>730 defined daily doses) were associated with a more pronounced decreased risk of upgrade to GG ≥ 3 (HR 0.41, 95% CI 0.05–0.88, and HR 0.32, 95% CI 0.15–0.99, respectively). Initiation of atenolol use prior to prostate cancer diagnosis had a slightly greater protective effect than drug initiation postdiagnosis (HR 0.79, 95% CI 0.43–0.98, and HR 0.83, 95% CI 0.30–0.99, respectively).ConclusionsBeta‐adrenergic blockade with atenolol use in men on active surveillance is associated with a reduced risk for clinically significant grade group pathologic upgrade.

Purpose: To compare the intra- and postoperative outcomes of single-port robotic donor nephrectomies (SP RDNs) and laparoscopic donor nephrectomies (LDNs). Materials and Methods: We retrospectively reviewed our institutional database for patients who received LDN or SP RDN between September 2020 and December 2022. Donor baseline characteristics, intraoperative outcomes, postoperative outcomes, and recipient renal function were extracted and compared between LDN and SP RDN. SP RDN learning curve analysis based on operative time and graft extraction time was performed using cumulative sum analysis. Results: One hundred forty-four patients underwent LDN and 32 patients underwent SP RDN. LDN and SP RDN had similar operative times (LDN: 190.3 +/- 28.0 minutes, SP RDN: 194.5 +/- 35.1 minutes, p = 0.3253). SP RDN patients had significantly greater extraction times (LDN: 83.2 +/- 40.3 seconds, SP RDN: 204.1 +/- 52.2 seconds, p < 0.0001) and warm ischemia times (LDN: 145.1 +/- 61.7 seconds, SP RDN: 275.4 +/- 65.6 seconds, p < 0.0001). There were no differences in patient subjective pain scores, inpatient opioid usage, or Clavien-Dindo II+ complications. Short- and medium-term postoperative donor and recipient renal function were also similar between the groups. SP RDN graft extraction time and total operative time learning curves were achieved at case 27 and 13, respectively. Conclusion: SP RDN is a safe and feasible alternative to LDN that minimizes postoperative abdominal incisional scars and has a short learning curve. Future randomized prospective clinical trials are needed to confirm the findings of this study and to identify other potential benefits and drawbacks of SP RDNs.

Introduction: The objective of this study was to stratify preoperative immune cell counts by cancer specific outcomes in patients with renal cell carcinoma (RCC) and a tumor thrombus after radical nephrectomy with tumor thrombectomy. Methods: Patients with a diagnosis of RCC with tumor thrombus that underwent radical nephrectomy with thrombectomy across an international consortium of seven institutions were included. Patients who were metastatic at diagnosis and those who received preoperative medical treatment were also included. Retrospective chart review was performed to collect demographic information, past medical history, preoperative lab work, surgical pathology, and follow up data. Neutrophil counts, lymphocyte counts, monocyte counts, neutrophil to lymphocyte ratios (NLR), lymphocyte to monocyte ratios (LMR), and neutrophil to monocyte ratios (NMR) were compared against cancer-specific outcomes using independent samples t-test, Pearson’s bivariate correlation, and analysis of variance. Results: One hundred forty-four patients were included in the study, including nine patients who were metastatic at the time of surgery. Absolute lymphocyte count preoperatively was greater in patients who died from RCC compared to those who did not (2 vs 1.4; p < 0.001). Patients with tumor pathology showing perirenal fat invasion had a greater neutrophil count compared to those who did not (7.5 vs 5.5; p = 0.010). Patients with metastatic RCC had a lower LMR compared to those without metastases after surgery (2.5 vs 3.2; p = 0.041). Tumor size, both preoperatively and on gross specimen, had an interaction with multiple immune cell metrics ( p < 0.05). Conclusions: Preoperative immune metrics have clinical utility in predicting cancer-specific outcomes for patients with RCC and a tumor thrombus. Additional study is needed to determine the added value of preoperative serum immune cell data to established prognostic risk calculators for this patient population.

Objectives: We sought to determine whether bladder cuff excision and its technique influence outcomes after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Methods and materials: A multicenter, international, retrospective analysis using the ROBotic surgery for Upper tract Urothelial Study (ROBUUST) 2.0 registry identified 1,718 patients undergoing RNU for UTUC between 2015 and 2023 at 17 centers across United States, Europe, and Asia. Data was gathered on (1) whether bladder cuff excision was performed and (2) what technique was including formal excision or other techniques (pluck technique, stripping/intussusception technique) and outcomes. Multivariate survival analyses were performed to compare the groups. Results: Most patients (90%, 1,540/1,718) underwent formal bladder cuff excision in accordance with EAU and AUA guidelines. 4% (68/1,718) underwent resection using other techniques, and 6% (110/1,718) did not have a bladder cuff excised. Median follow for the cohort was 24 months (IQR 9-44). - 44). When comparing formal bladder cuff excision to other excision techniques, there were no ences in oncologic or survival outcomes including bladder recurrence-free survival (BRFS), recurrence-free survival (RFS), metastasis survival (MFS), overall survival (OS), or cancer-specific survival (CSS). However, excision of any kind conferred a decreased bladder-specific recurrence compared to no excision. There was no difference in RFS, MFS, OS, or CSS when comparing bladder excision, other techniques, and no excision. Conclusions: Bladder cuff excision improves recurrence-free survival, particularly when considering bladder recurrence. This benefit conferred regardless of technique, as long as the intramural ureter and ureteral orifice are excised. However, the benefit of bladder excision on metastasis-free, overall, and cancer-specific survival is unclear. (c) 2024 Elsevier Inc. All rights are reserved, including text and data mining, AI training, and similar technologies.

444 Background: Renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus carries a poor prognosis and presents complex medical management to urologists. Long-term data examining RCC with IVC tumor thrombus is sparse. Specifically, markers predicting cancer-specific survival are lacking. Recently, immune cell markers in cancer, such as neutrophils, lymphocytes, and monocytes, have come into focus. These cell counts and/or ratios may provide a window into cancer-specific outcomes. The purpose of this study was to examine the use of immune cell ratios in patients with RCC and IVC tumor thrombus to predict survival outcomes through a collaboration project across North and South America. Methods: Patients were included in this study if they had a diagnosis of RCC with IVC tumor thrombus and underwent nephrectomy with IVC thrombectomy for their RCC. Data was reviewed and entered into a multi-institutional/continental database. Complete blood counts taken as close to the date prior to/date of surgery were used to calculate immune cell ratios. Neutrophil to (/) lymphocyte ratios were done by dividing patients’ neutrophil cell count by their lymphocyte count. Monocyte/lymphocyte ratios were calculated in the same manner. Independent samples t-test was used to test for significance in cause of death post-operatively (RCC versus non-RCC cause) based on immune cell ratio. Results: There were 107 patients included in the study with long-term follow-up data (Mean: 2.6 years; Range: 0-16-years). Of all patients, 43/107 died by the end of the study, with 31/43 (72.1%) dying due to RCC and 12/43 (27.9%) from other causes. No difference existed in neutrophil/lymphocyte ratios based on cause of death (p=0.260). Monocyte/lymphocyte ratios were significantly lower in those who died from RCC relative to another cause (p=0.035). Conclusions: Immune cell ratios may have a role in predicting death from RCC. In our study, monocyte/lymphocyte ratios were significantly lower in patients who died from RCC compared to death from other reasons. Our results stem from a multi-continental/institutional study, and thus hold clinical utility as an increased focus is turned towards including diverse populations in research. Urologists may consider monocyte/lymphocyte ratios in the future when managing patients with RCC and an IVC thrombus. [Table: see text]

You have accessJournal of UrologyDiversity, Equity & Inclusion: Health Equity & Outcomes I (PD05)1 May 2024PD05-05 HEALTH INEQUALITIES FOR RENAL CELL CARCINOMA WITH INFERIOR VENA CAVA TUMOR THROMBUS ACROSS NORTH AMERICA, CENTRAL/SOUTH AMERICA, AND ASIA Maxwell Sandberg, Mary Namugosa, Rory Ritts, Davis Temple, Wyatt Whitman, Claudia Marie-Costa, Justin Refugia, Benjamin Eilender, Parth Thakker, Mitchell Hayes, Rafael Ribiero Zanotti, Patricio Garcia Marchiñena, Ashok Hemal, Reza Mehrazin, Philippe Spiess, Stenio de Cassio Zequi, and Alejandro Rodriguez Maxwell SandbergMaxwell Sandberg , Mary NamugosaMary Namugosa , Rory RittsRory Ritts , Davis TempleDavis Temple , Wyatt WhitmanWyatt Whitman , Claudia Marie-CostaClaudia Marie-Costa , Justin RefugiaJustin Refugia , Benjamin EilenderBenjamin Eilender , Parth ThakkerParth Thakker , Mitchell HayesMitchell Hayes , Rafael Ribiero ZanottiRafael Ribiero Zanotti , Patricio Garcia MarchiñenaPatricio Garcia Marchiñena , Ashok HemalAshok Hemal , Reza MehrazinReza Mehrazin , Philippe SpiessPhilippe Spiess , Stenio de Cassio ZequiStenio de Cassio Zequi , and Alejandro RodriguezAlejandro Rodriguez View All Author Informationhttps://doi.org/10.1097/01.JU.0001008624.07191.ab.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus is treated with nephrectomy and IVC thrombectomy. This carries a high morbidity and mortality. With multi-institutional collaboration, the purpose of this study was to analyze cross-continental differences of RCC with IVC tumor thrombus between patients in North America (NA), Central/South America (CSA), and Asia. METHODS: Patients with RCC who underwent nephrectomy with renal vein and/or IVC thrombectomy were retrospectively analyzed. Patients were from NA, CSA, and Asia. NA patients were all from the United States. CSA patients were from Mexico, Argentina, Brazil, Peru, Chile, and Uruguay. Asia patients were from South Korea. All comparisons were done based on the continent (NA, CSA, Asia) where a patient had their surgery and follow-up. Metastatic symptoms were defined as shortness of breath, bone pain, or neurologic symptoms. International Metastatic RCC Database Consortium (IMDC) scores were all calculated using an online scoring system. Chi-squared test, independent samples t-test, and analysis of variance were used for statistical testing. Any patient with a missing variable on review was excluded from analysis for that particular variable. RESULTS: The study included 312 patients (55 NA, 200 CSA, 57 Asia). All results are shown in Table 1. Of note, thrombus level was significantly different using both the Neves and Ciancio classification systems between continents (p<0.001), with a greater thrombus level in CSA patients. Surgical approach differed between continents, with laparoscopic cases done most often in CSA (p<0.001). Further, tumor grade (p<0.001) and stage (p<0.001) were significantly greater in CSA. A greater proportion of patients in CSA and Asia had metastatic disease compared to NA (p=0.034). Time to death after surgery was equivalent across continents (p=0.131). If metastases were present, time to death from initial diagnosis was quickest in CSA (p<0.001). CONCLUSIONS: Patients from NA, CSA, and Asia who are diagnosed with RCC and a tumor thrombus do not present the same and have different outcomes peri- and post-operatively. This includes important cancer-specific variables which have impacts on patient morbidity and mortality. Considering increased efforts on health equity in urology, the causes of these differences call for further investigation. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e91 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Maxwell Sandberg More articles by this author Mary Namugosa More articles by this author Rory Ritts More articles by this author Davis Temple More articles by this author Wyatt Whitman More articles by this author Claudia Marie-Costa More articles by this author Justin Refugia More articles by this author Benjamin Eilender More articles by this author Parth Thakker More articles by this author Mitchell Hayes More articles by this author Rafael Ribiero Zanotti More articles by this author Patricio Garcia Marchiñena More articles by this author Ashok Hemal More articles by this author Reza Mehrazin More articles by this author Philippe Spiess More articles by this author Stenio de Cassio Zequi More articles by this author Alejandro Rodriguez More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023MP47-04 HYPERTENSION IS ASSOCIATED WITH WORSENED ONCOLOGICAL SURVIVAL OUTCOMES IN PATIENTS UNDERGOING NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA: ANALYSIS OF THE ROBUUST REGISTRY Sohail Dhanji, Franklin Liu, Kevin Hakimi, Hooman Djaladat, Firas Abdollah, Mark L. Gonzalgo, Linhui Wang, Matteo Ferro, Courtney Yong, Jacob Taylor, Savio D. Pandolfo, Francesco Porpiglia, Enrico Checcucci, Benjamin M. Eilender, Daniel D. Eun, Spencer H. Bell, Erika Wood, Alireza Ghoreifi, Matthew Davis, Alex Stephens, Gabriele Tuderti, Dinno F. Mendiola, Marco Tozzi, Riccardo Autorino, Chandru P. Sundaram, Reza Mehrazin, Vitaly Margulis, Giuseppe Simone, Zhenjie Wu, and Ithaar Derweesh Sohail DhanjiSohail Dhanji More articles by this author , Franklin LiuFranklin Liu More articles by this author , Kevin HakimiKevin Hakimi More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Mark L. GonzalgoMark L. Gonzalgo More articles by this author , Linhui WangLinhui Wang More articles by this author , Matteo FerroMatteo Ferro More articles by this author , Courtney YongCourtney Yong More articles by this author , Jacob TaylorJacob Taylor More articles by this author , Savio D. PandolfoSavio D. Pandolfo More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , Benjamin M. EilenderBenjamin M. Eilender More articles by this author , Daniel D. EunDaniel D. Eun More articles by this author , Spencer H. BellSpencer H. Bell More articles by this author , Erika WoodErika Wood More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Matthew DavisMatthew Davis More articles by this author , Alex StephensAlex Stephens More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Dinno F. MendiolaDinno F. Mendiola More articles by this author , Marco TozziMarco Tozzi More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Chandru P. SundaramChandru P. Sundaram More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Zhenjie WuZhenjie Wu More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Impact of hypertension (HTN) on oncologic outcomes in upper tract urothelial carcinoma (UTUC) is uncertain with emerging reports suggesting risk with respect to intravesical recurrence after Radical Nephroureterectomy (RNU). We sought to analyze the impact of HTN on UTUC outcomes in a contemporary cohort of patients who underwent RNU. METHODS: We performed a multi-center retrospective analysis of patients who underwent RNU for UTUC utilizing the ROBUUST (ROBotic surgery for Upper tract Urothelial cancer STudy) database. Primary outcome was all-cause mortality (ACM); secondary outcomes were cancer-specific mortality (CSM) and recurrence. The cohort was divided into groups based on hypertension status for analyses. Multivariable cox regression analyses were conducted to elucidate predictors for outcomes, and Kaplan-Meier analyses (KMA) were performed to analyze for overall (OS), cancer-specific (CSS) and recurrence-free survival (RFS) stratified by HTN status. RESULTS: We analyzed 865 patients (488 with hypertension/377 without hypertension; mean follow up 30.5 months). Comparing patients with hypertension versus those without, there was no significant difference in percentage of male gender (59.8% vs 59.2%, p=0.839), mean age (72.12 vs 68.57, p=0.086), tumor size (3.8 vs. 4.0 cm, p=0.425) or positive margin rate (5.3% vs 4.8%, p=0.713) between the cohorts, while patients with hypertension had a significantly greater rate of high tumor grade (78.5% vs 69.5%, p=0.005). Multivariable analysis demonstrated hypertension to be an independent risk factor for worsened ACM (HR 1.83, p=0.013, CSM (HR 2.41, p=0.010) and recurrence (HR 1.41, p=0.022). KMA comparing patients with hypertension versus patients without hypertension, revealed significantly lower 3-year OS (66.9% vs 79.8%, p=0.003), 3-year CSS (77.2% vs 87.5%, p=0.030), and 3-year PFS (48.8% vs. 60.6%, p=0.032) for patients with hypertension. CONCLUSIONS: Hypertension is an independent risk factor for worsened oncologic and survival outcomes in patients undergoing RNU for UTUC. Further investigation is warranted to confirm these findings and elucidate mechanisms of action and explore strategies to improve outcomes with improved control of hypertension. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e644 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sohail Dhanji More articles by this author Franklin Liu More articles by this author Kevin Hakimi More articles by this author Hooman Djaladat More articles by this author Firas Abdollah More articles by this author Mark L. Gonzalgo More articles by this author Linhui Wang More articles by this author Matteo Ferro More articles by this author Courtney Yong More articles by this author Jacob Taylor More articles by this author Savio D. Pandolfo More articles by this author Francesco Porpiglia More articles by this author Enrico Checcucci More articles by this author Benjamin M. Eilender More articles by this author Daniel D. Eun More articles by this author Spencer H. Bell More articles by this author Erika Wood More articles by this author Alireza Ghoreifi More articles by this author Matthew Davis More articles by this author Alex Stephens More articles by this author Gabriele Tuderti More articles by this author Dinno F. Mendiola More articles by this author Marco Tozzi More articles by this author Riccardo Autorino More articles by this author Chandru P. Sundaram More articles by this author Reza Mehrazin More articles by this author Vitaly Margulis More articles by this author Giuseppe Simone More articles by this author Zhenjie Wu More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023MP39-09 RADICAL THERAPY FOR LOW-RISK UPPER TRACT UROTHELIAL CARCINOMA (ROBUUST COLLABORATIVE GROUP) Nick Corsi, Chase Morrison, Matthew Davis, Alex Stephens, Devin Rogers, Gabriele Tuderti, Dinno F. Mendiola, Linhui Wang, Enrico Checcucci, Spencer H. Bell, Courtney Yong, Sohail Dhanji, Kevin Hakimi, Jacob Taylor, Erika Wood, Alireza Ghoreifi, Marco Tozzi, Benjamin M. Eilender, Chandru Sundaram, Ithaar H. Derweesh, Vitaly Margulis, Matteo Ferro, Giuseppe Simone, Reza Mehrazin, Mark L. Gonzalgo, Hooman Djaladat, Francesco Porpiglia, Daniel D. Eun, Zhenjie Wu, Riccardo Autorino, and Firas Abdollah Nick CorsiNick Corsi More articles by this author , Chase MorrisonChase Morrison More articles by this author , Matthew DavisMatthew Davis More articles by this author , Alex StephensAlex Stephens More articles by this author , Devin RogersDevin Rogers More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Dinno F. MendiolaDinno F. Mendiola More articles by this author , Linhui WangLinhui Wang More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , Spencer H. BellSpencer H. Bell More articles by this author , Courtney YongCourtney Yong More articles by this author , Sohail DhanjiSohail Dhanji More articles by this author , Kevin HakimiKevin Hakimi More articles by this author , Jacob TaylorJacob Taylor More articles by this author , Erika WoodErika Wood More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Marco TozziMarco Tozzi More articles by this author , Benjamin M. EilenderBenjamin M. Eilender More articles by this author , Chandru SundaramChandru Sundaram More articles by this author , Ithaar H. DerweeshIthaar H. Derweesh More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , Matteo FerroMatteo Ferro More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , Mark L. GonzalgoMark L. Gonzalgo More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Daniel D. EunDaniel D. Eun More articles by this author , Zhenjie WuZhenjie Wu More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Inaccurate preoperative staging is common in upper tract urothelial carcinoma (UTUC). It is useful to stratify low- and high-risk disease to appropriately select patients more likely to benefit from renal-sparing surgery (RSS) vs. radical nephroureterectomy (RNU). We provide an update of contemporary management of low-risk UTUC across high-volume centers and hypothesize that many low-risk cases are still frequently treated with RNU. METHODS: Patients were abstracted from an international cohort of 13 high-volume centers in the United States, Europe, and Asia (ROBUUST 2.0) undergoing treatment for UTUC from 2011-2022. We focused on patients with cN0M0 low-risk disease, as defined by: unifocal disease, tumor size < 2 cm, negative for high-grade cytology, low-grade on ureteroscopic biopsy, and no invasive aspect on preoperative CT. Clinical, pathologic, and recurrence data was collected. Descriptive statistics and Kaplan-Meier survival curves with log rank testing were performed. A trend analysis was completed to evaluate low-risk treatment modality by year RESULTS: Of the 1596 cases, 148 patients met the criteria of low-risk. 90% were treated with RNU. Trend analysis showed a peak utilization of RNU for low-risk disease around years 2016-2018, with a decline in more recent years (Fig 1A). Mean age was 69.3 (11.9) years, with most males (62%), normal weight (BMI: 24.7±5.3), ECOG of 0 (66%), and no prior history of bladder cancer (91%). Mean follow-up time was 40 months, and 52% of patients were ≤pT1 on final pathology. 15.6% (21/134) experienced recurrence following treatment with RNU, with a mean time to recurrence 21.8 (23.2) months. 57% (8/14) experienced recurrence following RSS, with a mean time to recurrence of 14.6 (10.6) months (Fig 1B; log-rank p = 0.62). Most recurred within the bladder (90% in RNU, 50% in RSS) with the other recurrences occurring in the ipsilateral/contralateral upper urinary tract. No distant recurrences were recorded in RSS. CONCLUSIONS: A significant majority of low-risk patients undergo RNU. While recurrence rate was higher in RSS (albeit non-statistically significant), none of these recurrences represented a distant metastasis. Our results should be considered within the framework of a retrospective design but provide insight to treatment patterns at high-volume centers. Source of Funding: n/a. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e538 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nick Corsi More articles by this author Chase Morrison More articles by this author Matthew Davis More articles by this author Alex Stephens More articles by this author Devin Rogers More articles by this author Gabriele Tuderti More articles by this author Dinno F. Mendiola More articles by this author Linhui Wang More articles by this author Enrico Checcucci More articles by this author Spencer H. Bell More articles by this author Courtney Yong More articles by this author Sohail Dhanji More articles by this author Kevin Hakimi More articles by this author Jacob Taylor More articles by this author Erika Wood More articles by this author Alireza Ghoreifi More articles by this author Marco Tozzi More articles by this author Benjamin M. Eilender More articles by this author Chandru Sundaram More articles by this author Ithaar H. Derweesh More articles by this author Vitaly Margulis More articles by this author Matteo Ferro More articles by this author Giuseppe Simone More articles by this author Reza Mehrazin More articles by this author Mark L. Gonzalgo More articles by this author Hooman Djaladat More articles by this author Francesco Porpiglia More articles by this author Daniel D. Eun More articles by this author Zhenjie Wu More articles by this author Riccardo Autorino More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023MP54-17 FERTILITY PRESERVATION RATES AMONG TRANSGENDER GIRLS IN A MULTIDISCIPLINARY TRANSGENDER PROGRAM Nir Tomer, Eva Baldisserotto, Alexandra Siegal, Benjamin Eilender, Erin Miller, Mabel Yau, Matthew Oransky, Joshua Safer, and Neha Malhotra Nir TomerNir Tomer More articles by this author , Eva BaldisserottoEva Baldisserotto More articles by this author , Alexandra SiegalAlexandra Siegal More articles by this author , Benjamin EilenderBenjamin Eilender More articles by this author , Erin MillerErin Miller More articles by this author , Mabel YauMabel Yau More articles by this author , Matthew OranskyMatthew Oransky More articles by this author , Joshua SaferJoshua Safer More articles by this author , and Neha MalhotraNeha Malhotra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fertility preservation (FP) should be an important step in health care prior to initiating gender affirming hormonal therapy (GAHT) or puberty blockade in transgender and gender diverse (TGD) people. However, FP is often not integrated into comprehensive gender affirming care. Prior studies show low rates of FP in transgender youth. The aim of this study was to understand how the integration of a pediatric urology team into our Center for Transgender Medicine and Surgery program would impact the overall number of transgender girls who pursue fertility preservation. METHODS: To assess the success of fertility preservation, we performed a retrospective review of a database of all TGD patients who were 18 years or younger with testes, and sought GAHT. Patients were evaluated and followed in our Center for Transgender Medicine and Surgery from 4/2022 through 10/2022. Demographics, age, hormonal treatment, Tanner stages, and FP use were recorded from the medical record. Successful sperm banking was defined as freezing >1 vial of sperm. RESULTS: Twenty seven patients ranging from ages 10-17 years old were referred to pediatric urology for FP. Of patients referred to the clinic, 20 (74.1%) were interested in pursuing/are in the process of sperm banking. Of the patients who didn’t pursue FP, 1 (3.7%) of the patients were prepubertal (Tanner I), 4 (14.8 %) patients declined to attempt FP because they wanted to avoid masturbation, and 2 (7.4%) patients declined referral altogether. Twelve patients began the process of FP with sperm banking - ten of whom successfully froze sperm within WHO reference ranges of semen parameters and 2 children were azoospermic. Upon review, these 2 patients with azoospermia were found to already have started hormonal suppression. CONCLUSIONS: Our data suggest that a large percentage of patients may be interested in fertility preservation. The integration of a pediatric urology team can help to increase access to this service. Importantly, that the children who already started pubertal suppression were azoospermic highlights the importance of the integration of pediatric urology and FP into the health care process prior to pubertal suppression therapy. In our program, counseling on GAHT and puberty blockers’ impact on fertility is introduced early and pediatric urology consultation is offered concurrently or even prior to endocrinology consultation. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e760 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nir Tomer More articles by this author Eva Baldisserotto More articles by this author Alexandra Siegal More articles by this author Benjamin Eilender More articles by this author Erin Miller More articles by this author Mabel Yau More articles by this author Matthew Oransky More articles by this author Joshua Safer More articles by this author Neha Malhotra More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 May 2022MP42-12 HIGHER PREOPERATIVE EGFR IS A PREDICTOR OF WORSE RENAL FUNCTION DECLINE AFTER ROBOTIC ASSISTED RADICAL CYSTECTOMY Shirin Razdan, Benjamin Eilender, John Pfail, Mariely Garcia, Daniel Ranti, Shoshana Rosenzweig, Abolfazl Hosseini, Jari Radros, Reza Mehrazin, Peter Wiklund, and John Sfakianos Shirin RazdanShirin Razdan More articles by this author , Benjamin EilenderBenjamin Eilender More articles by this author , John PfailJohn Pfail More articles by this author , Mariely GarciaMariely Garcia More articles by this author , Daniel RantiDaniel Ranti More articles by this author , Shoshana RosenzweigShoshana Rosenzweig More articles by this author , Abolfazl HosseiniAbolfazl Hosseini More articles by this author , Jari RadrosJari Radros More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , Peter WiklundPeter Wiklund More articles by this author , and John SfakianosJohn Sfakianos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002608.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients with muscle invasive bladder cancer or high risk noninvasive bladder cancer, renal function decline is a concern after radical cystectomy with urinary diversion. The pathophysiology of this decline is multifactorial, with subclinical acidosis and metabolic derangements from the diversion thought to contribute. It is unknown whether patients with baseline chronic kidney disease (CKD) are at increased risk of further decline in renal function. METHODS: We performed a retrospective review of two high volume robotic assisted radical cystectomy (RARC) centers between 2016-2020. Preoperative demographics and comorbidities were collected. Postoperative estimated glomerular filtration rate (eGFR) was calculated at 12 and 24 months to determine short-term rate in decline of eGFR. Absolute and percent changes in eGFR were calculated. RESULTS: There were a total of 555 patients who underwent RARC. Men comprised 76.2% of the cohort. Neoadjuvant chemotherapy was given in 31% of patients and adjuvant chemotherapy was given in 4.81% of patients. Higher preoperative eGFR (B -0.549, 95% CI -0.708 - -0.391, p<0.001) and presence of diabetes mellitus (B -15.414, 95% CI -24.820- -6.008, p=0.001) were significant predictors of eGFR decline at 12 months. At 24 months, presence of diabetes mellitus (B -11.799, 95% CI -21.816 - -1.782, p=0.021) and higher preoperative eGFR (B -0.621, 95% CI -0.796 - -0.446, p<0.001) were correlated with a steeper decline in eGFR. Higher preoperative eGFR was also predictive of upstaging to CKD3 or higher post operatively (OR 1.019, 95% CI 1.004-1.034, p=0.015). Intracorporeal diversion was protective, whereas presence of hypertension, diabetes mellitus, and higher preoperative eGFR predicted greater decline in eGFR. CONCLUSIONS: Patients with higher preoperative eGFR and diabetes are at increased risk of renal function decline post RARC at 12 and 24 months. This suggests that patients with risk factors for renal function decline, but otherwise normal renal function at baseline, are a particularly vulnerable population for progression to CKD after RARC and should be counseled and closely followed postoperatively for renal function deterioration. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e735 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shirin Razdan More articles by this author Benjamin Eilender More articles by this author John Pfail More articles by this author Mariely Garcia More articles by this author Daniel Ranti More articles by this author Shoshana Rosenzweig More articles by this author Abolfazl Hosseini More articles by this author Jari Radros More articles by this author Reza Mehrazin More articles by this author Peter Wiklund More articles by this author John Sfakianos More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION:In patients with muscle invasive bladder cancer or high risk noninvasive bladder cancer, renal function decline is a concern after radical cystectomy with urinary diversion. The pathophysiology of this decline is multifactorial, with subclinical acidosis and metabolic derangements from the diversion thought to contribute. It is unknown whether patients with baseline chronic kidney disease (CKD) are at increased risk of further decline in renal function. METHODS:We performed a retrospective review of two high volume robotic assisted radical cystectomy (RARC) centers between 2016 and 2020. Preoperative demographics and comorbidities were collected. Postoperative estimated glomerular filtration rate (eGFR) was calculated at 12 and 24 months to determine short-term rate in decline of eGFR. Absolute and percent changes in eGFR were calculated. RESULTS:There were a total of 555 patients who underwent RARC. Men comprised 76.2% of the cohort. Neoadjuvant chemotherapy was given in 31% of patients and adjuvant chemotherapy was given in 4.81% of patients. Higher preoperative eGFR (B -0.549, 95% CI -0.708 to -0.391, P < 0.001) and presence of diabetes mellitus (B -15.414, 95% CI -24.820 to -6.008, P = 0.001) were significant predictors of eGFR decline at 12 months. At 24 months, presence of diabetes mellitus (B -11.799, 95% CI -21.816 to -1.782, P = 0.021) and higher preoperative eGFR (B -0.621, 95% CI -0.796 to -0.446, P < 0.001) were correlated with a steeper decline in eGFR. Higher preoperative eGFR was also predictive of upstaging to CKD3 or higher post operatively (OR 1.019, 95% CI 1.004-1.034, P = 0.015). Intracorporeal diversion was protective, whereas presence of hypertension, diabetes mellitus, and higher preoperative eGFR predicted greater decline in eGFR. CONCLUSION:Patients with higher preoperative eGFR and diabetes are at increased risk of renal function decline post RARC at 12 and 24 months. This suggests that patients with risk factors for renal function decline, but otherwise normal renal function at baseline, are a particularly vulnerable population for progression to CKD after RARC and should be counseled and closely followed postoperatively for renal function deterioration.

INTRODUCTION AND OBJECTIVE: COVID-19 created immense anxiety amongst caregivers and unique strain on healthcare resources which is ongoing. We created a protocol to address this by examining the nature of consults (C) during the pandemic, describe which C needed to be managed in-person, and demonstrated that remote management of many C is appropriate. METHODS: A REDCAP database was used over a six weeks to record urology C at our institution. Data included COVID-status of the patient, reason for C, patient characteristics, and type of intervention required. RESULTS: We received 154 C during the study period. 53% were evaluated in person. 47% were managed remotely. Most common reasons for C were difficult foley catheter placement (21%), obstructing stones(16%), retention (14%) and hematuria (12%). Less common entities included priapism (3%) and Fournier's gangrene (3%). At the time of C 58% were COVID negative, 30% were COVID positive. After evaluation, 44% of C needed no intervention, 27% required a foley, 8% required bladder irrigation and 4% required stenting or nephrostomy placement. Outcomes of those evaluated remotely did not reflect any issues with the care rendered. Fig 1 represents C requests and Fig 2 interventions. CONCLUSIONS: This study showed a higher percentage of C during COVID-19 requiring intervention compared to pre-COVID literature which we successfully identified. 44% did not require acute in-patient intervention. We have shown there is an important role that remote care can and should play in our specialty. Not all C need hands on intervention and studies such as this will result in a safe and logical algorithm for the management of C. With this approach, it became very apparent that not all C are appropriate. This can lead to enhancing the skill set of other house staff. Lastly, the lack of urgency of a large percentage of what we are consulted for becomes apparent. In the face of demands for decreased work hours amongst house staff, strained resources during the pandemic, and the anxiety of the unknown of this virus, we have been able to redefine how C services are delivered.

Coronavirus disease–2019 (COVID-19), a disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, has become an unprecedented global health emergency, with fatal outcomes among adults of all ages throughout the world. There is a high incidence of infection and mortality among cancer patients with evidence to support that patients diagnosed with cancer and SARS-CoV-2 have an increased likelihood of a poor outcome. Clinically relevant changes imposed as a result of the pandemic, are either primary, due to changes in timing or therapeutic modality; or secondary, due to altered cooperative effects on disease progression or therapeutic outcomes. However, studies on the clinical management of patients with genitourinary cancers during the COVID-19 pandemic are limited and do little to differentiate primary or secondary impacts of COVID-19. Here, we provide a review of the epidemiology and biological consequences of SARS-CoV-2 infection in GU cancer patients as well as the impact of COVID-19 on the diagnosis and management of these patients, and the use and development of novel and innovative diagnostic tests, therapies, and technology. This article also discusses the biomedical advances to control the virus and evolving challenges in the management of prostate, bladder, kidney, testicular, and penile cancers at all stages of the patient journey during the first year of the COVID-19 pandemic.

You have accessJournal of UrologyProstate Cancer: Localized: Active Surveillance II (MP62)1 Sep 2021MP62-18 ATENOLOL IS ASSOCIATED WITH REDUCED RISK OF PROSTATE CANCER UPGRADING: A MULTICENTER RETROSPECTIVE STUDY Ali Zahalka, Ethan Fram, Lauren Howard, Evan Garden, Larkin Mohn, Jay Annam, Allison Reagan, Benjamin Eilender, Amanda Dehoedt, Emily Wiggins, Ilir Agalliu, Stephen Freedland, Ash Tewari, and Kara Watts Ali ZahalkaAli Zahalka More articles by this author , Ethan FramEthan Fram More articles by this author , Lauren HowardLauren Howard More articles by this author , Evan GardenEvan Garden More articles by this author , Larkin MohnLarkin Mohn More articles by this author , Jay AnnamJay Annam More articles by this author , Allison ReaganAllison Reagan More articles by this author , Benjamin EilenderBenjamin Eilender More articles by this author , Amanda DehoedtAmanda Dehoedt More articles by this author , Emily WigginsEmily Wiggins More articles by this author , Ilir AgalliuIlir Agalliu More articles by this author , Stephen FreedlandStephen Freedland More articles by this author , Ash TewariAsh Tewari More articles by this author , and Kara WattsKara Watts More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002102.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Increased adrenergic innervation is observed in prostate cancer (PC) and is associated with aggressive disease. This is mediated by beta-adrenergic receptors in the tumor microenvironment. Among beta-blocker types, use of Atenolol was previously shown to reduce incident risk of clinically significant PC. However, it is unknown whether continued Atenolol use is associated with a sustained protective effect on PC progression. We therefore examined the association of Atenolol use on the risk of PC upgrading on repeat biopsy in a multicenter analysis. METHODS: A retrospective review of men who underwent initial biopsy for suspicion of PC and received at least one additional prostate biopsy (eg. active surveillance) between 2006 and 2019 across three diverse urban hospitals was performed. Active Atenolol users were those with at least two prescription refills within the year preceding initial biopsy, and duration of use calculated from medication initiation to last refill prior to repeat biopsy. Patient demographics, pre-biopsy PSA, and biopsy pathology were collected. Multivariable logistic regression analysis was performed to evaluate the association between Atenolol use and risk of upgrading, defined as any increase in primary or secondary Gleason grade on repeat biopsy. RESULTS: Among 1,779 men analyzed, 37% self-reported as Black, and 43% had an initial biopsy positive for PC (PC+), 33% of which had upgrading on repeat biopsy. Of men who had an initial negative biopsy (PC-), 44% had disease upgrading. On multivariable analysis, Atenolol use was associated with decreased odds of upgrading on repeat biopsy (PC- OR 0.70, CI 0.45-0.94, p=0.03; PC+ OR 0.63, CI 0.39-0.86, p=0.02). In a dose-dependent manner, greater duration of Atenolol exposure (>3 years) was associated with the greatest decreased odds of upgrading (PC- OR 0.51, CI 0.24-0.85, p=0.04; PC+ OR 0.53, CI 0.37-0.65, p=0.01). CONCLUSIONS: Use of the beta-blocker Atenolol is associated with a reduced odd of PC upgrading on repeat biopsy in our large multicenter population, and greater duration of Atenolol use was associated with a dose dependent decrease in upgrading. Future studies should test whether Atenolol can prevent PC progression in a post-PC diagnosis cohort (eg. active surveillance) as a novel therapeutic strategy. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1099-e1100 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ali Zahalka More articles by this author Ethan Fram More articles by this author Lauren Howard More articles by this author Evan Garden More articles by this author Larkin Mohn More articles by this author Jay Annam More articles by this author Allison Reagan More articles by this author Benjamin Eilender More articles by this author Amanda Dehoedt More articles by this author Emily Wiggins More articles by this author Ilir Agalliu More articles by this author Stephen Freedland More articles by this author Ash Tewari More articles by this author Kara Watts More articles by this author Expand All Advertisement PDF downloadLoading ...

PURPOSE:To review non-opioid based protocols in urologic oncologic surgery and describe our institutional methods of eliminating peri-operative opioids.METHODS:A thorough literature review was performed using PUBMED to identify articles pertaining to reducing or eliminating narcotic use in genitourinary cancer surgery. Studies were analyzed pertaining to protocols utilized in genitourinary cancer surgery, major abdominal and/or pelvic non-urologic surgery.RESULTS:Reducing or eliminating peri-operative narcotics should begin with an institutionalized protocol made in conjunction with the anesthesia department. Pre-operative regimens should consist of appropriate counseling, gabapentin, and acetaminophen with or without a non-steroidal anti-inflammatory medications. Prior to incision, a regional block or local anesthetic should be delivered. Anesthesiologists may develop opioid-free protocols for achieving and maintaining general anesthesia. Post-operatively, patients should be on a scheduled regimen of ketorolac, gabapentin, and acetaminophen.CONCLUSION:Eliminating peri-operative narcotic use is feasible for major genitourinary oncologic surgery. Patients not only have improved peri-operative outcomes but also are at significantly reduced risk of developing long-term opioid use. Through the implementation of a non-opioid protocol, urologists are able to best serve their patients while positively contributing to reducing the opioid epidemic.

Purpose: To provide a review of high-risk urologic cancers and the feasibility of delaying surgery without impacting oncologic or mortality outcomes. Materials and methods: A thorough literature review was performed using PubMed and Google Scholar to identify articles pertaining to surgical delay and genitourinary oncology. We reviewed all relevant articles pertaining to kidney, upper tract urothelial cell, bladder, prostate, penile, and testicular cancer in regard to diagnostic, surgical, or treatment delay. Results: The majority of urologic cancers rely on surgery as primary treatment. Treatment of unfavorable intermediate or high-risk prostate cancer, can likely be delayed for 3 to 6 months without affecting oncologic outcomes. Muscle-invasive bladder cancer and testicular cancer can be treated initially with chemotherapy. Surgical management of T3 renal masses, high-grade upper tract urothelial carcinoma, and penile cancer should not be delayed. Conclusion: The majority of urologic oncologic surgeries can be safely deferred without impacting long-term cancer specific or overall survival. Notable exceptions are muscle-invasive bladder cancer, high-grade upper tract urothelial cell, large renal masses, testicular and penile cancer. Joint decision making among providers and patients should be encouraged. Clinicians must manage emotional anxiety and stress when decisions around treatment delays are necessary as a result of a pandemic. (C) 2020 Elsevier Inc. All rights reserved.

for NMP revealed a significant number of cases in which this outcome may have been avoided, although it does not appear that NMP can be avoided entirely. Our data indicate that NMP will still be found after >2% of nephrectomies, even with optimal management. Moving forward, awareness and implementation of repeat imaging, renal mass biopsy, and surveillance may decrease the rates of unnecessary interventions for NMP.

To provide a review of high-risk urologic cancers and the feasibility of delaying surgery without impacting oncologic or mortality outcomes. A thorough literature review was performed using PubMed and Google Scholar to identify articles pertaining to surgical delay and genitourinary oncology. We reviewed all relevant articles pertaining to kidney, upper tract urothelial cell, bladder, prostate, penile, and testicular cancer in regard to diagnostic, surgical, or treatment delay. The majority of urologic cancers rely on surgery as primary treatment. Treatment of unfavorable intermediate or high-risk prostate cancer, can likely be delayed for 3 to 6 months without affecting oncologic outcomes. Muscle-invasive bladder cancer and testicular cancer can be treated initially with chemotherapy. Surgical management of T3 renal masses, high-grade upper tract urothelial carcinoma, and penile cancer should not be delayed. The majority of urologic oncologic surgeries can be safely deferred without impacting long-term cancer specific or overall survival. Notable exceptions are muscle-invasive bladder cancer, high-grade upper tract urothelial cell, large renal masses, testicular and penile cancer. Joint decision making among providers and patients should be encouraged. Clinicians must manage emotional anxiety and stress when decisions around treatment delays are necessary as a result of a pandemic.