Methylated DNA Markers in Voided Urine for the Identification of Clinically Significant Prostate Cancer.

Introduction: Non-invasive assays are needed to better discriminate patients with prostate cancer (PCa) to avoid over-treatment of indolent disease. We analyzed 14 methylated DNA markers (MDMs) from urine samples of patients with biopsy-proven PCa relative to healthy controls and further studied discrimination of clinically significant PCa (csPCa) from healthy controls and Gleason 6 cancers.

Methods: To evaluate the panel, urine from 24 healthy male volunteers with no clinical suspicion for PCa and 24 men with biopsy-confirmed disease across all Gleason scores was collected.

Predictors of Excellent Urology Residents at the Time of the Urology Match.

Objective: To update our experience and report on features predictive of high-quality urology residents at the time of the urology match, because data predicting which medical students will mature into excellent urology residents are sparse.

Methods: We reviewed our experience with 84 urology residents who graduated from 2006 to 2023. Residents were independently scored 1-10 based on overall quality by the current and former Program Director.

Effect of Preoperative Multiparametric Magnetic Resonance Imaging on Oncologic and Functional Outcomes Following Radical Prostatectomy.

Background: Advancements in imaging technology have been associated with changes to operative planning in treatment of localized prostate cancer. The impact of these changes on postoperative outcomes is understudied.

Objective: To compare oncologic and functional outcomes between men who had computed tomography (CT) and those who had multiparametric magnetic resonance imaging (mpMRI) prior to undergoing radical prostatectomy.

A Contemporary Analysis of Ureteral Reconstruction 30-Day Morbidity Utilizing the National Surgical Quality Improvement Program Database: Comparison of Minimally Invasive Open Approaches.

To characterize 30-day morbidity of upper ureteral reconstruction (UUR) and lower ureteral reconstruction (LUR) surgery by comparing open and minimally invasive surgery (MIS) approaches using a national surgical outcomes registry. The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for patients who underwent UUR and LUR between 2007 and 2017. Primary endpoints included 30-day complications, transfusion, readmission, return to operating room (ROR), and prolonged postoperative length of stay (LOS).

Long-term Success With Diminished Opioid Prescribing After Implementation of Standardized Postoperative Opioid Prescribing Guidelines: An Interrupted Time Series Analysis.

Objective: To assess longitudinal prescribing patterns for patients undergoing urologic surgery in the nearly 2-year time frame before and after implementation of an evidence-based opioid prescribing guideline to accurately characterize the impact on postoperative departmental practices.

Patients And Methods: Historical prescribing data for adults who underwent 21 urologic procedures at 3 academic institutions were used to derive a 4-tiered guideline for postoperative opioid prescribing. The guideline was implemented on January 16, 2018, and prescribing patterns including quantity of opioids prescribed (in oral morphine equivalents [OMEs]) and refill rates were compared for opioid-naïve patients undergoing urologic surgery before (January 1, 2016, through January 15, 2018; N=10,649) and after (January 16, 2018, through September 30, 2019; N=9422) guideline implementation.

Telemedicine in Urology: The Socioeconomic Impact.

The emergence of the COVID-19 pandemic and subsequent public health emergency (PHE) have propelled telemedicine several years into the future. With the rapid adoption of this technology came socioeconomic inequities as minority communities disproportionately have yet to adopt telemedicine. Telemedicine offers solutions to patient access issues that have plagued urology, helping address physician shortages in rural areas and expanding the reach of urologists.

Impact of Urology Trainee Debt Levels on Future Practice Choices and Expectations.

Introduction: Excessive trainee debt continues to be a problem. Little is known about how debt influences future practice decisions. We sought to examine the correlation between educational debt and anticipated practice choices and career expectations to better understand the impact of debt on urology trainees to inform urology workforce policy.

Screening Postoperative Hemoglobin after Robot-Assisted Radical Prostatectomy-Frequently Used, but Is It Necessary?

Introduction: Robot-assisted radical prostatectomy is associated with low rates of postoperative transfusion and hemorrhage. At our institution the decision to obtain screening hemoglobin testing after uncomplicated robot-assisted radical prostatectomy is left to surgeon discretion. It is unknown whether this testing represents high value care.

A Serum C-Reactive Protein and Procalcitonin-Based Risk Score to Predict Urinary Infection in Patients with Obstructive Urolithiasis Undergoing Decompression.

The aim of this study was to develop a risk score utilizing C-reactive protein (CRP) and procalcitonin to better predict a clinical infection for patients with obstructive urolithiasis. A retrospective review was performed of patients presenting to the emergency room from December 2017 to February 2019 and who underwent upper urinary tract decompression due to concern for infection in the setting of obstructing urolithiasis. Over 30 clinical parameters were assessed and a composite risk score was created.

Malpractice Litigation in Iatrogenic Ureteral Injury: a Legal Database Review.

Objective: To examine the factors associated with iatrogenic ureteral injury litigation and outcomes.

Methods: The Westlaw legal database was queried for all iatrogenic ureteral injury cases. Variables extracted included available clinical factors, method of settlement, and litigation outcomes.

Long-term outcomes of incidental prostate cancer at radical cystectomy.

Objective: We evaluated the natural history and long-term outcomes of incidentally detected prostate cancer (PCa) at radical cystectomy (RC) for bladder cancer (BCa).

Patients And Methods: We identified 1,640 male patients who underwent RC between 1992 and 2012. Patients were stratified as clinically insignificant and clinically significant PCa, based on Grade Group (GG) 1 and ≥2, respectively.

Treatment Outcomes in Patients With Symptomatic Lymphoceles Following Radical Prostatectomy Depend Upon Size and Presence of Infection.

Objective: To guide treatment decisions for symptomatic lymphoceles after radical prostatectomy. We examined our experience to create a treatment algorithm.

Materials And Methods: We evaluated all patients that underwent radical prostatectomy at our institution from 2003 to 2012.

How to perform a robotic pyeloplasty utilizing the da Vinci SP platform: tips and tricks.

Robotic pyeloplasty has become more prevalent with the evolution and dissemination of robotic surgery. The da Vinci SP robotic platform is a new technology that has allowed for true single port surgery, compared to the previous multiport robotic platforms. As the SP has been utilized for an increasing number of urologic procedures, it can also be successfully used for pyeloplasty.

Comparison of prescribing patterns before and after implementation of evidence-based opioid prescribing guidelines for the postoperative urologic surgery patient.

Background: We developed evidence-based guidelines for postoperative opioid prescribing after urologic surgery and assessed changes in prescribing after implementation.

Methods: Prescribing data for adults who underwent 21 urologic procedures were used to derive a four-tiered guideline for postoperative opioid prescribing. This was implemented on January 1, 2018, and prescribing patterns including quantity of opioids prescribed (oral morphine equivalents; OME) and refill rates were compared between patients undergoing surgery prior to (January-April, 2017; n equals 1732) and after (January-April, 2018; n equals1376) implementation.

Access to Urological Care and Internet Connectivity in the United States: A Geospatial Analysis.

Introduction: Telemedicine video visits have been suggested as a mechanism to improve access to urological care in geographically isolated communities. However, Internet availability is not consistent across the United States. This study aims to better understand the interplay of broadband Internet, urologist density and county demographics to inform the strategic deployment of urological telemedicine.

Magnet-Assisted Robotic Prostatectomy Using the da Vinci SP Robot: An Initial Case Series.

Tissue retraction during minimally invasive surgery has been achieved to date with patient positioning or additional instrumentation. The Levita™ Magnetic Surgical System (San Mateo, CA), a novel, noninvasive, magnetic retraction device for minimally invasive surgery, has been used to facilitate reduced-port robotic prostatectomy using a multiport robotic platform. With the release of the da Vinci SP robotic system (Intuitive, Sunnyvale, CA), we now report a multi-institutional initial case series of magnet-assisted robotic prostatectomy using the single-port robotic platform.

Robotic One Access Surgery (R-1): Initial Preclinical Experience for Urological Surgeries.

Laparoendoscopic single-site surgery was developed to minimize the morbidity associated with laparoscopic surgery. Application of robotics in urologic surgery has been widely adopted given the advantages it provides over standard laparoscopy including 3-dimensional vision, improved ergonomics, enhanced precision and dexterity. The real benefit of robotic laparoendoscopic single-site surgery is still unbalanced by the limitations of this approach and the sole applicability by highly skilled surgeons.

Evaluation of Medical School Grading Variability in the United States: Are All Honors the Same?

Purpose: The medical student performance evaluation (MSPE) summarizes a residency applicant's academic performance. Despite attempts to improve standardized clerkship grading, concerns regarding grade inflation and variability at United States medical schools persist. This study's aim was to describe current patterns of clerkship grading and applicant performance data provided in the MSPE.

Initial Experience with da Vinci Single-port Robot-assisted Radical Prostatectomies.

Background: Single-port robotic surgery is being adopted for various surgical procedures. There have been interest in and clinical use of single-port robot-assisted radical prostatectomy (spRARP), but little reported data on feasibility and early outcomes.

Objective: To describe our institution's initial experience with spRARP utilizing the da Vinci single-port (SP) robotic system.

Technical Considerations of Single Port Ureteroneocystostomy Utilizing da Vinci SP Platform.

Objective: To demonstrate technical considerations of a true single port robotic assisted ureteroneocystostomy using the da Vinci SP platform (Intuitive Surgical, Sunnyvale, CA).

Methods: We present a 34 year-old female with an obliterative right distal ureteral stricture after undergoing a total abdominal hysterectomy for benign indications. After a period of ureteral rest, the patient elected to undergo a robotic assisted ureteroneocystostomy using the da Vinci SP platform.

Wide Variation in Opioid Prescribing After Urological Surgery in Tertiary Care Centers.

Objective: To describe postoperative opioid prescribing practices in a large cohort of patients undergoing urological surgery.

Patients And Methods: We identified 11,829 patients who underwent 21 urological surgical procedures at 3 associated facilities from January 1, 2015, through December 31, 2016. After converting opioids to oral morphine equivalents (OMEs), prescribing patterns were compared within and across procedures.

Impact of time from biopsy to surgery on complications, functional and oncologic outcomes following radical prostatectomy.

Introduction: To determine the impact of time from biopsy to surgery on outcomes following radical prostatectomy (RP) as the optimal interval between prostate biopsy and RP is unknown.

Material And Methods: We identified 7, 350 men who underwent RP at our institution between 1994 and 2012 and had a prostate biopsy within one year of surgery. Patients were grouped into five time intervals for analysis: ≤ 3 weeks, 4-6 weeks, 7-12 weeks, 12-26 weeks, and > 26 weeks.

Heterogeneity of risk within Gleason 4 + 4, 4 + 5 and 5 + 4 prostate cancer.

Objects: This study hypothesized that biopsy Gleason score 8 (b.G.S.