Bacillus Calmette-Guérin (BCG) therapy is the standard of care for high-risk non-muscle invasive bladder cancer (NMIBC). The South West Oncology Group (SWOG) protocol recommends 27 instillations over 36 months to optimise outcomes; however, adherence to this intensive regimen remains challenging worldwide. To assess compliance with the SWOG BCG protocol within our institution, identify barriers to adherence, and highlight areas for quality improvement and cost efficiency. A retrospective review was conducted of patients who commenced BCG induction between January 2021 and December 2023. Data collected included demographics, tumour grade, cystoscopy timing, and adherence to the BCG protocol. Deviations and reasons for non-compliance were extracted from clinical documentation. Cost implications of incomplete therapy were analysed. Thirty-four patients received 38 BCG induction courses. All completed induction, and 79.4

BackgroundRadiomics refers to the conversion of medical images into high-throughput, quantifiable data to analyze disease patterns, aid decision-making, and predict prognosis. Radiogenomics is an extension of radiomics and involves a combination of conventional radiomics techniques with molecular analysis in the form of genomic and transcriptomic data. In the field of bladder cancer, studies have investigated the development, implementation, and efficacy of radiomic and radiogenomic nomograms in predicting tumor grade, gene expression, and oncological outcomes, with variable results. We aimed to perform a systematic review of the current literature to investigate the development of a radiomics-based nomogram to predict oncological outcomes in bladder cancer.Materials and methodsThe Medline, EMBASE, and Web of Science databases were searched up to February 17, 2023. Gray literature was also searched to further identify other suitable publications. Quality assessment of the included studies was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 and Radiomics Quality Score.ResultsRadiogenomic nomograms generally had good performance in predicting the primary outcome across the included studies. The median area under the curve, sensitivity, and specificity across the included studies were 0.83 (0.63-0.973), 0.813, and 0.815, respectively, in the training set and 0.75 (0.702-0.838), 0.723, and 0.652, respectively, in the validation set.ConclusionsSeveral studies have demonstrated the predictive potential of radiomic and radiogenomic models in advanced pelvic oncology. Further large-scale studies in a prospective setting are required to further validate results and allow generalized use in modern medicine.

BACKGROUND:Transurethral resection of bladder tumour (TURBT) is the gold standard for diagnosing and risk-stratifying bladder cancer. Accurate and comprehensive operative documentation is critical for ensuring effective patient management. The European Association of Urology (EAU) guidelines provide a framework for TURBT documentation, including tumour characteristics, procedural details, and complications. However, adherence to these guidelines varies, necessitating quality improvement initiatives. AIMS:This study aimed to assess the quality of TURBT operative notes at a single institution before and after implementing a standardised electronic TURBT template based on EAU guidelines. METHODS:A closed-loop audit was conducted at an academic teaching hospital. Operative notes for 40 consecutive TURBT cases from December 2021 to September 2022 were evaluated against EAU documentation criteria. Following the introduction of a standardised electronic TURBT template, a second audit cycle of 40 cases from September 2022 to March 2023 was conducted. Key documentation elements, including tumour location, appearance, size, multifocality, procedural steps, resection completeness, and complications, were compared. RESULTS:The introduction of the electronic template significantly improved documentation adherence, increasing overall compliance from 69 to 93%. Notable improvements were observed in tumour appearance (65 to 97.5%), tumour size (67.5 to 90%), completeness of resection (55 to 95%), and complication recording (2.5 to 75%). CONCLUSIONS:A structured electronic TURBT template enhances the quality and completeness of operative documentation, aligning with EAU guidelines. Standardised templates facilitate better communication, continuity of care, and quality improvement in TURBT procedures, ultimately contributing to improved patient management and outcomes.

Focal therapy has been approved by both NICE and EAU for localised prostate cancer treatment as part of a prospective registry; however, it is not yet available in Ireland. This study aims to assess the proportion of patients with prostate cancer who are suitable for this treatment and to assess attitudes amongst specialists in Ireland. All patients with a new prostate cancer diagnosis in a tertiary-referral unit within a 12-month period had their radiological and clinicopathological parameters examined by an expert in the delivery of focal therapy to assess their suitability for treatment. Secondly, a questionnaire addressing current knowledge and attitudes was sent to all consultant urologists and trainees nationally. Two hundred seven patients were seen in a prostate cancer diagnosis clinic in 2023. Following exclusions, of the 191 patients with clinically localised disease, 50

Imaging techniques, such as computed tomography (CT) and fluoroscopy, are essential for the diagnosis and treatment of urolithiasis. There is increasing concern regarding the cumulative radiation dose associated with medical imaging and its adverse effects. This study aimed to assess radiation exposure in patients undergoing endoscopic management of urolithiasis and to identify factors associated with increased exposure. A retrospective analysis of all consecutive symptomatic urolithiasis cases who underwent endoscopic surgery over a two-year period at a tertiary referral center was performed. The cumulative radiation dose was recorded per stone episode, and the effective dose (ED) then calculated. Multivariable regression analysis was performed to determine the association between ED and patient, stone, and procedural characteristics. Between January 2020 and December 2021, 250 patients underwent endoscopic intervention for urolithiasis; 71

AbstractBackgroundFinancial toxicity of bladder cancer care may influence how patients utilize healthcare resources, from emergency department (ED) encounters to office visits. We aim to examine whether greater household net worth (HHNW) confers differential access to healthcare resources after radical cystectomy (RC).MethodsThis population‐based cohort study examined the association between HHNW and healthcare utilization costs in the 90 days post‐RC in commercially insured patients with bladder cancer. Costs accrued from the index hospitalization to 90 days after including health plan costs (HPC) and out‐of‐pocket costs (OPC). Multivariable logistic regression models were generated by encounter (acute inpatient, ED, outpatient, and office visit).ResultsA total of 141,903 patients were identified with HHNW categories near evenly distributed. Acute inpatient encounters incurred the greatest HPC and OPC. Office visits conferred the lowest HPC while ED visits had the lowest OPC. Black patients harbored increased odds of an acute inpatient encounter (OR 1.22, 95% CI 1.16–1.29) and ED encounter (OR 1.20, 95% CI 1.14–1.27) while Asian (OR 0.76, 95% CI 0.69–0.85) and Hispanic (OR 0.74, 95% CI 0.69–0.78, p < 0.001) patients had lower odds of an outpatient encounter, compared to White counterpart. Increasing HHNW was associated with decreasing odds of acute inpatient or ED encounters and greater odds of office visits.ConclusionsLower HHNW conferred greater risk of costly inpatient encounters while greater HHNW had greater odds of less costly office visits, illustrating how financial flexibility fosters differences in healthcare utilization and lower costs. HHNW may serve as a proxy for financial flexibility and risk of financial hardship than income alone.

Background: To report objective long-term complications and health related quality of life (HRQOL) outcomes after radical prostatectomy (RP) with and without radiation therapy (RT) for prostate cancer (CaP).Methods: We analyzed patients diagnosed with CaP who underwent RP from the UCSF Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry between 1995 and 2020. Cox proportional hazards were used to assess risk of postoperative com-plications which included cystitis, gastrointestinal (GI) toxicity, incontinence requiring a surgical procedure, ureteral injury and urinary stricture. Repeated measures mixed models were used to assess the effects of radiation and complications on patient-reported urinary, bowel, and sexual function after surgery.Results: Of 6,258 men who underwent RP, cumulative incidence of EBRT was 9.1% at 5 years after surgery. Patients who received post-operative radiation were at increased risk for onset of cystitis (HR 5.60, 95% CI 3.40-9.22, P < 0.01). Receipt of RT was not associated with other complications. In repeated measures analysis, postoperative RT was associated with worsening general health scores, adjusting for complications of incontinence, urinary stricture, GI toxicity or ureteral injury, independent of whether patients had those complications.Conclusions: RT after RP was associated with an increase in the risk of cystitis and worse general health in the long term. Other complications and HRQOL outcomes did not demonstrate differences by whether patients had RT or not. While post-operative RT is the only curative option for CaP after RP, patients and providers should be aware of the increased risks when making treatment decisions.(c) 2023 Elsevier Inc. All rights reserved.

You have accessJournal of UrologyCME1 Apr 2023PD41-04 FIRST IN MAN CLINICAL DATA THROUGH 24-MONTHS OF A NOVEL, MINIMALLY INVASIVE TREATMENT FOR LOWER URINARY TRACT SYMPTOMS SECONDARY TO BENIGN PROSTATIC HYPERPLASIA Thomas H. Lynch, Peter E. Lonergan, and Paul Anderson Thomas H. LynchThomas H. Lynch More articles by this author , Peter E. LonerganPeter E. Lonergan More articles by this author , and Paul AndersonPaul Anderson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The ProVee Expander is a nitinol implant which is deployed between the bladder neck and the verumontanum to mechanically open the prostatic urethra without ablation, resection or piercing of the prostate. The first in man (FIM) evaluation to demonstrate the safety and feasibility of the ProVee was conducted at the Royal Melbourne Hospital, Australia. The Primary Endpoint was successful deployment of the implant. Secondary endpoints included 1) the rates of complications throughout the follow-up periods and 2) a preliminary assessment of the effectiveness in alleviating lower urinary tract symptoms LUTS using the IPSS, QoL and Qmax measurements METHODS: This was a prospective, non-randomised, 10 patient safety and feasibility study. Males ≥50 years, IPSS >15, Qmax <12 mL/s and prostate volume 30-80 cc were enrolled. No washout for medications was mandated and it is noteworthy that 7 of the 10 subjects were on BPH or OAB drug therapy immediately prior to the procedure and discontinued their medication from the day of the index procedure. Follow up visits were performed at 2 weeks, 1, 3, 6, 12 and 24 months using the IPSS, Qmax, PVR, IIEF, pain score and flexible cystoscopy at 3, 6 and 12 months. RESULTS: Men aged 58 – 75 years with a mean IPSS of 23 and mean Qmax of 8 ml/s were enrolled. The ProVee was successfully deployed in all subjects and all men voided following the procedure and no catheterisations were required. Reported postoperative AEs were typically mild and transient. All 10 subjects have completed 24-month follow up and all data has been independently monitored from source. The device was well tolerated with no unexpected procedural or device related adverse events or complications in any subject. No device migration was detected and there were no reported cases of de novo retrograde ejaculation. Although the trial was not powered to demonstrate efficacy there was a 40% improvement in Qmax at 24-months. All men not on LUTS medication prior to the procedure showed a≥30% improvement in IPSS at 24-months and there were no surgical re-treatments through 24-months. CONCLUSIONS: The ProVee Expander can be safely and reliably deployed in the prostatic urethra. The 24-month data from this FIM study of 10 subjects demonstrates the ProVee can safely alleviate LUTS in men with benign prostatic hyperplasia. Further larger clinical studies commenced in June 2022 and are ongoing. Source of Funding: ProVerum Limited © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1059 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas H. Lynch More articles by this author Peter E. Lonergan More articles by this author Paul Anderson More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE To assess the long-term incidence of treatment-related toxicities and quality of life (QOL) outcomes associated with toxicity after external beam radiotherapy (EBRT) for prostate cancer. METHODS We identified all men who had EBRT between 1994 and 2017 from Cancer of the Prostate registry. CaPSURE was queried for patient-reported and International Classification of Diseases9/10 and Current Procedural Terminology codes. The Medical Outcomes Studies Short Form 36 and the University of California, Los Angeles Prostate Cancer Index were used to provide measures of general health, sexual, urinary, and bowel function. Repeated measures mixed models were used to determine QOL change after onset of toxicity. RESULTS From a total of 15,332, 1744 (11.4%) men had EBRT. The median follow-up was 7.9 years (interquartile range [IQR] 4.3-12.7). The median time to onset of any toxicity including urinary pad usage in 265 (15.4% at 8 years) men was 4.3 years (IQR 1.8-8.0). The most frequent toxicity was hemorrhagic cystitis (104, 5.9% at 8 years) after a median of 3.7 years (1.3-7.8), gastrointestinal (48, 2.7% at 8 years) after a median of 4.2 years (IQR 1.3-7.8), followed by urethral stricture (47, 2.4% at 8 years) after a median of 3.7 years (IQR 1.9-9.1). Repeated measures mixed models found that onset of hemorrhagic cystitis was associated with change in general health over time. CONCLUSION EBRT for prostate cancer is associated with distinct treatment-related toxicities which can occur many years after treatment and can affect QOL. These results may help men understand the long-term implications of treatment decisions. UROLOGY 178: 114-119, 2023. & COPY; 2023 Elsevier Inc. All rights reserved.

PURPOSE:Contemporary treatment strategies for localized prostate cancer (PCa) have been evolved over time. However, there is little data regarding survival outcomes based on initial treatment by risk group in this new era. This study aims to evaluate survival outcomes among men who underwent observation, radiotherapy, or radical prostatectomy for localized PCa using a population-based cohort. MATERIALS AND METHODS:The Surveillance, Epidemiology, and End Results (SEER) prostate with watchful waiting dataset (2010-2016) was used. We included men diagnosed with localized PCa and clinical stage T1c-2cN0M0. Other inclusion criteria were age 50-79 years, prostate-specific antigen (PSA) ≤50 ng/mL, and initial treatment with observation (active surveillance/watchful waiting), radiotherapy, or radical prostatectomy. PCa risk was assessed using the D'Amico classification. The primary endpoint was overall survival. Secondary endpoints included PCa-specific survival. Inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression and competing risk analysis were performed to assess outcomes. RESULTS:After IPTW-adjusting, pseudo-population comprised 521,656 men (observation: 170,428, radiotherapy: 175,628, radical prostatectomy: 175,600) at a median 36.5 month follow-up. Observation demonstrated the lowest 5-year overall survival rate (91.6%) after IPTW-adjusting in comparison to radiotherapy (92.4%) and radical prostatectomy (96.1%, p<0.001). Men who underwent radical prostatectomy had the lowest cumulative PCa-specific and all-cause mortality (p<0.001). Compared to observation, radiotherapy (sub-distribution hazard ratio [sHR], 0.89; 95% CI, 0.81-0.97; p=0.012) and radical prostatectomy (sHR, 0.46; 95% CI, 0.41-0.52; p<.001) had a lower risk of PCa-specific mortality in competing risk analysis after adjustment for all other factors and other-cause death. CONCLUSIONS:Intermediate-term mortality risk in men with localized PCa were lower with active treatments compared to observation-especially for intermediate- and high-risk disease. However, observation represents a safe management strategy in men within the low-risk group.

Although there are several decision aids for the treatment of localized prostate cancer (PCa), there are limitations in the consistency and certainty of the information provided. We aimed to better understand the treatment decision process and develop a decision-predicting model considering oncologic, demographic, socioeconomic, and geographic factors. Men newly diagnosed with localized PCa between 2010 and 2015 from the Surveillance, Epidemiology, and End Results Prostate with Watchful Waiting database were included (n = 255,837). We designed two prediction models: (1) Active surveillance/watchful waiting (AS/WW), radical prostatectomy (RP), and radiation therapy (RT) decision prediction in the entire cohort. (2) Prediction of AS/WW decisions in the low-risk cohort. The discrimination of the model was evaluated using the multiclass area under the curve (AUC). A plausible Shapley additive explanations value was used to explain the model's prediction results. Oncological variables affected the RP decisions most, whereas RT was highly affected by geographic factors. The dependence plot depicted the feature interactions in reaching a treatment decision. The decision predicting model achieved an overall multiclass AUC of 0.77, whereas 0.74 was confirmed for the low-risk model. Using a large population-based real-world database, we unraveled the complex decision-making process and visualized nonlinear feature interactions in localized PCa.