Objectives:
The acetabular labrum is theorized to have an important role in the normal function of the hip through the hip fluid seal. The hip fluid seal functions to create intra-articular fluid ...pressurization and stability to distractive forces. Yet, the effect of a labral tear or partial labral resection, and interventions including labral repair and labral reconstruction, on the hip fluid seal remain to be defined. The purpose of the current study was to characterize the hip fluid seal, including intra-articular fluid pressurization and stability to distraction, in six different labral conditions: (1) intact, (2) labral tear, (3) labral repair, (4) partial resection, (5) labral reconstruction with iliotibial band, and (6) complete resection. Additionally, the current study investigates the effect of looped (3a) and through (3b) type labral suture repairs on the hip fluid seal.
Methods:
Eight cadaveric hips with a mean age of 47 (range 41-51) years were included in the study. Hips were compressed using an Instron testing device with a force of 2.7 times body weight (2118 N), simulating the single leg stance phase of gait, while intra-articular pressure was continuously measured with three miniature 1.0 x 0.3 mm pressure transducers. Additionally, the distractive strength of the hip fluid seal was recorded after each loading cycle. Three loading trials were performed for each labral condition. Specimens were randomized to looped or through type labral suture repairs within matched hips. Peak intra-articular pressures and distractive strength measurements for each condition were normalized relative to the intact state of each hip (percentage of intact state). Statistical analyses were performed utilizing a general linear model with repeated measures analysis for several predetermined comparisons of labral conditions.
Results:
Intra-articular fluid pressurization of the intact state varied from 78 to 422 kPa, while the distractive strength of the hip fluid seal ranged from 124 to 150 N. Labral tear, partial resection, and complete resection resulted in average decreases in pressurization of 25%, 47%, and 76%, and decreases in distractive strength of 24%, 71%, and 73% respectively, compared to the intact state. Through type labral suture repair resulted in significantly greater improvement in fluid pressurization, compared to the labral tear state, than the looped type repair (+66.4% vs. -12.5%, p 0.029). Labral reconstruction resulted in a mean normalized pressurization of 110% and distraction of 66%, with an improvement in pressurization of 53% and distraction of 37% compared to a partial labral resection (p=0.012 and p=0.021, respectively). A moderate positive correlation between peak fluid pressurization and distractive strength was present (Pearson correlation coefficient 0.435, p=0.016).
Conclusion:
The presence of a labral tear or partial labral resection results in decreases in intra-articular fluid pressurization and stability to a distractive force. Through type labral suture repair restores the hip fluid seal significantly better than a looped type repair at time zero. Labral reconstruction with an iliotibial band graft significantly improves pressurization (to levels similar to the intact state) and stability to distractive force, compared to a partial labral resection.
Purpose Gleason 6 (3+3) is the most commonly diagnosed prostate cancer among men with prostate specific antigen screening, the most histologically well differentiated and is associated with the most ...favorable prognosis. Despite its prevalence, considerable debate exists regarding the genetic features, clinical significance, natural history, metastatic potential and optimal management. Materials and Methods Members of the Young Urologic Oncologists in the Society of Urologic Oncology cooperated in a comprehensive search of the peer reviewed English medical literature on Gleason 6 prostate cancer, specifically focusing on the history of the Gleason scoring system, histological features, clinical characteristics, practice patterns and outcomes. Results The Gleason scoring system was devised in the early 1960s, widely adopted by 1987 and revised in 2005 with a more restrictive definition of Gleason 6 disease. There is near consensus that Gleason 6 meets pathological definitions of cancer, but controversy about whether it meets commonly accepted molecular and genetic criteria of cancer. Multiple clinical series suggest that the metastatic potential of contemporary Gleason 6 disease is negligible but not zero. Population based studies in the U.S. suggest that more than 90% of men newly diagnosed with prostate cancer undergo treatment and are exposed to the risk of morbidity for a cancer unlikely to cause symptoms or decrease life expectancy. Efforts have been proposed to minimize the number of men diagnosed with or treated for Gleason 6 prostate cancer. These include modifications to prostate specific antigen based screening strategies such as targeting high risk populations, decreasing the frequency of screening, recommending screening cessation, incorporating remaining life expectancy estimates, using shared decision making and novel biomarkers, and eliminating prostate specific antigen screening entirely. Large nonrandomized and randomized studies have shown that active surveillance is an effective management strategy for men with Gleason 6 disease. Active surveillance dramatically reduces the number of men undergoing treatment without apparent compromise of cancer related outcomes. Conclusions The definition and clinical relevance of Gleason 6 prostate cancer have changed substantially since its introduction nearly 50 years ago. A high proportion of screen detected cancers are Gleason 6 and the metastatic potential is negligible. Dramatically reducing the diagnosis and treatment of Gleason 6 disease is likely to have a favorable impact on the net benefit of prostate cancer screening.
•Study sites participating in a pragmatic clinical trial in bladder cancer completed monthly surveys on the impact of the COVID-19 Public Health Emergency on elective surgery, bladder cancer care, ...and availability of intravesical bacillus Calmette-Guerin.•Bladder cancer care was minimally restricted compared with more pronounced restrictions seen in general elective surgeries during the COVID-19 pandemic.•Although elective surgery was paused at 76% of sites in May 2020, 48% of sites in January 2021, and 52% of sites in January 2022, bladder cancer care was much less restricted.•Over those same periods, coinciding with COVID-19 incidence waves, TURBT was restricted at 10%, 14%, and 14% of sites, respectively, radical cystectomy was restricted at 10%, 14%, and 19% of sites, respectively, and cystoscopy was restricted at 33%, 0%, and 10% of sites, respectively.
Academic and community urology centers participating in a pragmatic clinical trial in non-muscle-invasive bladder cancer completed monthly surveys assessing restrictions in aspects of bladder cancer care due to the COVID-19 Public Health Emergency. Our objective was to describe pandemic-related restrictions on bladder cancer care.
We invited 32 sites participating in a multicenter pragmatic bladder cancer trial to complete monthly surveys distributed through REDCap beginning in May 2020. These surveys queried sites on whether they were experiencing restrictions in the use of elective surgery, transurethral resection of bladder tumors (TURBT), radical cystectomy, office cystoscopy, and intravesical bacillus Calmette-Guerin (BCG) availability. Responses were collated with descriptive statistics.
Of 32 eligible sites, 21 sites had at least a 50% monthly response rate over the study period and were included in the analysis. Elective surgery was paused at 76% of sites in May 2020, 48% of sites in January 2021, and 52% of sites in January 2022. Over those same periods, coinciding with COVID-19 incidence waves, TURBT was restricted at 10%, 14%, and 14% of sites, respectively, radical cystectomy was restricted at 10%, 14%, and 19% of sites, respectively, and cystoscopy was restricted at 33%, 0%, and 10% of sites, respectively.
Bladder cancer care was minimally restricted compared with more pronounced restrictions seen in general elective surgeries during the COVID-19 pandemic.
Background Bladder cancer poses a significant public health burden, with high recurrence and progression rates in patients with non-muscle-invasive bladder cancer (NMIBC). Current treatment options ...include bladder-sparing therapies (BST) and radical cystectomy, both with associated risks and benefits. However, evidence supporting optimal management decisions for patients with recurrent high-grade NMIBC remains limited, leading to uncertainty for patients and clinicians. The CISTO (Comparison of Intravesical Therapy and Surgery as Treatment Options) Study aims to address this critical knowledge gap by comparing outcomes between patients undergoing BST and radical cystectomy. Methods The CISTO Study is a pragmatic, prospective observational cohort trial across 36 academic and community urology practices in the US. The study will enroll 572 patients with a diagnosis of recurrent high-grade NMIBC who select management with either BST or radical cystectomy. The primary outcome is health-related quality of life (QOL) at 12 months as measured with the EORTC-QLQ-C30. Secondary outcomes include bladder cancer-specific QOL, progression-free survival, cancer-specific survival, and financial toxicity. The study will also assess patient preferences for treatment outcomes. Statistical analyses will employ targeted maximum likelihood estimation (TMLE) to address treatment selection bias and confounding by indication. Discussion The CISTO Study is powered to detect clinically important differences in QOL and cancer-specific survival between the two treatment approaches. By including a diverse patient population, the study also aims to assess outcomes across the following patient characteristics: age, gender, race, burden of comorbid health conditions, cancer severity, caregiver status, social determinants of health, and rurality. Treatment outcomes may also vary by patient preferences, health literacy, and baseline QOL. The CISTO Study will fill a crucial evidence gap in the management of recurrent high-grade NMIBC, providing evidence-based guidance for patients and clinicians in choosing between BST and radical cystectomy. The CISTO study will provide an evidence-based approach to identifying the right treatment for the right patient at the right time in the challenging clinical setting of recurrent high-grade NMIBC. Trial registration ClinicalTrials.gov, NCT03933826. Registered on May 1, 2019. Keywords: Non-muscle invasive bladder cancer, Pragmatic trial, Radical cystectomy, Administration, intravesical, Patient-centered care, Quality of life, Observational study
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