Publications by authors named "Kevin Shee"

Postoperative infections after ureteroscopy are common and potentially devastating complications. National and international guidelines recommend treatment of symptomatic positive urine cultures prior to operation, but how to manage patients with asymptomatic colonization remains unclear. In clinical practice, there is wide variation in the choice and duration of antibiotics for these patients.

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Background And Objective: Active surveillance (AS) of prostate cancer (PCa) is the standard of care for low-grade disease, but there is limited guidance on tailoring protocols for stable patients. We investigated long-term outcomes for patients without initial progression and risk factors for upgrade.

Methods: Men on AS with Gleason grade group (GG) 1 PCa on three serial biopsies, ≥5 yr without progression, and ≥10 yr of follow-up were included.

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The absence of predictive markers for kidney stone recurrence poses a challenge for the clinical management of stone disease. The unpredictability of stone events is also a significant limitation for clinical trials, where many patients must be enrolled to obtain sufficient stone events for analysis. In this study, we sought to use machine learning methods to identify a novel algorithm to predict stone recurrence.

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Background And Objective: Active surveillance (AS) of prostate cancer (PCa) involves regular monitoring for disease progression. The aim is to avoid unnecessary treatment while ensuring appropriate and timely treatment for those whose disease progresses. AS has emerged as the standard of care for low-grade (Gleason grade 1, GG 1) PCa.

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Background: Urologic guidelines universally recommend increasing fluid intake for kidney stone prevention. Increased voided volume is thought to help reduce stone recurrence and severity, but supporting evidence is limited.

Patients And Methods: Nephrolithiasis outcomes and 24-h urine data for patients from the Registry for Stones of the Kidney and Ureter (ReSKU), a registry of nephrolithiasis patients collected between 2015 and 2020, were retrospectively analysed.

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Background: Prostate cancers featuring an expansile cribriform (EC) pattern are associated with worse clinical outcomes following radical prostatectomy (RP). However, studies of the genomic characteristics of Gleason pattern 4 subtypes are limited.

Objective: To explore transcriptomic characteristics and heterogeneity within Gleason pattern 4 subtypes (fused/poorly formed, glomeruloid, small cribriform, EC/intraductal carcinoma [IDC]) and the association with biochemical recurrence (BCR)-free survival.

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Article Synopsis
  • The study evaluates how using imaging techniques like transrectal ultrasound and MRI affects the T-staging of prostate cancer compared to traditional digital rectal exams for better management.
  • It analyzed 2,222 patients who had surgery and assessed how many had their Cancer of the Prostate Risk Assessment (CAPRA) scores change based on imaging versus digital exams.
  • The results showed that both staging methods had similar accuracy in predicting cancer recurrence, indicating that imaging-based staging could enhance clinical decision-making with only minor differences in outcomes.
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  • Residual fragments (RFs) after percutaneous nephrolithotomy (PCNL) can negatively affect patients' quality of life, and this study aimed to analyze their natural history and impacts based on different sizes of RFs.
  • The study included data from 439 patients and found that larger RFs (>4 mm) were linked to higher rates of reintervention and complications, while smaller RFs (≤2 mm) had better outcomes in terms of passage and lower regrowth rates.
  • Factors such as age, body mass index, and RF size were significant predictors of stone-related events, emphasizing the importance of managing residual fragments for better patient outcomes after PCNL.
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Although the American Urological Association recently dropped the very low-risk (VLR) subcategory for low-risk prostate cancer (PCa) and the European Association of Urology does not substratify low-risk PCa, the National Comprehensive Cancer Network (NCCN) guidelines still maintain this stratum, which is based on the number of positive biopsy cores, tumor extent in each core, and prostate-specific antigen density. This subdivision may be less applicable in the modern era in which imaging-targeted prostate biopsies are common practice. In our large institutional active surveillance cohort of patients diagnosed from 2000 to 2020 (n = 1276), the number of patients meeting NCCN VLR criteria decreased significantly in recent years, with no patient meeting VLR criteria after 2018.

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In order to proliferate in unfavourable conditions, cancer cells can take advantage of the naturally occurring endoplasmic reticulum-associated unfolded protein response (UPR) via three highly conserved signalling arms: IRE1α, PERK and ATF6. All three arms of the UPR have key roles in every step of tumour progression: from cancer initiation to tumour growth, invasion, metastasis and resistance to therapy. At present, no cure for metastatic prostate cancer exists, as targeting the androgen receptor eventually results in treatment resistance.

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Purpose: Clinical guidelines suggest that for low-grade, clinically localized prostate cancer, patients with higher volume of disease at diagnosis may benefit from definitive therapy, although the data remain unclear. Our objective was to determine associations between low-grade prostate cancer volume and outcomes in men managed with primary radical prostatectomy.

Materials And Methods: Men with cT1-2N0/xM0/x prostate cancer, prostate specific antigen at diagnosis <10 ng/mL, and Gleason grade group 1 pathology on diagnostic biopsy managed with primary radical prostatectomy were included.

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Objective: The utilization of video telemedicine has dramatically increased due to the COVID-19 pandemic. However, significant social and technological barriers have led to disparities in access. We aimed to identify factors associated with patient inability to successfully initiate a video visit across a high-volume urologic practice.

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Background: Enzalutamide is an antiandrogen used to treat both metastatic and nonmetastatic prostate cancer. Here we present results from a phase 2 trial designed to determine the safety, tolerability, and efficacy of adding enzalutamide to standard androgen deprivation therapy with radiation therapy in high-risk localized or regional, nonmetastatic patients with prostate cancer.

Methods And Materials: Enrollment criteria included at least 2 of the following: stage cT3a/b, prostate specific antigen (PSA) ≥20 ng/mL, Gleason grade 8 to 10, ≥33% core involvement on biopsy, or pelvic lymph node involvement on computed tomography or magnetic resonance imaging.

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Primary hyperoxalurias are a devastating family of diseases leading to multisystem oxalate deposition, nephrolithiasis, nephrocalcinosis and end-stage renal disease. Traditional treatment paradigms are limited to conservative management, dialysis and combined transplantation of the kidney and liver, of which the liver is the primary source of oxalate production. However, transplantation is associated with many potential complications, including operative risks, graft rejection, post-transplant organ failure, as well as lifelong immunosuppressive medications and their adverse effects.

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Objective: To rank percentages of underrepresented residents in surgical subspecialties and understand the experience of mentees and mentors who participated in the inaugural University of California, San Francisco Urology UnderRepresented Trainees Entering Residency (UReTER) Mentorship Program for Black, Indigenous, and/or LatinX medical students applying into urology.

Methods: Medical student mentees across the country were recruited via social media and email listservs. Demographic information and photos of mentors were presented on the UReTER website.

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Purpose: Patients and providers often lack clinical decision tools to enable effective shared decision making. This is especially true in the rapidly changing therapeutic landscape of metastatic kidney cancer. Using the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria, a validated risk prediction tool for patients with metastatic renal cell carcinoma, we created and user-tested a novel interactive visualization for clinical use.

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Objectives: To determine if older men with Gleason grade group (GG) 1 prostate cancer have a higher risk of having adverse pathology at radical prostatectomy after initially being managed with active surveillance (AS).

Methods: A total of 365 patients with GG1 prostate cancer initially managed with AS followed by delayed radical prostatectomy were identified. The primary outcome was adverse pathology after delayed radical prostatectomy in the men that were <65 years vs.

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Article Synopsis
  • Primary hyperoxaluria 1 (PH1) is a serious condition characterized by kidney stones, rapid kidney failure, and buildup of calcium oxalate in the body.
  • Treatment often requires a combined kidney and liver transplant due to limited options available.
  • In a reported case, monthly injections of Nedosiran, an RNA interference therapy, significantly lowered plasma oxalate levels and reduced the need for hemodialysis, postponing the need for transplant in the patient.
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  • Fulvestrant is an antiestrogen used to treat ER-positive breast cancer by blocking estrogen receptor activity and can be enhanced with proteasome inhibitors like ixazomib.
  • A phase Ib study evaluated the safety and efficacy of combining fulvestrant and ixazomib, establishing an MTD of 4 mg for ixazomib in patients with advanced ER+ breast cancer.
  • The combination showed a good safety profile, with one partial response noted, and a median progression-free survival of 51 days, suggesting potential benefit for patients resistant to fulvestrant.
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  • The study investigates the impact of neoadjuvant chemotherapy (NAC) on the immune microenvironment in metastatic triple-negative breast cancer (TNBC) and its relation to patient outcomes.
  • Researchers analyzed immune-related gene expression in 83 breast tumors, including TNBC, before and after chemotherapy, linking certain gene changes to recurrence-free and overall survival rates.
  • Findings indicate that TNBC shows a positive immune response to NAC, correlating with improved outcomes, while signs of cytotoxic T-cells in peripheral blood may suggest ongoing cancer presence and potential recurrence.
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Background: Among patients diagnosed with non-muscle invasive bladder cancer (NMIBC), 30% to 70% experience recurrences within 6 to 12 years of diagnosis. The need to screen for these events every 3 to 6 months and ultimately annually by cystoscopy makes bladder cancer one of the most expensive malignancies to manage.

Objective: The purpose of this study was to identify reproducible prognostic microRNAs in resected non-muscle invasive bladder tumor tissue that are predictive of the recurrent tumor phenotype as potential biomarkers and molecular therapeutic targets.

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  • Scientists studied gliomas, which are types of brain tumors, to see how changes in genes can affect how long patients live and how likely their cancer is to come back.
  • They looked at tissue samples from 293 patients to find specific gene mutations and other changes that might predict patient outcomes.
  • The findings showed that some gene mutations, like IDH1 and MGMT, were linked to better survival rates, while others, like FLT3 and TP53, were linked to worse outcomes.
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Purpose: Circulating tumor DNA in plasma may present a minimally invasive opportunity to identify tumor-derived mutations to inform selection of targeted therapies for individual patients, particularly in cases of oligometastatic disease where biopsy of multiple tumors is impractical. To assess the utility of plasma DNA as a "liquid biopsy" for precision oncology, we tested whether sequencing of plasma DNA is a reliable surrogate for sequencing of tumor DNA to identify targetable genetic alterations.

Methods: Blood and biopsies of 1-3 tumors were obtained from 4 evaluable patients with advanced breast cancer.

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