Extracellular vesicles (EVs) have brought great momentum to the non-invasive liquid biopsy procedure for the detection, characterization, and monitoring of cancer. Despite the common use of PSA ...(prostate-specific antigen) as a biomarker for prostate cancer, there is an unmet need for a more specific diagnostic tool to detect tumor progression and recurrence. Exosomes, which are EVs that are released from all cells, play a large role in physiology and pathology, including cancer. They are involved in intercellular communication, immune function, and they are present in every bodily fluid studied-making them an excellent window into how cells are operating. With liquid biopsy, EVs can be isolated and analyzed, enabling an insight into a potential therapeutic value, serving as a vehicle for drugs or nucleic acids that have anti-neoplastic effects. The current application of advanced technology also points to higher-sensitivity detection methods that are minimally invasive. In this review, we discuss the current understanding of the significance of exosomes in prostate cancer and the potential diagnostic value of these EVs in disease progression.
Retropulsion of stone fragments during ureteroscopic laser lithotripsy (URSLL) remains a challenge for urologists and is associated with increased operative time and reduced stone-free rate (SFR). In ...this study, we compared the rate of retropulsion of ureteral stones during URSLL between the standard dorsal lithotomy (SDL) position and dorsal lithotomy position with reverse Trendelenburg (RT).
Patients with ureteral stones requiring surgical intervention between May 2019 and January 2022 were randomized to undergo URSLL in either SDL or RT positions. The primary outcome of this study was stone retropulsion. Secondary outcomes included retropulsion to the kidney, SFR, operative time, 30-day emergency department visits and complications, and the need for conversion from semirigid to flexible ureteroscope. Differences between groups were evaluated using the chi-square test, Fisher exact test, Kruskal-Wallis test, or
-test.
A total of 114 patients were included in the study, with 57 patients in each group. There were no differences between groups in terms of baseline demographics or stone characteristics. Retropulsion was significantly less frequent in the RT group (68.4%
10.5%,
< 0.01). Similarly, the RT group was favored for lower risk of retropulsion into the kidney (40.4%
5.3%,
< 0.01), operative time (43.5
33.0 minutes,
= 0.02), and need for ureteroscope conversion (16.7%
2.2%,
= 0.04). There was no difference in the SFR (100%
95%,
= 0.49).
RT positioning during URSLL for ureteral stones significantly decreases the rate of stone retropulsion, operative time, and the need for conversion from semirigid to flexible ureteroscope.
Transgender individuals represent 0.55% of the US population, equivalent to 1.4 million transgender adults. In transgender women, feminisation can include a number of medical and surgical ...interventions. The main goal is to deprive the phenotypically masculine body of androgens and simultaneously provide oestrogen therapy for feminisation. In gender-confirming surgery (GCS) for transgender females, the prostate is usually not removed. Due to limitations of existing cohort studies, the true incidence of prostate cancer in transgender females is unknown but is thought to be less than the incidence among cis-gender males. It is unclear how prostate cancer develops in androgen-deprived conditions in these patients. Six out of eleven case reports in the literature presented with metastatic disease. It is thought that androgen receptor-mediated mechanisms or tumour-promoting effects of oestrogen may be responsible. Due to the low incidence of prostate cancer identified in transgender women, there is little evidence to drive specific screening recommendations in this patient subpopulation. The treatment of early and locally advanced prostate cancer in these patients warrants an individualised thoughtful approach with input from patients' reconstructive surgeons. Both surgical and radiation treatment for prostate cancer in these patients can profoundly impact the patient's quality of life. In this review, we discuss the evidence surrounding screening and treatment of prostate cancer in transgender women and consider the current gaps in our knowledge in providing evidence-based guidance at the molecular, genomic and epidemiological level, for clinical decision-making in the management of these patients.
To examine female author representation within publications in the field of urology from the United States from 2000-2019.
All 25,787 articles with a U.S. correspondence address published in the two ...largest U.S. headquartered general urology journals, Urology and Journal of Urology, were analyzed from 2000-2019. Gender was assigned to each first and last author based on the author's first name. First names were matched to a database of U.S. Social Security Administration data to determine gender.
Overall female authorship, female senior authorship, and female first authorship exhibited a significant upward trend from 2000 to 2019 (P <0.001, P <0.001, P = 0.002). As the number of female last authors increased, female last authors were significantly more likely to publish with female first authors, and significantly less likely publish with male first authors (P <0.001, P <0.001). Furthermore, we found a significant difference for female authors being less likely to get cited than male authors (p = 0.02), despite the greater proportion of females that authored research articles with higher citation counts compared to males (P <0.05).
Despite the significant progress in female representation within urological publications, female-authored publications continue to constitute a smaller proportion of the urological literature and are less likely to be cited. Our study provides the first evidence on the current status of female underrepresentation within academic urology and literature productivity at this watershed moment. As the number of female urologists evolves, these findings will be of significant impact in the advancement of female investigators in urology.
Lower pole renal stones are associated with the lowest stone-free status of any location in the urinary tract during retrograde intrarenal surgery. Prior work has suggested displacing lower pole ...stones to a more accessible part of the kidney to improve stone-free status. We sought to prospectively compare the efficacy of laser lithotripsy in situ vs after displacement during retrograde intrarenal surgery for lower pole stones.
Between July 2017 and May 2022 patients undergoing retrograde intrarenal surgery for lower pole stones were randomized into an in situ or displacement group. Demographics, comorbidities, and operative parameters were documented. Primary outcome was stone-free status, determined by combination of abdominal x-ray and renal ultrasound at 30-day follow-up. Secondary outcomes included operative time, 30-day complications, emergency department visits, and readmissions.
A total of 138 patients (69 per group) were enrolled and analyzed. Baseline characteristics were similar between groups. Stone-free status significantly favored the displacement group over the in situ group (95% vs 74%,
= .003, n=62 in each group). Operative time, total laser energy usage, 30-day complications, and 30-day emergency department visits or hospital readmissions were similar between groups. On multivariate analysis only study group allocation was significantly associated with stone-free status (
= .024).
Basket displacement of lower pole stones results in a significantly higher stone-free status compared to in situ lithotripsy. The technique is simple, atraumatic, and requires no additional equipment costs and little additional operative time, making it a practical tool in the treatment of lower pole stones.
The COVID-19 pandemic exploits existing inequalities in social determinants of health (SDOH) in disease burden and access to healthcare. Few studies have examined these emerging disparities using ...indicators of SDOH.
To evaluate predictors of COVID-19 test positivity, morbidity, and mortality and their implications for inequalities in SDOH and for future policies and health care improvements.
A cross sectional analysis was performed on all patients tested for COVID-19 on the basis of symptoms with either a history of travel to at risk regions or close contact with a confirmed case, across the Mount Sinai Health System (MSHS) up until April 26th 2020.
Primary outcome was death from COVID-19 and secondary outcomes were test positivity, and morbidity (e.g., hospitalization and intubation caused by COVID-19).
Of 20,899 tested patients, 8,928 tested positive, 1,701 were hospitalized, 684 were intubated, and 1,179 died from COVID-19. Age, sex, race/ethnicity, New York City borough (derived from first 3 digits of zip-code), and English as preferred language were significant predictors of test positivity, hospitalization, intubation and COVID-19 mortality following multivariable logistic regression analyses.
People residing in poorer boroughs were more likely to be burdened by and die from COVID-19. Our results highlight the importance of integrating comprehensive SDOH data into healthcare efforts with at-risk patient populations.
Objectives
To analyse the clinical utility of a prediction model incorporating both clinical information and a novel biomarker, p2PSA, in order to inform the decision for prostate biopsy in an Irish ...cohort of men referred for prostate cancer assessment.
Patients and Methods
Serum isolated from 250 men from three tertiary referral centres with pre‐biopsy blood draws was analysed for total prostate‐specific antigen (PSA), free PSA (fPSA) and p2PSA. From this, the Prostate Health Index (PHI) score was calculated (PHI = (p2PSA/fPSA)*√tPSA). The men's clinical information was used to derive their risk according to the Prostate Cancer Prevention Trial (PCPT) risk model. Two clinical prediction models were created via multivariable regression consisting of age, family history, abnormality on digital rectal examination, previous negative biopsy and either PSA or PHI score, respectively. Calibration plots, receiver‐operating characteristic (ROC) curves and decision curves were generated to assess the performance of the three models.
Results
The PSA model and PHI model were both well calibrated in this cohort, with the PHI model showing the best correlation between predicted probabilities and actual outcome. The areas under the ROC curve for the PHI model, PSA model and PCPT model were 0.77, 0.71 and 0.69, respectively, for the prediction of prostate cancer (PCa) and 0.79, 0.72 and 0.72, respectively, for the prediction of high grade PCa. Decision‐curve analysis showed a superior net benefit of the PHI model over both the PSA model and the PCPT risk model in the diagnosis of PCa and high grade PCa over the entire range of risk probabilities.
Conclusion
A logical and standardized approach to the use of clinical risk factors can allow more accurate risk stratification of men under investigation for PCa. The measurement of p2PSA and the integration of this biomarker into a clinical prediction model can further increase the accuracy of risk stratification, helping to better inform the decision for prostate biopsy in a referral population.
Understanding the factors that influence the decision of urology residents to pursue an Endourology Society (ES) fellowship and the criteria used by applicants to rank programs may help residents and ...program directors (PDs) optimize the match process. In the present study, we surveyed current ES fellows to gain better insight surrounding their decision-making process.
A survey was emailed to all ES fellows, comprising Endourology and Stone Disease (ESD), Laparoscopic and Robotic Surgery (MIS), and combination of ESD/MIS (COM) programs. A Likert scale ranging from 1 to 5 was used. The survey captured demographics such as geographic region, program type, duration, applicants' reasons for pursuing fellowship, criteria for ranking programs, and perceived improvements in surgical comfort levels at the end of their training.
Out of the 60 fellows who were surveyed, 40 (66.7%) responded. Among the respondents, 9 (22.5%) pursued ESD, 10 (25%) pursued MIS, and 21 (52.5%) pursued COM programs. The primary reason for seeking a fellowship was to improve surgical skills while increasing earning potential and enhancing research opportunities were deemed the least important. Fellows enrolled in 1-year programs were less likely to pursue fellowships for academic reasons. The two most significant factors in selecting a program were both related to gaining operative experience. Lastly, there was an increase in the level of comfort performing all endourological surgeries independently after fellowship.
ES fellowship is seen as an opportunity to hone surgical skills and increase job competitiveness. When selecting a program, operative experience is the most important factor, and fellowship improves operative confidence. The information obtained from this study may mutually help guide future applicants and PDs in the decision process of the Endourology Match.
PDF
