Purpose:Disease-specific health awareness (HA) campaigns are a crucial opportunity to improve patient education and ideally outcomes. Our study aimed to understand the impact of genitourinary HA months on engaging public search interests in the United States of America. Methods:We utilized Google Trends to examine public interest in genitourinary conditions during monthly awareness campaigns over 19 years (2004-2022). The relative search volume (RSV) differences between 2004 and 2022 for each term were examined using the Wilcox Signed-Ranked test, while HA months were compared to those of non-HA (NHA) months using Mann-Whitney U-test. Terms were categorized as oncological or benign. Regressions were used to examine differences between search terms in both categories. Results:The median RSV, for the calendar year, increased significantly for "kidney stone" (+53.5; P < 0.0001), "Benign Prostatic Hyperplasia" (+24.5; P < 0.001), and "erectile dysfunction" (+21.5; P ≤ 0.01). Furthermore, the median HA-RSV increased significantly between 2004 and 2022 for "kidney stone" (+57, P < 0.001) and "Erectile dysfunction" (+20; P < 0.01). There were no statistically significant differences (P > 0.05) between HA-RSV and NHA-RSV for any search terms. Oncologic diseases had a higher median RSV (69 [interquartile ranges (IQR): 58-76]) compared to benign diseases (46 [IQR: 35-55.25]) (P < 0.001). Conclusion:Public health interest in select terms increased over time. HA months did not significantly affect public interest. Oncologic diseases had higher RSV compared to benign diseases. Research is critical to improve campaign methodology inside and outside HA months for increased public health engagement.

Introduction: Retzius-sparing prostatectomy was promoted with the early continence result. The long-term oncologic outcome is still unknown. In this study, we aimed to compare the intermediate-term oncologic outcomes of these two approaches in patients' cohort who were treated as part of a randomized controlled trial. Methods: A total of 120 patients were previously randomized equally to receive Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RARP) vs standard robot-assisted laparoscopic radical prostatectomy (S-RARP) between January 2015 and April 2016. Baseline, surgical, and pathologic characteristics as well as oncologic outcomes were assessed. The analysis was done based on the treatment received. Result: Sixty-three patients underwent S-RARP, whereas 57 patients underwent RS-RARP. There was no statistically significant difference in the baseline nor surgical characteristics. The median follow-up was 71.24 (interquartile range: 59.75-75.75) months. There were more pathologic T3 diseases in RS-RARP. There was no significant difference in the positive margin status nor in the biochemical recurrence (BCR) rate among both groups. After S-RARP and RS-RARP, 6 and 10 patients had BCR, and the 5 years BCR-free survival was 91% and 85%, respectively (p = 0.21). Conclusion: In this cohort, there was no difference in BCR in the patients who received either technique. Further multi-institutional studies with a larger sample size and longer follow-up are required.

You have accessJournal of UrologyHistory of Urology Forum II (HF02)1 May 2024HF02-13 BEND ME, SHAPE ME: HISTORICAL TREATMENTS OF PEYRONIE'S DISEASE Sami E. Majdalany, Amarnath Rambhatla, Ali A. Dabaja, and Naveen Kachroo Sami E. MajdalanySami E. Majdalany , Amarnath RambhatlaAmarnath Rambhatla , Ali A. DabajaAli A. Dabaja , and Naveen KachrooNaveen Kachroo View All Author Informationhttps://doi.org/10.1097/01.JU.0001008760.25751.09.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peyronie's disease (PD), a challenging urologic condition characterized by penile pain, curvature, and sexual dysfunction, has caused bother for centuries. We examined some of the more creative PD treatments over time. METHODS: A comprehensive literature review was performed using PubMed database, Google Scholar, and texts regarding the "historical treatments of PD," "induratio penis plastica," or "Van Buren's disease". RESULTS: PD was first pictorially displayed in 3000 BC Minoan art. The Kama Sutra described curvatures of the penis leading to winding of semen. However, it was not until Gabriele Fallopius in 1561 described erectile maintenance dysfunction in a patient with incurvature of the penis. In 1743, François Gigot de la Peyronie seminally described the disease process, depicting an indurated penis with curvature – "Induratio penis plastica". Peyronie began treatments of topical mercury and regular massaging of the plaque with Holy mineral water from Baréges. One hundred years later, Walsham and Spencer were the first to use mercury and iodine injections directly into the penile plaques attempting to dissolve them. This was immediately abandoned due to severe toxic side effects. In 1874, American physician, William Holme Van Buren recommended electrical current via diathermy and in 1943, American urologist Miley B Wesson reported having cured 2 patients via this technique over a 9-year treatment course. His patients would attach an electrode from a home diathermy machine to their penis and begin electrical therapy for 1 hour daily. Wesson also experimented with acidification to dissolve the plaques by prescribing oral disodium phosphate; however, no success was achieved with this option. Later in 1876, hyperthermia to the penile plaques was tested and found to soften plaques with multiple treatments. Over an 87-year period, a variety of oral and topical treatments were experimented with including: sulfur, copper sulfate, salicylates, estrogens, thiosinamin, acidification with disodium phosphate, arsenic, fibrinolysin, and milk. In 1922, German physician, Kumer reported the successful dissolution of Peyronie's plaques via direct insertion of radium seeds, but later discovered long term detrimental effects to the penis. CONCLUSIONS: The treatments for PD have a led a long and winding history. Despite many inventive options over 280 years, we still utilize the mechanical massage prescribed by François de la Peyronie. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e277 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Sami E. Majdalany More articles by this author Amarnath Rambhatla More articles by this author Ali A. Dabaja More articles by this author Naveen Kachroo More articles by this author Expand All Advertisement PDF downloadLoading ...

We performed a literature review to identify articles regarding the state of urological cancers in low-to-middle-income countries (LMICs). The challenges that LMICs face are multifactorial and can include poor health education, inadequate screening, as well as limited access to treatment options and trained urologists. Many of the gold standard treatments in high-income countries (HICs) are scarce in LMICs due to their poor socioeconomic status, leading to an advanced stage of disease at diagnosis and, ultimately, a higher mortality rate. These standards of care are vital components of oncological disease management; however, the current and sparse literature available from LMICs indicates that there are many obstacles delaying early diagnosis and management options in LMICs. In the era of evolving medical diagnosis and treatments, sufficient data must be gathered and understood in order to provide appropriate diagnostic and treatment options to curtail rising mortality rates and, therefore, help to alleviate the burden in LMICs.

You have accessJournal of UrologyStone Disease: Surgical Therapy (Including ESWL) IV (PD47)1 May 2024PD47-12 DOES ANESTHESIA TYPE MATTER IN SHOCKWAVE LITHOTRIPSY? Sami E. Majdalany, Kangli Chen, Stephanie Daignault-Newton, David A. Leavitt, Khurshid R. Ghani, Casey A. Dauw, Naveen Kachroo, and for the Michigan Urological Surgery Improvement Collaborative Sami E. MajdalanySami E. Majdalany , Kangli ChenKangli Chen , Stephanie Daignault-NewtonStephanie Daignault-Newton , David A. LeavittDavid A. Leavitt , Khurshid R. GhaniKhurshid R. Ghani , Casey A. DauwCasey A. Dauw , Naveen KachrooNaveen Kachroo , and for the Michigan Urological Surgery Improvement Collaborative View All Author Informationhttps://doi.org/10.1097/01.JU.0001008652.62443.0a.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies have shown a benefit for general anesthesia (GA) in shockwave lithotripsy (SWL) however there are no specific anesthesia recommendations in the AUA guidelines. We evaluated statewide practice patterns and predictors for use of GA over sedation in SWL and compared whether anesthesia type affected outcome and patient-reported outcomes (PRO). METHODS: Adult patients undergoing SWL between 2016-2023 were identified using the Michigan Urological Surgery Improvement Collaborative's Reducing Operative Complications from Kidney Stones prospectively collected clinical registry. Outcome measures included stone-free rates (SFR), complications and emergency department (ED) visits. PRO data, available beginning in 2020, included patient pain scores (PROMIS Pain Intensity and Pain Interference) and overall treatment satisfaction (ICIQ-S) assessed pre- and post-operatively (7-10 days and 4-6 weeks). A logistic mixed model was used to assess anesthesia type by patient and pre-surgery factors with a random effect for provider within practice and report the Intra-class correlation (ICC). RESULTS: Among 13,182 cases identified from 36 practices, wide variation in GA utilization was noted (Figure 1). During this study period, numbers in receipt of SWL declined but GA rates increased (22% to 55%). Preoperative mean stone diameter was the only clinical predictor for GA use (OR 1.04, 95%CI 1.02-1.06, p<0.001). ICC was 79% indicating very strong within practice patterns for GA utilization highlighting the influence of provider choice in this model. There were no significant differences in outcomes between patients receiving general anesthesia and sedation: complication rates (0.13% vs 0.22%, p=0.3), ED visits (3.6% vs 3.4%, p=0.5), or 60-day SFR (40% vs 39%, p=0.09). PRO data from 273 SWL surgeries showed no significant difference in pre- or post-operative pain intensity or interference between those receiving GA or sedation and no evidence of a difference in treatment satisfaction. CONCLUSIONS: Wide variation in GA use over sedation at SWL was identified, primarily driven by the provider, with increasing rates over time. Anesthesia type did not significantly affect patient safety, outcome or patient experience questioning the role of GA in SWL patients. Download PPT Source of Funding: Blue Cross Blue Shield of Michigan © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e985 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Sami E. Majdalany More articles by this author Kangli Chen More articles by this author Stephanie Daignault-Newton More articles by this author David A. Leavitt More articles by this author Khurshid R. Ghani More articles by this author Casey A. Dauw More articles by this author Naveen Kachroo More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction: Ureteral stents can cause significant patient discomfort, yet the temporal dynamics and impact on activities remain poorly characterized. We employed an automated tool to collect daily ecological momentary assessments (EMAs) regarding pain and the ability to work following ureteroscopy with stenting. Our aims were to assess feasibility and better characterize the postoperative patient experience. Materials and Methods: As an exploratory endpoint within an ongoing clinical trial, patients undergoing ureteroscopy with stenting were asked to complete daily EMAs for 10 days postoperatively or until the stent was removed. Questionnaires were distributed through text messages and included a pain scale (0-10) and a single item from the validated Patient-Reported Outcomes Measurement Information System Ability to Participate in Social Roles and Activities instrument, as well as days missed from work or school. Results: Among the first 65 trial participants, 59 completed at least 1 EMA (overall response rate 91%). Response rates were >85% for each time point through postoperative day (POD)10. Median respondent age was 58 years (interquartile range [IQR] 50-67), and 56% were female. Stones were 54% renal and 46% ureteral, with a median diameter of 9 mm (IQR 7-10). Median stent dwell time was 7 days (IQR 6-8). Pain scores were highest on POD1 (median score 4) and declined on each subsequent day, reaching a median score of 2 on POD5. Sixty-three percent of patients on POD1 reported that they had trouble performing their usual work at least sometimes, but by POD5, this was <50% of patients. Patients who work or attend school reported a median of 1 day missed (IQR 0-2). Conclusions: An automated daily EMA system for capturing patient-reported outcomes was demonstrated to be feasible with sustained excellent engagement. Patients with stents reported the worst pain and interference with work on POD1, with steady improvements thereafter, and by POD5, the majority of patients had minimal pain or trouble performing their usual work. This work is associated with a registered clinical trial [NCT05026710].

OBJECTIVE To characterize the demographics, educational background, and scholarly characteristics of current urology residency program directors (PDs).METHODS Urology programs were identified by the listing on the "Accredited US Urology Programs" section of American Urological Association website as of October 2021. Demographics and academic data were collected via publicly available department website and Google search engine.Metrics obtained included years of service as PD from time of appointment, sex, medical school/residency/fellowship, all-time H-index, dual degrees obtained, and professorial ranking.RESULTS One hundred and forty-seven accredited urological residencies were reviewed; every PD was included. The majority were male (78%) and fellowship trained (68%). Women represented only 22% of PDs. The median active time served as PD, as of 11/2021, was 4 years (IQR: 27). Forty (28%) were faculty at the same program they completed their residency. The median all-time H-index was 12 (IQR: 7-19; range 1-61). Twelve PDs also served as chair of their department.CONCLUSION The vast majority of PDs are male, fellowship trained, and have served for less than 5 years. Future studies are necessary to follow the trends of representation in leaders of urology residency programs.& COPY; 2023 Elsevier Inc. All rights reserved.

PurposeTo investigate the conditional overall survival (OS) of metastatic castration-resistant prostate cancer (mCRPC) patients receiving docetaxel chemotherapy. MethodsWe used deidentified patient-level data from the Prostate Cancer DREAM Challenge database and the control arm of the ENTHUSE 14 trial. We identified 2158 chemonaive mCRPC patients undergoing docetaxel chemotherapy in the five randomized clinical trials. The 6-month conditional OS was calculated at times 0, 6, 12, 18, and 24 months from randomization. Survival curves of each group were compared using the log-rank test. Patients were then stratified into low- and high-risk groups based on the median predicted value of our recently published nomogram predicting OS in mCRPC patients. ResultsNearly half (45%) of the study population was aged between 65 and 74 years. Median interquartile range prostate-specific antigen for the overall cohort was 83.2 (29.6-243) ng/mL, and 59% of patients had bone metastasis with or without lymph node involvement. The 6-month conditional survival rates at 0, 6, 12, 18, and 24 months for the entire cohort were 93% (95% confidence interval [CI]: 92-94), 82% (95% CI: 81-84), 76% (95% CI: 73-78), 75% (95% CI: 71-78), and 71% (95% CI: 65-76). These rates were, respectively, 96% (95% CI: 95-97), 92% (95% CI: 90-93), 84% (95% CI: 81-87), 81% (95% CI: 77-85), and 79% (95% CI: 72-84) in the low-risk group and 89% (95% CI: 87-91), 73% (95% CI: 70-76), 65% (95% CI: 60-69), 64% (95% CI: 58-70), and 58% (95% CI: 47-67) in the high-risk group. ConclusionThe conditional OS for patients undergoing docetaxel chemotherapy tends to plateau over time, with the main drop in conditional OS happening during the first year from initiating docetaxel treatment. That is the longer a patient survives, the more likely they are to survive further. This prognostic information could be a useful tool for a more accurate tailoring of both follow-up and therapies. Patient SummaryIn this report, we looked at the future survival in months of patients with metastatic castration resistant prostate cancer on chemotherapy who have already survived a certain period. We found that the longer time that a patient survives, the more likely they will continue to survive. We conclude that this information will help physicians tailor follow-ups and treatments for patients for a more accurate personalized medicine.

OBJECTIVE To assess the incidence, cumulative healthcare burden, and financial impact of inpatient admissions for radiation cystitis (RC), while exploring practice differences in RC management between teaching and nonteaching hospitals. METHODS We focused on 19,613 patients with a diagnosis of RC within the National Inpatient Sample (NIS) from 2008 to 2014. ICD-9 diagnosis and procedure codes were used. Complex-survey procedures were used to study the descriptive characteristics of RC patients and the procedures received during admission, stratified by hospital teaching status. Inflation-adjusted cost and cumulative annual cost were calculated for the study period. Multivariable logistic regression was used to study the impact of teaching status on the high total cost of admission. RESULTS Median age was 76 (interquartile range 67-82) years. Most of the patients were males (73%; P < .001). 59,571 (61%) patients received at least one procedure, of which, 24,816 (25.5%) received more than one procedure. Median length of stay was 5 days (interquartile range 2-9). Female patients and patients with a higher comorbidity score were more frequently treated at teaching hospitals. A higher proportion of patients received a procedure at a teaching hospital (64% vs 59%; P < .001). The inflation-adjusted cost was 9207 USD and was higher in teaching hospitals. The cumulative cost of inpatient treatment of RC was 63.5 million USD per year and 952.2 million USD over the study period. CONCLUSION The incidence of RC-associated admissions is rising in the US. This disease is a major burden to US healthcare. The awareness of the inpatient economic burden and healthcare utilization associated with RC may have funding implications.

Background: Social media use in medicine has exploded, with uptake by most physicians and patients. There is a risk of dissemination of inaccurate information about urological conditions on social media. Physicians, as key opinion leaders, must play a role in sharing evidence-based information through social media.Objective: To identify and describe the top 100 urology influencers on the Twitter social media platform and to correlate Twitter influence with academic impact in urology.Design, setting, and participants: Twitter influence scores for the search topic "urology"were collected in April 2022 using published methodology. The top 100 personal accounts with the highest computed scores were linked to individuals' names, all-time h index, geographic location, specialty, attributed sex, and board certification status in this cross-sectional study.Outcome measurements and statistical analysis: We examined the correlation between influence rank and h index.Results and limitations: Of the top 100 Twitter influencers on the topic of urology, the majority are from the USA (64%), male (85%), and practicing urologists (91%). Some 93% of US urology influencers are board-certified. Only 22 of the 50 US states are represented. The second most frequent country is the UK, with ten urology influencers. The median all-time h index is 42 (interquartile range 28.25-58). There is a weak positive correlation between influence rank and h index (r = 0.23; p = 0.02). Limitations of the study include the inability to validate the accuracy of the proprietary ranking algorithm and investigation of just one social media platform.Conclusions: The top Twitter influencers in urology are mostly board-certified US urologists. Collectively, influencers have a relatively greater academic impact in comparison to the average urologist, although there is a weak positive correlation between Twitter influence and h index among top Twitter influencers.

OBJECTIVE Vaginal prolapse is a known complication after radical cystectomy, requiring additional procedures in 10% of the patients.(1) This results from loss of level I and II vaginal support due to the removal of pelvic structures. In addition, a neobladder urinary diversion, with Valsalva voiding, predisposes to vaginal prolapse. A genital-sparing approach with paravaginal repair can help prevent such complications. METHODS The genital sparing technique preserves the uterus, fallopian tubes, ovaries, and vagina, while paravaginal repair involves suturing of the lateral vaginal wall to the arcuate fascia located on the medial aspect of the obturator internus muscle. The procedure begins by placing the patient in a lithotomy position, with a steep Trendelenburg. Standard 6 port cystectomy configuration is utilized with an additional 15 mm port for bowel anastomosis. Initially, the ureters and lateral bladder space are mobilized. Posteriorly a dissection plane is developed separating the bladder from the anterior vaginal wall. Distal dissection is carefully performed in that plane to avoid disrupting the urethral-external sphincter complex. Then the bladder is dropped from anterior attachments, the Dorsal venous complex (DVC) and bladder neck are exposed. Urethra is transected distal to the bladder neck, after circumferential mobilization, to complete the cystectomy, again avoiding disruption of the continence mechanism, and opening the endo-pelvic fascia. Cystectomy and pelvic lymph node dissection are completed in a standard fashion. The arcuate fascia is identified bilaterally for level I paravaginal repair. The lateral aspect of the paravaginal tissue is secured to this ligament, using 3 interrupted Polydioxanone (PDS) sutures, bilaterally. An ileal " Hautman's W pouch" neobladder is constructed using 50 cm of the small intestine, similar to the previously reported technique.(2)Bricker-type uretero-ileal anastomosis is performed over a double J stent. Bowel continuity is restored by a side-to-side anastomosis using endo-GIA (gastrointestinal anastamosis EndoGIA (TM)) staplers. RESULTS No intra or postoperative complications were noted. Robot dock time was 8 hours and 23 minutes with an EBL of 100 mL. The patient was discharged on post operative day (POD) 6 and Foley catheter with ureteral stents was removed on POD 27 after a cystogram confirmed no leaks. At 6-month follow-up, the patient reported good continence using a single pad, voiding every 3-4 hours. Fluoro-urodynamics demonstrated 651 mL capacity, low-pressure voiding, minimal residual urine, and no reflux. No prolapse was noted on fluoroscopy and pelvic examination with the Valsalva maneuver. The patient reported a good satisfaction level, regarding her urinary symptoms. CONCLUSION We report satisfactory short-term outcomes of a feasible technique to prevent postcystectomy prolapse; however, long-term follow-up of a larger cohort can help establish its efficacy. (c) 2023 Elsevier Inc. All rights reserved.

You have accessJournal of UrologyCME1 Apr 2023MP54-07 STENTS AND SHOCKWAVE LITHOTRIPSY - THE WHO AND THE WHY: RESULTS FROM A STATEWIDE COLLABORATIVE Sami E. Majdalany, Monica van Til, Stephanie Daignault-Newton, David Leavitt, Khurshid Ghani, Casey Dauw, Naveen Kachroo, and Michigan Urological Surgery Improvement Collaborative Sami E. MajdalanySami E. Majdalany More articles by this author , Monica van TilMonica van Til More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , David LeavittDavid Leavitt More articles by this author , Khurshid GhaniKhurshid Ghani More articles by this author , Casey DauwCasey Dauw More articles by this author , Naveen KachrooNaveen Kachroo More articles by this author , and Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Shockwave lithotripsy (SWL) is a commonly performed stone procedure in the US. AUA guidelines do not recommend routine stent placement for SWL patients. We evaluated statewide practice patterns and predictors for stent placement at the time of SWL and whether stent placement affected stone free rates (SFR) and 30-day complication rates. METHODS: Adult patients undergoing SWL between 2016-2022 were identified using the MUSIC Reducing Operative Complications from Kidney Stones prospectively collected registry. We determined stent usage prior and during SWL across practices and collected demographic, clinical, stone and procedural factors. Outcomes included peri-operative management, complications and SFR. Multivariable logistic regression was used to identify predictors of stent placement at time of SWL. RESULTS: Among 13,063 cases identified from 35 practices (222 urologists), wide practice variation in stent placement patterns were noted ranging from 0-17% (Figure 1). Overall, 2.3% cases were stented at the time of SWL and 15.5% had a prior stent. Stent on a string was performed in 26 cases (9%) by 11 urologists (54% by 1 provider). Stented SWL patients (prior/time of SWL) were more likely to be older, have a higher Charlson comorbidity index, solitary kidney, 1st upper tract stone, ureteral stone, larger stone, hydronephrosis and positive urinalysis/urine culture (all p<0.01). Stented patients were more likely to have peri-op and post-op antibiotics and anticholinergics (p<0.001). Predictors of stent placement at time of SWL included ureteral stones (OR1.6, 95%CI 1.1-2.3, p=0.01), larger stones (OR1.2, 95%CI 1.216-1.23, p<0.001), African-American race (OR1.8, 95%CI 1.03-3.0, p=0.039) and hydronephrosis (OR1.8, 95%CI 1.3-2.6, p<0.001). There were no differences in emergency department (ED) visits between stented and unstented patients (5.3% vs 3.9%, p=0.21) or 60-day SFR (34% vs 40%, p=0.10). Stented patients had significantly higher infectious complications (3% vs 0.6%, p<0.001). CONCLUSIONS: Variation exists amongst urologists regarding stent usage with SWL, influenced by specific patient and stone factors as well as provider preference. Although ED visits and SFR did not differ, stented patients had a significantly increased post operative infection rate. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e756 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sami E. Majdalany More articles by this author Monica van Til More articles by this author Stephanie Daignault-Newton More articles by this author David Leavitt More articles by this author Khurshid Ghani More articles by this author Casey Dauw More articles by this author Naveen Kachroo More articles by this author Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract Introduction: Limited data exist on trends in PSA screening in men with a family history of prostate cancer. The aims of our study were to (1) study age-stratified temporal trends in PSA screening from 2000-2018 for men with a family history of prostate cancer and Black men with a family history of prostate cancer, and (2) identify determinants associated with receipt of PSA screening in the aforementioned groups. Methods: We identified men aged ≥40 years without a prior history of prostate cancer using data from National Health Interview Survey 2000-2018 who self-reported PSA testing in the last 12 months. Age-stratified temporal trends and weighted multivariable logistic regression analyses were assessed. Results: PSA screening increased for men with a family history of prostate cancer between National Health Interview Survey 2000 (28.9%) and 2005 (41.9%), with stable rates for the following years. Black men with a family history of prostate cancer showed no significant change in PSA screening rates regardless of age. Controlling for sociodemographics and access to health care provider, younger age (40-54) and later survey years (2013-2018) were associated with a lower likelihood of PSA screening overall and for Black men, but not for those with a positive family history. Conclusions: Data from a nationally representative study of U.S. men indicated that the annual PSA screening rates for men with a family history of prostate cancer was higher than reported for the overall male population. We believe this represents the first study on trends and determinants of PSA screening in U.S. men with a family history of prostate cancer.

BACKGROUND:Estimation of life expectancy (LE) is important for the relative benefit of prostate specific antigen (PSA) screening. Limited data exists regarding screening for Black men with extended LE. The aim of the current study was to assess temporal trends in screening in United States (US) Black men with limited vs. extended LE, using a nationally representative dataset. MATERIALS AND METHODS:Using the National Health Institution Survey (NHIS) 2000 to 2018, men aged ≥40 without prior history of prostate cancer (PCa) who underwent PSA screening in the last 12 months were stratified into limited LE (ie, LE <15 years) and extended LE (ie, LE≥15 years) using the validated Schonberg index. LE-stratified temporal trends in PSA screening were analyzed for all men, and then in Black men. Weighted multivariable analyses and dominance analyses identified the predictors of PSA screening. RESULTS:PSA screening declined over the study period both for all eligible men with limited and extended LE, particularly between NHIS 2008 and 2013 (27.9%-20.7% in the extended). Screening increased significantly in Black men with extended LE (17.6% in 2010-25.7% in 2018). However, LE was not an independent predictor of screening in the Black cohort. Prior recipient of colonoscopy (55%-57%) and visit to health care provider (24%-32%) were the most important determinants for screening. CONCLUSION:For US men with extended LE, only 1 in 4 receive PSA screening, with a decline over the study-period. Screening rates increased for Black men. However, these changes were not driven by LE consideration itself, but participation in other screenings and access to a provider.

You have accessJournal of UrologyCME1 Apr 2023MP77-04 RACIAL DISPARITIES IN FUTURE DEVELOPMENT OF LETHAL PROSTATE CANCER BASED ON PSA LEVELS IN MIDLIFE Matthew Davis, Alexander Stephens, Chase Morrison, Sami Majdalany, Rafe Affas, Sohrab Arora, Nicholas Corsi, Ivan Rakic, Akshay Sood, Craig Rogers, and Firas Abdollah Matthew DavisMatthew Davis More articles by this author , Alexander StephensAlexander Stephens More articles by this author , Chase MorrisonChase Morrison More articles by this author , Sami MajdalanySami Majdalany More articles by this author , Rafe AffasRafe Affas More articles by this author , Sohrab AroraSohrab Arora More articles by this author , Nicholas CorsiNicholas Corsi More articles by this author , Ivan RakicIvan Rakic More articles by this author , Akshay SoodAkshay Sood More articles by this author , Craig RogersCraig Rogers More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous literature has examined prostate cancer (PCa) mortality in a Scandinavian population based on midlife PSA results. The aim of our study was to examine racial disparities in PCa mortality based on midlife PSA results in a North American population. METHODS: Our cohort included self-identified White and Black men aged 40-59 years, who received their first PSA through our health system between the years 1995 and 2019. Next, patients were divided into 4 categories based on age as follows: 40 to 44, 45 to 49, 50 to 54, and 55 to 59 years. First PSA testing represented the main predictor of interest, and it was categorized based on median and 90th percentile for each age category. Fine-Gray regression was used to examine the impact of the value of PSA at first testing on the risk of developing lethal PCa (i.e. PCa-specific mortality) by race after accounting for all confounders including Charlson comorbidity index among others. Cancer-specific mortality and overall mortality were obtained by linking our database to the Michigan Vital Records registry. RESULTS: A total of 112,967 men met inclusion criteria, of whom 82,084 (73%) were White and 30,883 (27%) were Black. Median and 90th percentile PSA were 0.7 and 2.0 ng/ml, respectively, in White men compared to 0.7 and 2.1 ng/ml, respectively, in Black men. For White men aged 40 to 44, 45 to 49, 50 to 54, and 55 to 59 years, median PSA was respectively 0.6, 0.7, 0.7, and 0.9 ng/ml compared to 0.6, 0.7, 0.8, and 0.9 ng/ml in Black men. The 90th percentile PSA in White men was respectively 1.3, 1.6, 2.0, and 2.8 ng/ml compared to 1.4, 1.8, 2.4, and 3.8 ng/ml in Black men. For the same age categories, the estimated rate of lethal PCa at 20 years was significantly higher in Black men when using the 90th percentile PSA cutoff (see Table 1). Median (IQR) follow-up was 6.7 (2.9 - 14.4) years for White men and 9.9 (4.4 - 16.4) years for Black men. On multivariable analysis, these findings were confirmed. CONCLUSIONS: Our findings suggest that Black men are significantly more likely to develop lethal PCa based on previously published midlife first-time PSA cutoffs. This information suggests that a lower midlife PSA cutoff could be considered amongst Black men. To the best of our knowledge, our report is the first to examine the racial disparities in lethal PCa based on first-time PSA results in a diverse North American cohort. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1102 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Davis More articles by this author Alexander Stephens More articles by this author Chase Morrison More articles by this author Sami Majdalany More articles by this author Rafe Affas More articles by this author Sohrab Arora More articles by this author Nicholas Corsi More articles by this author Ivan Rakic More articles by this author Akshay Sood More articles by this author Craig Rogers More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...

Pelvic organ prolapse is a well-understood clinical condition in many women that can lead to pelvic discomfort, sexual dysfunction, and voiding difficulty. Iatrogenic pelvic organ prolapse is a known complication of radical cystectomy with urinary diversion in women. The prevention, diagnosis, and management of this complication are not well described in literature and practice, creating a gap in the surgical care of women with bladder cancer. We sought to further investigate this phenomenon. While many causes of post-cystectomy pelvic organ prolapse are the same as those in the general female population, it is imperative to describe the normal anatomy and physiology of the female pelvis that, when disrupted during radical cystectomy, can increase the risk of this phenomenon. The clinical evaluation of post-cystectomy pelvic organ prolapse requires pelvic examinations and few diagnostic studies. Traditional management of pelvic organ prolapse may be challenging after radical cystectomy; thus, it is important for surgeons to have knowledge of the existing techniques for prevention and correction of this distressing sequala. In this manuscript, we present the evidence-based literature regarding this subject matter and describe the techniques at our institution to prevent and treat this condition. Robust prospective studies are needed to better understand the prevention and management of pelvic organ prolapse after radical cystectomy in women.

The top 100 Twitter influencers in urology are mostly board-certified US urologists. Collectively, influencers have a relatively greater academic impact compared to the average urologist. However, there is a weak positive correlation between Twitter influence and h index among top influencers.