Intraoperative Tranexamic Acid in Radical Cystectomy: Impact on Bleeding, Thromboembolism, and Survival Outcomes.

Purpose: Perioperative blood transfusion has been reported in > 50% of patients undergoing radical cystectomy (RC). Unfortunately, perioperative blood transfusion (PBT) in patients undergoing RC has been associated with poor oncological outcomes. Tranexamic acid (TXA) use has been proposed to decrease the need for PBT.

Prehabilitative/rehabilitative exercise, nutrition, and psychological support for bladder cancer: A scoping review of randomized clinical trials.

The study of prehabilitation and rehabilitation ([p]rehabilitation) to alleviate the sequelae of bladder cancer and its treatment has generated numerous opportunities to improve the quality of life of bladder cancer survivors. The authors conducted a scoping review of randomized clinical trials (RCTs) to identify knowledge gaps in and research directions for (p)rehabilitative support for those affected by bladder cancer. The authors systematically searched six databases and synthesized key findings from RCTs conducted from January 1, 2004, through March 15, 2022, that enrolled participants with bladder cancer, survivors, or caregivers in outpatient (p)rehabilitative programs (e.

A Tale of 102,726 Messages: Characterizing the Modern Urologist's Portal Message Burden After Common Urologic Surgeries.

Introduction: We aimed to characterize patient portal messaging use after urologic surgery to identify administrative burden and evaluate postoperative clinical associations.

Methods: Epic was queried for all urologic surgeries performed at the Mayo Clinic enterprise between 2019 and 2022. Data from the highest volume procedures were extracted including patient-generated portal messages to their provider and emergency department (ED) visits within 6 months of surgery.

Testicular cancer malpractice trends.

Objective: Medical and surgical advancements have been made in testicular cancer management over the past 50 years. The evolution of practice standards is expected to provide patients benefits in quality of life and oncologic outcomes, but changes in care standards can introduce potential opportunities for increased malpractice claims against providers. We seek to evaluate if modifications in testicular cancer management have translated to a rise in malpractice lawsuits.

Germline Pathogenic Variants Identified in Patients With Genitourinary Malignancies Undergoing Universal Testing: A Multisite Single-Institution Prospective Study.

Purpose: This study aimed to investigate the prevalence of pathogenic germline variants (PGVs) in hereditary cancer genes utilizing a universal testing approach and to determine the rate of PGVs that would have been missed based on National Comprehensive Cancer Network (NCCN) guidelines in genitourinary (GU) malignancies.

Materials And Methods: A multisite, single-institution prospective germline genetic test (GGT) was universally offered to patients with new or active diagnoses of GU malignancies (prostate, bladder, and renal) from April 2018 to March 2020 at Mayo Clinic sites. Participants were offered GGT using a next-generation sequencing panel of > 80 genes.

Single incision robotic cystectomy and urinary diversion.

Purpose: In this review, we aim to provide readers with a balanced understanding of all aspects of single incision robotic cystectomy (SIRC) and urinary diversion using the single-port (SP) robot. The review will trace the historical progression from open surgery to the introduction of minimally invasive approaches and present an in-depth description of the SIRC technique, offering a step-by-step guide for reference. Emphasis will be placed on indications and patient selection criteria to equip surgeons with well-rounded insights for decision-making.

Patient reported treatment burden and attitudes towards in-home intravesical therapy among patients with bladder cancer.

Purpose: To quantify patient reported treatment burden while receiving intravesical therapy for bladder cancer and to survey patient perspectives on in-home intravesical therapy.

Materials And Methods: We conducted a cross-sectional survey of the Bladder Cancer Advocacy Network Patient Survey Network. Survey questions were developed by investigators, then iteratively revised by clinician and patient advocates.

Budgetary Impact of Including the Urinary Genomic Marker Cxbladder Detect in the Evaluation of Microhematuria Patients.

Introduction: Current AUA guidelines mandate a risk-stratified approach for the evaluation of microhematuria. Urine genomic tests with high negative predictive value could further reduce unnecessary diagnostic testing and morbidity, but the economic impact is unknown. This study modeled the financial impact of Cxbladder Detect on microhematuria evaluations.

Bacillus Calmette-Guerin (BCG) therapy is safe and effective in non-muscle invasive bladder cancer (NMIBC) patients with immunomodulating conditions.

Introduction: Bacillus Calmette-Guerin (BCG) is the most effective therapy available to treat high-risk nonmuscle invasive bladder cancer (NMIBC) patients. However, for patients with immunomodulating conditions BCG is a relative contraindication due to efficacy and safety concerns. To our knowledge, no population-level study evaluating the efficacy and safety profile of BCG for immunomodulated patients exists.

Surgical Site Infections in Open and Laparoscopic Operations in Rooms With Open-floor Drainage Systems.

Introduction: Surgical site infections are common postoperative complications. Some operating rooms have open-floor drainage systems for fluid disposal during endourologic cases, although nonendoscopy cases are not always allowed in these rooms. We hypothesized that operating rooms with open-floor drainage systems would not materially affect risk of surgical site infections for patients undergoing open and laparoscopic procedures.

Patient, Physician, Hospital Factors Associated With Readmission After Radical Cystectomy.

Introduction: Patient and clinical factors are the most commonly identified variables associated with hospital readmission after radical cystectomy, but other factors may be important drivers of outcomes, such as hospital and physician characteristics. This study investigates the contribution of patient, physician, and hospital factors in hospital readmission after radical cystectomy.

Methods: This was a retrospective review of the Surveillance, Epidemiology, and End Results-Medicare database focusing on bladder cancer patients who underwent radical cystectomy between 2007 and 2016.

Extended Anticoagulation after Radical Cystectomy Using Direct Acting Oral Anticoagulants: A Single-Institutional Experience.

Introduction: Extended prophylactic anticoagulation therapy with enoxaparin 40 mg daily is effective in reducing the incidence of venous thromboembolism (VTE) after radical cystectomy. In an effort to improve compliance, we modified our extended anticoagulation options to direct oral anticoagulants (DOAs; eg apixaban 2.5 mg twice daily or rivaroxaban 10 mg daily).

Safety, Tolerability, and Preliminary Efficacy of TAR-200 in Patients With Muscle-invasive Bladder Cancer Who Refused or Were Unfit for Curative-intent Therapy: A Phase 1 Study.

Purpose: Half of patients with muscle-invasive bladder cancer worldwide may not receive curative-intent therapy. Elderly or frail patients are most affected by this unmet need. TAR-200 is a novel, intravesical drug delivery system that provides sustained, local release of gemcitabine into the bladder over a 21-day dosing cycle.

NCCN Guidelines® Insights: Prostate Cancer Early Detection, Version 1.2023.

The NCCN Guidelines for Prostate Cancer Early Detection provide recommendations for individuals with a prostate who opt to participate in an early detection program after receiving the appropriate counseling on the pros and cons. These NCCN Guidelines Insights provide a summary of recent updates to the NCCN Guidelines with regard to the testing protocol, use of multiparametric MRI, and management of negative biopsy results to optimize the detection of clinically significant prostate cancer and minimize the detection of indolent disease.

Preliminary Surgical Outcomes After Single Incision Robotic Cystectomy (SIRC).

Objective: To report the preliminary surgical outcomes for single incision robotic cystectomy (SIRC). Robotic cystectomy is associated with low utilization rates of orthotopic neobladders due to challenges related to intracorporeal sowing and configuration. A new technique that shortens the learning curve and reduces the incisional footprint may improve outcomes and lead to greater utilization of neobladders.

The effect of prior prostate cancer treatment on perioperative and pathological outcomes after cystectomy.

Introduction: A comprehensive analysis on outcomes in the perioperative and pathological setting in patients with a prior diagnosis of prostate cancer has not been performed. The objective of this study is to describe the effect of prior prostate cancer treatment on perioperative and pathological outcomes after cystectomy.

Materials And Methods: This was a retrospective review of all male patients who underwent cystectomy at our institution from 01/01/2007-01/01/2020.

A comparison of naloxegol versus alvimopan at the time of cystectomy and urinary diversion.

Introduction: The use of alvimopan at the time of cystectomy has been associated with improved perioperative outcomes. Naloxegol is a less costly alternative that has been used in some centers. This study aims to compare the perioperative outcomes of patients undergoing cystectomy with urinary diversion who receive the mu-opioid antagonist alvimopan versus naloxegol.

BCG Administration after Prior Radiation Treatment for Prostate Cancer.

Introduction: Prostate radiotherapy is associated with worse oncologic outcomes in patients with bladder cancer. The underlying mechanism is incompletely understood but is thought to be related to an altered microenvironment promoting tumorigenesis. However, there is a gap in the literature regarding how the effect of BCG varies according to prior radiotherapy in patients with non-muscle invasive bladder cancer (NMIBC).

Defining radical cystectomy using the ICD-10 procedure coding system.

Introduction: The International Classification of Diseases-10-Procedure Coding System (ICD-10-PCS) is markedly more complex than the preceding ICD-9 system, which has increased the difficulty of identifying radical cystectomy (RC) in administrative datasets. Given the absence of a consensus code definition for RC, we sought to develop and internally validate a list of ICD-10-PCS codes for RC.

Materials And Methods: All RCs performed from January 2019 to December 2020 were identified from our prospectively maintained registries and split into training (2019) and validation (2020) cohorts.