BACKGROUND:Consumer product-related genital injuries in females across all age groups are understudied. Existing research focuses primarily on paediatric populations. We aimed to determine characteristics, trends and predictors of hospitalisation. METHODS:The National Electronic Injury Surveillance System database was queried for female genital injuries from 2013 to 2022. We stratified our population into four age groups (<18, 18-34, 35-54, >54 years). Automated text matching and manual reviews were employed for variable extraction. χ2 tests and logistic regression were conducted, accounting for survey design and weights. RESULTS:9054 cases representing a national estimate of 252 329 injuries (95% CI 188 059 to 316 599) were identified. Paediatric injuries were most common (61%) and seniors had the highest hospitalisation rates (28%). Falls were common in paediatric (51%) and senior (48%) groups, whereas self-induced and topical application injuries were more frequent among adults aged 18-34 and 35-54. Injuries predominantly involved playground equipment and bicycles in children, razors and massage devices in adults aged 18-34 and 35-54 and household structures in seniors. Hospitalisation increased over the decade from 7% to 9%; significant predictors of hospitalisation were Asian race (OR=3.39, 95% CI 1.83 to 6.30), fractures (OR=7.98, 95% CI 4.85 to 13.1) and urethral injury (OR=3.15, 95% CI 1.30 to 7.63). CONCLUSIONS:Our study identifies distinct patterns in female genital injuries across ages. In the paediatric cohort, injuries are often linked to playgrounds and bicycles. For adults, grooming products are frequently implicated. Seniors commonly suffer injuries from household structures such as bathtubs. These patterns may inform discussions on tailored preventive strategies.

Background and objective:Robot-assisted surgery (RAS) has steadily become more prevalent in urology. The Da Vinci multiport surgical robot (DVM-SR) continues to lead the field. In recent years, new multiport surgical robots (NM-SRs) have been introduced to the market; however, their safety and efficacy remain unassessed. This study aims to give a comprehensive evaluation of the perioperative, oncological, and functional outcomes of NM-SRs and a comparison with the DVM-SR. Methods:A systematic search was performed in PubMed, Scopus, Web of Science, Embase, and clinicaltrial.gov to identify studies that evaluate NM-SRs in major urological surgeries assessing perioperative, functional, and oncological endpoints. A meta-analysis was performed comparing NM-SRs with the DVM-SR for safety, and functional and oncological outcomes. Key findings and limitations:Seventy-four studies involving 5487 patients were included in the review. Nine platforms were studied: Hinotori, Hugo RAS, Revo-I, Versius, Avatera, Senhance, KangDuo Surgical Robot-01, Dexter, and Toumai. NM-SRs were used to perform robot-assisted radical prostatectomy (RARP; 41 studies), partial nephrectomy (RAPN; 14 studies), radical nephrectomy (RARN; four studies), adrenalectomy (four studies), nephroureterectomy (two studies), RARN and thrombectomy (one study), colpopexy (four studies), pyeloplasty (seven studies), simple nephrectomy (four studies), simple prostatectomy (three studies), and ureteral surgery (four studies). Cystectomies with NM-SRs were described only in case reports and were excluded. The comparative analysis between NM-SRs and the DVM-SR showed similar outcomes in terms of intraoperative SATAVA grade ≥2 complications (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.25, 3.1, p = 0.9 for RARP and OR 0.59, 95% CI 0.11, 3.3, p = 0.5 for RAPN), postoperative high-grade complications (Clavien-Dindo ≥IIIa, OR 0.85, 95% CI 0.4, 2, p = 0.7 for RARP and OR 0.59, 95% CI 0.1, 3.3, p = 0.6 for RAPN), and positive surgical margins (OR 0.90, 95% CI 0.72, 1.1, p = 0.3 for RARP and OR 1.65, 95% CI 0.3, 9.1, p = 0.6 for RAPN). For patients undergoing RARP, biochemical recurrence and urinary continence rates at 3 mo were comparable (OR 0.99 [95% CI 0.5, 1.8, p = 1] and OR 0.99 [95% CI 0.77, 1.3, p = 0.9], respectively). The achievement of the trifecta for RAPN appeared to be similar between the included studies on NM-SRs and the DVM-SR (OR 1.3, 95% CI 0.4, 4.4, p = 0.7). The small sample size of the included studies and the preliminary nature of the results represent the major limitations. Conclusions and clinical implications:When compared with the DVM-SR, NM-SRs may offer similar safety, and oncological and functional outcomes across most surgeries for both benign and malignant diseases. Further research is needed to explore the potential of NM-SRs, given the promising initial findings. Patient summary:New multiport surgical robots (NM-SRs) appear to be safe and effective compared with the Da Vinci surgical robotic system. However, further research is required to thoroughly assess their long-term outcomes and cost effectiveness. NM-SRs represent an opportunity to spread the use of robot-assisted surgery globally.

We aimed to examine the association between patient age and procedural intervention, especially nephrectomy, in patients with renal trauma in the National Trauma Data Bank (NTDB). We queried the 2013–2020 NTDB for adult renal trauma patients with an American Association for the Surgery of Trauma (AAST) grade. Patients without AAST grade or with no sign of life were excluded. We constructed a multinomial logistic regression model to demonstrate the association between age and procedural interventions (renal angioembolization, renorrhaphy and nephrectomy). Models were adjusted for patient, hospital, and clinical factors. Our cohort was comprised of 49,884 patients with renal trauma aged 18–89 years, of which 691 (1.4

Introduction Recent advancements in prostate cancer diagnostics and the strategic use of advanced imaging have enhanced our ability to accurately stage patients. The 8th edition of the American Joint Committee on Cancer (AJCC) classification system indicates that the extent of lymph node involvement is associated with more advanced disease stages. This study aims to compare cancer specific survival (CSS) and distant metastasis free survival (MFS) for patients with PCa staged as cN1 or cM1a according to the AJCC classification and treated at a single institution. Methods A total of 207 Patients diagnosed with PCa and clinically suspicious lymphadenopathy treated with radical prostatectomy and extended lymph node dissection (eLND) with or without neoadjuvant androgen deprivation therapy (NADT) between October 2007 and September 2022 were retrospectively identified. Patients were classified as either cN1 or cM1a based on the initial staging. The true positivity of the suspected nodes was confirmed either clinically, through pre-operative re-staging after NADT, or through the final pathological examination. The exact extent of the eLND was based on the location of the positive nodes. Exclusion criteria were the presence of bone and/or visceral metastases, salvage prostatectomy, the use of chemotherapy prior to surgery, and false positive cN1 or cM1a patients. Kaplan-Meyer curves and Cox proportional hazard ratios were estimated to compare CSS and MFS. The date of surgery was considered the time 0 for all the endpoints. Distant metastases were defined as the detection of at least one metastasis outside the pelvic lymph nodes and/or the prostate bed. Results 150 men were classified as cN1, and 57 had at least one retroperitoneal node involved (cM1a). The median age at surgery was 63 years (IQR 58-67). There were no differences between ASA score (p 0.61). Median initial PSA was comparable between the two groups (15.6 ng/ml, IQR 8.35-34.3, p 0.07). Patients in the cM1a group had a higher number of clinically positive nodes (p < 0.001), with a larger median diameter (15 versus 11 mm, p 0.01). Among the cM1a PCa, 26 presented with involvement of common iliac nodes only, while 31 had also other positive retroperitoneal nodes. Most of the patients had a pT ≥ 3b (65.6%), there were no differences in terms of pT stage (p 0.08), pN stage (p 0.79) and final Gleason score (p 0.09) between the two groups. On Cox regression analysis, clinical nodal status was not a statistically significant predictor of MFS even after adjusting for pathological T-stage (HR 1.07, 95%CI 0.66, 1.72, p 0.78). Nodal stage was not a statistically significant predictor of CSS after adjusting for statistically significant predictors (HR1.06, 95%CI 0.46, 2.45, p 0.90). Conclusions Radical prostatectomy remains a viable primary treatment option for patients with positive lymph nodes, irrespective of the N stage or the extent of lymph node involvement. Our study shows that radical prostatectomy does not negatively affect distant metastasis-free survival (MFS) or cancer-specific survival (CSS) in patients with cM1a disease.

INTRODUCTION:We conducted a population-based analysis of Fournier gangrene (FG) to compare risk factors and mortality with those of perineal cellulitis. METHODS:We analyzed National Inpatient Sample data (2016-2020) to identify FG and perineal cellulitis cases. Demographic, comorbidity, and procedural data were extracted. Logistic models assessed risk factors of FG diagnosis and mortality. RESULTS:A total of 73,472 cellulitis and 9326 FG cases were identified corresponding to 74,905 (range, 63,050-79,165) and 9115 (range, 7925-11,080) median yearly weighted cases, respectively. FG diagnosis vs cellulitis was positively associated with Native American race (odds ratio [OR], 1.46; 95% CI, 1.19-1.79), weekend (OR, 1.12; 95% CI, 1.06-1.18) or December (OR, 1.33; 95% CI, 1.22-1.44) admissions, diabetes mellitus (OR, 2.51; 95% CI, 2.38-2.64), and malignancy (OR, 2.29; 95% CI, 2.07-2.54). Conversely, Hispanic (OR, 0.79; 95% CI, 0.74-0.85) and Asian/Pacific Islander races (OR, 0.83; 95% CI, 0.69-0.99) and the highest household income quartile (OR, 0.84; 95% CI, 0.78-0.90) were linked to a reduced likelihood of FG diagnosis. Elevated mortality risks were observed with female sex (OR, 1.33; 95% CI, 1.08-1.63), Native American ethnicity (OR, 2.29; 95% CI, 1.14-4.57), and procedural frequency (OR, 1.27; 95% CI, 1.24-1.3) among FG cases. CONCLUSIONS:Various patient and clinical factors are linked to the development and mortality of FG compared with perineal cellulitis. Improved access to care and understanding of FG can enhance patient outcomes.

Introduction Prostate cancer management presents a significant healthcare burden, with the need to efficiently triage patients for treatment. Our objective is to leverage large language models to predict physician-recommended treatment plans from unstructured clinical notes. By accurately predicting treatment plans, we aim to risk stratify and triage patients effectively, thereby optimizing the allocation of physician resources. Methods 448 unstructured initial urology consultation patient notes following first positive prostate cancer biopsy were identified. The recommended and final treatments received were manually annotated to establish ground truth labels (Table 1). The dataset was split 80:20 for training and testing, preprocessed to remove plan sections and formatted into question-answer (QA) format. A domain-specific large language model (LLM) inspired by GPT and a specialized tokenizer (PCa-LLM) for prostate cancer terminology were developed. QA models were built using the PCa-LLM and compared with those using GPT-2 as the backbone to predict recommended and final treatments. Results For the physician-recommended treatment plans, our LLM (PCa-LLM) showed superior performance with higher AUROC scores for curative vs. non-curative treatments (0.78 vs. 0.65), chemo-hormonal vs. other non-curative treatments (0.89 vs. 0.65), and surveillance vs. all other treatments (0.72 vs. 0.70), while both models achieved the same high AUROC of 0.99 for chemo-hormonal vs. all other treatments. For final treatments, PCa-LLM demonstrated better AUROC for curative vs. non-curative treatments (0.77 vs. 0.74) and chemo-hormonal vs. other non-curative treatments (0.71 vs. 0.66), while GPT2 outperformed PCa-LLM for surveillance vs. all other treatments (0.78 vs. 0.70). Both models achieved an AUROC of 0.99 for chemo-hormonal vs. all other treatments. Conclusions PCa-LLM accurately predicted most treatment categories better than GPT2, with higher AUROC scores, and can be utilized to triage prostate cancer patients using initial consultation notes.

OBJECTIVE:To provide insight into the epidemiologic characteristics and trends of genitourinary (GU) self-inflicted injury (SII). METHODS:We used data from the National Trauma Databank between 2017 and 2020. We described the characteristics of GU SII cases based on injured organ and then compared male and female injuries. RESULTS:We identified 56,463 patients with SII, of which 1508 (2.7%) had GU involvement. Most cases were male patients (77.3%) and white (70.6%). Median age was 35 years (IQR 26-50). The most commonly injured GU organs were kidney (43.4%), followed by scrotum/testes (22.5%), and penis (18.2%). Most cases (89.9%) represented a single-organ injury whereas 10.1% had 2 or more GU organs injured. Seventy-three of those with kidney injuries (11.2%) underwent nephrectomy. Only 1 patient performing GU SII had a diagnosis code for transsexualism but the majority (82.2%) suffered from pre-existing conditions of which 20.5% had 3 or more comorbidities. More than half the population (54.9%) had preexisting diagnosed mental or personality disorder. A non-GU co-injury was present in most cases (70.8%), most commonly affecting another abdominal organ (44.3%) or fractures (41.3%). A positive drug screen was found in 30.7% of cases. Most patients survived though 15.4% died. Ninety-four percentage of fatal cases had a concomitant non-GU injury. CONCLUSION:GU injuries account for 2.6% of all SII. These patients are often young white males with known mental or personality disorders. Kidneys were the most common injured and mortality was highest in cases of kidney and bladder injuries with multi-organ trauma involving non-GU organs.

Introduction External beam radiotherapy (EBRT) is a curative treatment modality for localized prostate cancer, but 8–13% of patients treated with radiation and androgen deprivation therapy experience biochemical recurrence (BCR) at five years, as defined by the Phoenix criteria (PSA rise ≥ 2 ng/ml above the nadir). Concerns arise from the Phoenix criteria being based on conventionally fractionated EBRT while newer forms of radiation may have different PSA kinetics. Additionally, periodic PSA testing, while cost-effective, may not differentiate between local and distant recurrence, and conventional imaging has limitations in lower PSA ranges. PSMA-ligand PET/CT imaging has higher sensitivity and detection rates, even with PSA <0.5 ng/ml, increasing its role in BCR evaluation. This study aims to analyze PSMA-ligand PET/CT performance in patients with rising PSA post-radiotherapy comparing those above and below the Phoenix threshold. Methods Retrospective review of PSMA-PET scans performed at our institution until 02/27/2023 was conducted to identify patients with initial BCR detected by PSMA-PET after RT. Primary outcome included lesion detection rate, defined as any positive finding on PSMA-PET. Local and oligometastatic recurrences were deemed potentially salvageable (suitable for focal salvage therapy). Detection rate and potential for salvage focal therapy were compared in patients with BCR above and below the phoenix threshold (≥ 2ng/ml above nadir) using chi-square. Frequencies and percentages were used to report categorical variables. Continuous data were described using mean and standard deviation or, alternatively, median and range/interquartile range. Statistical significance was set at p < 0.05. Results 45 patients with BCR after radiation (29 above phoenix threshold and 16 below) were assessed by PSMA-PET. Prebiopsy PSA and age at radiation were comparable in both groups. ADT was utilized after radiation in 51.7% of patients above the threshold and 62.5% below. Median PSA nadir was 0.31 above and 0.1 below threshold while PSA at PSMA-PET was 4 above and 1.2 below threshold. Primary outcome, lesion detection was comparable below and above phoenix threshold (14/16 (87.5%) vs 29/29 (100%); p=0.903). Furthermore, there was a significantly higher proportion of patients with disease potentially amenable to salvage therapy when the PSA was below the Phoenix threshold vs above (14/14 (100%) vs 22/29 (76.8%); p = 0.045. Post-PSMA treatments utilized included ADT (34.5% ≥2 and 31.3% <2), ARSI (10.3% ≥2 and 12.5% <2), chemotherapy (3.4% ≥2 and 6.3% <2), cryoablation/image-guided ablation (17.2% ≥2 and 18.8% <2), and metastasis-directed therapy (27.6% ≥2 and 25% <2). Conclusions PSMA-PET demonstrates significant lesion detection capability even in patients with PSA levels below the Phoenix criteria for BCR. Lesions detected below the threshold can be identified by PSMA-PET, potentially allowing for focal salvage therapy to be administered before the disease progresses to polymetastasis. This emphasizes the utility of PSMA-PET in the early detection and management of recurrent prostate cancer, providing an opportunity for timely and targeted interventions.

Introduction Biochemical failure (BCF) after radical prostatectomy seems to increase the risk of disease recurrence and cancer specific mortality. The primary objective of this study is to explore potential peri-operative features that may predict an increased risk of PSA persistence, or BCF, following surgery. We specifically sought to investigate the role of preoperative MRI in predicting this outcome. Methods Patients treated at a single institution between 2006 and 2022 were identified from a prospectively maintained institutional registry. Our sample cohort included a total of 6833 men with negative pre-operative staging (cN0M0), and surgical pathology demonstrating negative margins and lymph nodes. Two measure PSA levels ≥ 0.1 ng/ml within 4-6 weeks after surgery was used as our definition of BCF. Logistic regression analysis was performed to generate odds ratios (OR) and assess the association between peri-operative risk factors and BCF. Features of interest included age, ethnicity, smoking status, pre-operative PSA, and clinical T stage (cT) based on the multiparametric magnetic resonance (mpMRI). Gleason score (GS) at diagnosis, pathological GS, tumor volume, pathological T stage (pT), and lymphovascular invasion (LVI) were analyzed as pathological factors. Results The patients were divided into two groups based on post-operative PSA value. 6263 did not have PSA persistence, while 570 met our definition of BCF. The median age was 62 years (IQR 57-67) for the patients without persistence, and 63 years (IQR 57-67) for those who had BCF. Median PSA was higher among patients with PSA persistence (6.3, IQR 4.5,10.3) compared to those without (5.7 ng/ml, IQR 4.2-8.0). Patients with BCF had a higher proportion of cT stage ≥ 3a at mpMRI (26.7% versus 18.7%) than patients with no BCF. Univariable logistic regression showed a statistically significant association between pathological and preoperative GS, cT and pT stage, LVI, tumor volume and history of smoking. In multivariable analysis, the association remained statistically significant only for definitive pathological features and the history of tobacco use. Results of the uni- and multivariable analyses are presented in table 1. Confounding assessment showed that smoking may confound the association between cT-stage, GS, and tumor volume. Conclusions Several pathological risk factors may increase the risk of PSA persistence after radical prostatectomy in patients who have localized disease preoperatively and pathologically and negative margins at surgery Understanding these predictors can serve as a valuable tool in patient counseling through the course of prostate cancer treatment.

Background Scant data exists on the impacts of prostate radiation on ejaculatory function. We performed a systematic review and meta-analysis to assess ejaculatory outcomes in men after prostate radiation.Methods We queried PubMed, Embase, and Web of Science to identify 17 articles assessing ejaculatory function post-radiation. The primary outcome was anejaculation rate and secondary outcomes included ejaculatory volume (EV), ejaculatory discomfort, and mean decline in ejaculatory function scores (EFS). We assessed study quality with the Newcastle-Ottawa scale. We calculated pooled proportions using inverse variance and random effects models.Results We identified 17 observational studies with 2,115 patients reporting ejaculatory profiles post-radiation. Seven studies utilized external beam radiation therapy, 7 brachytherapy, 1 stereotactic RT and 2 utilized either external or brachytherapy. Ten studies reported an anejaculation rate. Pooled proportion of patients having anejaculation, decreased EV and EjD were 18% (95% CI, 11–36%), 85% (95% CI, 81–89%) and 24% (95% CI, 16–35%), respectively. Five studies reported decline in EFS post-radiation.Conclusions Patients receiving radiation treatment may experience significant changes in their ejaculation, such as the absence of ejaculation, reduced EV, and EjD. It is important to counsel them about these potential side effects.

Purpose: We compare Fournier gangrene in female and male patients and identify mortality-associated characteristics in both. Materials and Methods: We used National Inpatient Sample data (2016-2020) to identify Fournier gangrene cases and extracted demographic, comorbidity, and procedural variables. Multivariable regression models were used to identify mortality risk factors for both cohorts. Results: We identified 2875 female (31%) and 6451 male patients (69%) with Fournier gangrene corresponding to an estimated 14,375 (95% CI, 13,784-14,966) and 32,255 (95% CI, 31,390-33,120) cases, respectively. Female patients were more likely to die than male patients (7.1% vs 5.7%, P < .0001, respectively). The median incidence rates were 1.7 (interquartile range, 1.5-1.8) and 4 (interquartile range, 3.6-4.3) cases per 100,000 person-years for female and male patients, respectively. Female patients had higher median age, longer hospital stays, more charges, procedures, and fecal diversion rates, but lower routine discharges than male patients (P < .05). Non-White female patients had increased mortality odds compared with White female patients (odds ratio [OR], 1.49; 95% CI, 1.07-2.07; P = .019). Prolonged interval until initial perineal debridement correlated with higher mortality odds in both female and male patients (OR, 1.02; 95% CI, 1-1.04; P = .034 vs OR, 1.03; 95% CI, 1.01-1.05; P < .0001). Diabetes lowered mortality odds in female and male patients (OR, 0.68; 95% CI, 0.47-0.99; P = .046 vs OR, 0.54; 95% CI, 0.41-0.7; P < .0001). Conclusions: In female patients, Fournier gangrene incidence surpasses previous reports, with slightly worse outcomes compared with male patients, emphasizing the need for precise clinical assessment and early intensive interventions.

Introduction:Patient perceptions of physician reimbursement commonly differ from actual reimbursement. This study aims to improve health care cost transparency and trust between patients, physicians, and the health care system by evaluating patient perceptions of Medicare reimbursement for artificial urinary sphincter (AUS) placement.Methods:We identified patients who underwent AUS placement at a single institution from 2014 to 2023. After obtaining informed consent, we administered a telephone survey to ask patients about their perceptions of Medicare reimbursement for AUS surgery and the amount they felt the physician should be compensated.Results:Sixty-four patients were enrolled and completed the survey. On average, patients estimated Medicare physician reimbursement to be $18,920, 25 times the actual average procedure reimbursement. Once informed that the actual amount was $757.52, 97% of respondents felt that the reimbursement was "somewhat lower" (13%) or "much lower" (84%) than what they considered fair. The average amount that patients felt the physician should be paid was $8,844, 12 times the actual average procedure reimbursement. Fifty-four percent of patients estimated their physician's reimbursement to be higher than what they later reported as being "fair," representing a presurvey belief that their physician was overpaid.Conclusions:Patient perceptions of physician reimbursement for AUS are vastly different than the actual amount paid. The discordance between patient perception and actual reimbursement could impact how patients view health care costs and the relationship with their provider.

You have accessJournal of UrologyProstate Cancer: Localized: Ablative Therapy I (MP25)1 May 2024MP25-03 SALVAGE RADICAL PROSTATECTOMY AFTER FOCAL THERAPY FOR PROSTATE CANCER Umar Ghaffar, Giuseppe Reitano, Vidit Sharma, Spyridon P. Basourakos, Grant M. Henning, and Robert J. Karnes Umar GhaffarUmar Ghaffar , Giuseppe ReitanoGiuseppe Reitano , Vidit SharmaVidit Sharma , Spyridon P. BasourakosSpyridon P. Basourakos , Grant M. HenningGrant M. Henning , and Robert J. KarnesRobert J. Karnes View All Author Informationhttps://doi.org/10.1097/01.JU.0001008692.26556.39.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Focal therapy (FT) is a popular alternative to radical approaches for selective patients with localized prostate cancer (PCa). FT carries low risk of sexual and urinary toxicities but high risk of recurrence requiring salvage treatments. The outcomes of salvage radical prostatectomy (SRP) following FT are sparsely reported in the existing literature. We report oncological and functional outcomes of this cohort at our institution. METHODS: A retrospective review of all SRP performed at our institute till December 2021 was conducted to identify patients who initially underwent FT for PCa before SRP. Surgical, oncological , and functional outcomes were described. Logistic regression was used to assess factors predicting composite outcome biochemical persistence or recurrence within 1 year. RESULTS: We identified 30 patients who underwent SRP post-FT (16 cryoablation, 12 High Intensity Focused Ultrasound (HIFU), 1 laser ablation and 1 thermal ablation). 2 patients underwent repeat FT before SRP. Types of SRP included 63.3% open and 36.7% laparoscopic. 2 patients had failure of SRP due to severe adhesions. 43.3% patients developed periprocedural complications. On follow-up 25% (7/28) had biochemical persistence (BCP), 28.6% (8/28) developed biochemical recurrence (BCR), 42.9% (12/28) were BCR-free while 1 was lost to follow-up. (Table 1) Of 25 patients who were continent prior to SRP, 72% were pad-free or on security pad only at 1 year. Of 18 patients who were not impotent prior to SRP, 44.4% had no erections while 50% had erections with or without therapy. Only positive surgical margins (PSM) were significant predictors of biochemical persistence or recurrence within 1 year (OR 30.0; 95% CI 2.9 to 315.6; p=0.005). CONCLUSIONS: SRP is feasible for patients with recurrence or failure after FT with good continence and adequate potency outcomes. SRP after FT has high risk of complications, BCP and BCR. PSM are predictive of biochemical failure or recurrence within 1 year of SRP. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e404 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Umar Ghaffar More articles by this author Giuseppe Reitano More articles by this author Vidit Sharma More articles by this author Spyridon P. Basourakos More articles by this author Grant M. Henning More articles by this author Robert J. Karnes More articles by this author Expand All Advertisement PDF downloadLoading ...

Artificial intelligence (AI) is the integration of human tasks into machine processes. The role of AI in kidney cancer evaluation, management, and outcome predictions are constantly evolving. We performed a narrative review utilizing PubMed electronic database to query AI as a method of analysis in kidney cancer research. Key search-words included: Artificial Intelligence, Supervised/Unsupervised Machine Learning, Deep Learning, Natural Language Processing, Neural Networks, radiomics, pathomics, and kidney or renal neoplasms or cancer. 72 clinically relevant and impactful studies related to imaging, histopathology, and outcomes were recognized. We anticipate the incorporation of AI tools into future clinical decision-making for kidney cancer.

PURPOSE:Overactive bladder (OAB) syndrome significantly impairs quality of life, often necessitating pharmacological interventions with associated risks. The fragility of OAB trial outcomes, as measured by the fragility index (FI: smallest number of event changes to reverse statistical significance) and quotient (FQ: FI divided by total sample size expressed as a percentage), is critical yet unstudied. MATERIALS AND METHODS:We conducted a systematic search for randomized controlled trials on OAB medications published between January 2000 and August 2023. Inclusion criteria were trials with two parallel arms reporting binary outcomes related to OAB medications. We extracted trial details, outcomes, and statistical tests employed. We calculated FI and FQ, analyzing associations with trial characteristics through linear regression. RESULTS:We included 57 trials with a median sample size of 211 participants and a 12% median lost to follow-up. Most studies investigated anticholinergics (37/57, 65%). The median FI/FQ was 5/3.5%. Larger trials were less fragile (median FI 8; FQ 1.0%) compared to medium (FI: 4; FQ 2.5%) and small trials (FI: 4; FQ 8.3%). Double-blinded studies exhibited higher FQs (median 2.9%) than unblinded trials (6.7%). Primary and secondary outcomes had higher FIs (median 5 and 6, respectively) than adverse events (FI: 4). Each increase in 10 participants was associated with a +0.19 increase in FI (p < 0.001). CONCLUSIONS:A change in outcome for a median of five participants, or 3.5% of the total sample size, could reverse the direction of statistical significance in OAB trials. Studies with larger sample sizes and efficacy outcomes from blinded trials were less fragile.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence (MP03)1 May 2024MP03-03 FRAILTY IN MEN UNDERGOING PROSTHETIC UROLOGIC PROCEDURES ASSOCIATES WITH POST-OPERATIVE SEPSIS, CARDIOVASCULAR COMPLICATIONS, AND DISCHARGE TO CONTINUED CARE Umar Ghaffar, Nikit Venishetty, Behzad Abbasi, Adrian Fernandez, Robert Pearce, Nizar Hakam, Kevin D. Li, Hiren Patel, and Benjamin N. Breyer Umar GhaffarUmar Ghaffar , Nikit VenishettyNikit Venishetty , Behzad AbbasiBehzad Abbasi , Adrian FernandezAdrian Fernandez , Robert PearceRobert Pearce , Nizar HakamNizar Hakam , Kevin D. LiKevin D. Li , Hiren PatelHiren Patel , and Benjamin N. BreyerBenjamin N. Breyer View All Author Informationhttps://doi.org/10.1097/01.JU.0001009488.55564.85.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Frailty has yet to be explored as a risk factor for urologic prosthetics post-operative complications. Our objective is to assess the impact of modified frailty index-5 (mFI-5) on post-surgery outcomes in patients undergoing urologic prosthetic procedures. METHODS: National Surgical Quality Improvement Program (NSQIP) 2015-2020 were reviewed. Male patients undergoing artificial urinary sphincter (AUS), urethral sling procedures and penile prosthesis (PP) were identified using CPT codes. The mFI-5 was calculated by assigning one point for each comorbidity present: diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and functionally dependent health status. Outcomes included morbidity (presence of any complication), mortality, Clavien grade 4/5 complications, prolonged length of stay (PLOS), operative time (OT), readmission, reoperation, discharge to continued care (DCC) and healthcare resource utilization (HU) (composite of PLOS, readmissions, DCC and reoperation). RESULTS: 3,608 patients (AUS 63.3%; Sling 25.7%; penile prosthesis 11.0%) were identified. Mean age was 69.2, and 21.7% of patients were very frail (mFI-5 ≥ 2). Frailty (mFI-5≥2 vs <2) was significantly associated with post-operative sepsis (OR 2.26; 1.02-5.00; p=0.044), cardiovascular complications (OR 4.33; 1.32-14.2, p=0.016), DCC (OR 6.5; 2.18-19.5; p<0.001) and OT (OR 1.01; 1.01-1.01; p<0.001). Frailty was not associated with overall morbidity, PLOS, reoperation, healthcare utilization, Clavien Grade 4/5 complications or mortality. CONCLUSIONS: Our study shows frailty in adults receiving urologic protheses is associated with greater odds of post-operative sepsis and cardiovascular complications. Additional research is warranted to investigate interventions aimed at optimizing the well-being of frail patients. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e22 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Umar Ghaffar More articles by this author Nikit Venishetty More articles by this author Behzad Abbasi More articles by this author Adrian Fernandez More articles by this author Robert Pearce More articles by this author Nizar Hakam More articles by this author Kevin D. Li More articles by this author Hiren Patel More articles by this author Benjamin N. Breyer More articles by this author Expand All Advertisement PDF downloadLoading ...

This cross-sectional study investigates injury trends associated with electric bicycles in the US from 2017 to 2022.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (MP52)1 May 2024MP52-01 PSMA-PET FOR INITIAL BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY Umar Ghaffar, Vidit Sharma, Giuseppe Reitano, Spyridon P. Basourakos, Grant M. Henning, Mohamed E. Ahmed, Ekamjit S. Deol, Geoffrey B. Johnson, Jack Andrews, Eugene D. Kwon, and Robert J. Karnes Umar GhaffarUmar Ghaffar , Vidit SharmaVidit Sharma , Giuseppe ReitanoGiuseppe Reitano , Spyridon P. BasourakosSpyridon P. Basourakos , Grant M. HenningGrant M. Henning , Mohamed E. AhmedMohamed E. Ahmed , Ekamjit S. DeolEkamjit S. Deol , Geoffrey B. JohnsonGeoffrey B. Johnson , Jack AndrewsJack Andrews , Eugene D. KwonEugene D. Kwon , and Robert J. KarnesRobert J. Karnes View All Author Informationhttps://doi.org/10.1097/01.JU.0001008864.84854.b7.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PSMA-PET-CT has emerged as a valuable modality for detecting biochemically recurrent (BCR) prostate cancer (PCa) and has outperformed conventional imaging (CI) especially in patients with high-risk disease. We performed a retrospective review to assess detection efficacy, patterns of recurrence and factors predicting positive PSMA-PET with initial BCR after radical prostatectomy (RP). METHODS: Retrospective review of PSMA-PET scans performed at our institution until 02/27/2023 was conducted to identify patients with initial BCR detected by PSMA-PET after RP. Primary outcome was detection rate and secondary outcomes included patterns of recurrence, comparison with CI and factors impacting detection via PSMA-PET. RESULTS: 153 patients were identified. Detection rate at BCR was 60.5% (92/153) for PSMA PET-CT. Patterns of lesion on PSMA-PET were local recurrence 21.6% (33/153), vesicourethral anastomosis 4.6% (7/153), regional node 31.4% (48/153), distant node 11.1% (17/153), osseous metastasis 10.5% (16/153), visceral metastasis 3.3% (5/153). PSMA scan was negative 26.1% (40/153) and indeterminate in 13.1% (20/153) cases. Among 115 patients who had CI within 3 months available, PSMA-PET had significantly higher lesion detection than CI (59.6% vs 45.6%; p=0.002). Post-PSMA PET management strategies included salvage radiation (65.3%), androgen deprivation therapy (60.1%), chemotherapy (2.6%) and metastasis directed therapy (5.3%). Pathologic N1 stage (OR 4.45; 95% CI 1.05-18.91; p=0.043) and positive surgical margins (2.58; 95% CI 1.05-6.31; p=0.038) were significant predictors of lesion detection on multivariable analysis. CONCLUSIONS: PSMA-PET has high detectability of lesion in BCR patients and may be utilized to guide management. Pathologic N1 stage and positive surgical margins are significant predictors of lesion detection. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e851 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Umar Ghaffar More articles by this author Vidit Sharma More articles by this author Giuseppe Reitano More articles by this author Spyridon P. Basourakos More articles by this author Grant M. Henning More articles by this author Mohamed E. Ahmed More articles by this author Ekamjit S. Deol More articles by this author Geoffrey B. Johnson More articles by this author Jack Andrews More articles by this author Eugene D. Kwon More articles by this author Robert J. Karnes More articles by this author Expand All Advertisement PDF downloadLoading ...

Objectives To evaluate the association between frailty and surgical outcomes using frailty indices and to assess tool performance. Genitourinary prosthetics, including artificial urinary sphincter (AUS), urethral sling, and penile prosthesis, are standard therapeutic interventions but are susceptible to complications. These procedures are often performed on older, frail patients, necessitating a deeper understanding of the relationship between frailty and postoperative morbidity Methods We utilized data from the NSQIP database (2011-2020) to identify patients undergoing urologic prosthetic procedures, including artificial urinary sphincter, sling, and penile prosthesis. Frailty was assessed using the modified frailty index-5 (mFI-5), the Risk Analysis Index (RAI-A) and ASA Class. Primary outcomes focused on 30-day postoperative morbidity, with secondary outcomes including mortality, length of stay, discharge disposition, readmissions, and reoperations. Logistic and linear regression models were constructed, adjusting for relevant clinical variables, and ROC curve plotted to compare the predictive abilities of mFI-5, RAI-A, and ASA classification. Results We identified 4,734 patients who underwent AUS, sling, or penile prosthesis surgeries. Frailty, as measured by RAI-A (OR 2.05, 95% CI 1.59-2.65, p<0.001) and ASA Class (OR 1.55, 95% CI 1.19-2.01, p=0.001), was significantly associated with postoperative morbidity, while mFI-5 was not. Cardiovascular complications and discharge to continued care were associated with all tools. ROC curve analysis showed that RAI-A had significantly greater predictive ability for postoperative morbidity than mFI-5 (p=0.023). Conclusions RAI-A and ASA are more effective than the mFI-5 in predicting postoperative morbidity, mortality, and other adverse outcomes in patients undergoing urologic prosthetic surgeries.

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia (MP11)1 May 2024MP11-06 GENDER DISPARITIES IN FOURNIER'S GANGRENE MORTALITY: INSIGHTS FROM NATIONAL INPATIENT SAMPLE DATA Behzad Abbasi, Emily Hacker, Umar Ghaffar, Nizar Hakam, Kevin Li, Sultan Alazzawi, Adrian Fernandez, Hiren Patel, and Benjamin Breyer Behzad AbbasiBehzad Abbasi , Emily HackerEmily Hacker , Umar GhaffarUmar Ghaffar , Nizar HakamNizar Hakam , Kevin LiKevin Li , Sultan AlazzawiSultan Alazzawi , Adrian FernandezAdrian Fernandez , Hiren PatelHiren Patel , and Benjamin BreyerBenjamin Breyer View All Author Informationhttps://doi.org/10.1097/01.JU.0001008564.85995.11.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To compare male and female Fournier's gangrene (FG) patients, with an emphasis on mortality predictors. METHODS: We employed National Inpatient Sample data (2016–2020) to identify FG cases using International Classification of Diseases (10th revision) codes. We extracted demographics, comorbidity, and procedural data and built logistic models for mortality prediction in both cohorts. RESULTS: We found 6,451 (69.2%) male and 2,875 (30.8%) female FG cases (death rates 5.7% and 7.1%, respectively). Women had higher median age, hospital stays, charges, procedures, and greater fecal diversion rates, but lower routine discharges and urinary diversion compared to men (p<0.05). Predictors of mortality common to both genders included age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.03–1.05 vs OR 1.04, 95% CI1.03–1.05), time to first debridement (OR 1.03, 95% CI 1.02–1.05 vs OR 1.02, 95% CI 1–1.04), and diabetes (OR 0.65, 95% CI 0.52–0.82 vs OR 0.62 , 95% CI 0.44–0.85). Gender-specific predictors of death for males included autoimmune diseases (OR 2.34, 95% CI 1.32–4.14), orchiectomy/penectomy (OR 1.71, 95% CI 1.25–2.34), perivascular diseases (OR 1.56, 95% CI 1.06–2.3), and chronic lung disease (OR 1.36, 95% CI 1.03–1.79), and for females comprised Native American Ethnicities (OR 3.93, 95% CI 1.27–12.17) and Asian/Pacific Islander (OR 3.39, 95% CI 1.32–8.69). South/Midwest regions (OR 0.62, 95% CI 0.46–0.84 and OR 0.64, 95% CI 0.45–0.9) and obesity (OR 0.74, 95% CI 0.58–0.96) were associated with lower mortality risk in men, while depression was associated with lower odds of mortality in women (OR 0.52, 95% CI 0.3–0.9). CONCLUSIONS: The patient profiles and clinical factors contributing to mortality in cases of FG are not identical between male and female individuals. These results offer insights into gender-specific aspects of the condition, informing tailored approaches to prevention and treatment. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e151 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Behzad Abbasi More articles by this author Emily Hacker More articles by this author Umar Ghaffar More articles by this author Nizar Hakam More articles by this author Kevin Li More articles by this author Sultan Alazzawi More articles by this author Adrian Fernandez More articles by this author Hiren Patel More articles by this author Benjamin Breyer More articles by this author Expand All Advertisement PDF downloadLoading ...