Impact of Gene Expression Classifier Testing on Adjuvant Treatment Following Radical Prostatectomy: The G-MINOR Prospective Randomized Cluster-crossover Trial.

Background And Objective: Decipher is a tissue-based genomic classifier (GC) developed and validated in the post-radical prostatectomy (RP) setting as a predictor of metastasis. We conducted a prospective randomized controlled cluster-crossover trial assessing the use of Decipher to determine its impact on adjuvant treatment after RP.

Methods: Eligible patients had undergone RP within 9 mo of enrollment, had pT3-4 disease and/or positive surgical margins, and prostate-specific antigen <0.

Surgeon Skill and Perioperative Outcomes in Robot-Assisted Partial Nephrectomy.

Importance: Technical skill in complex surgical procedures may affect clinical outcomes, and there is growing interest in understanding the clinical implications of surgeon proficiency levels.

Objectives: To determine whether surgeon scores representing technical skills of robot-assisted kidney surgery are associated with patient outcomes.

Design, Setting, And Participants: This quality improvement study included 10 urological surgeons participating in a surgical collaborative in Michigan from July 2021 to September 2022.

Practice-Level Variation in Opioid-Free Discharge Following Surgery for T1 Renal Masses: A MUSIC-KIDNEY Analysis.

Introduction: Opioid prescription following surgery has played a role in the current opioid epidemic. We evaluated practice-level variation in opioid prescribing following surgery for cT1 renal masses and examined the relationships between opioid-free discharge and postoperative emergency department (ED) visits and readmissions.

Methods: We retrospectively examined all T1 renal mass (RM) patients with data regarding postoperative opioid prescriptions within the Michigan Urological Surgery Improvement Collaborative-Kidney Mass: Identifying and Defining Necessary Evaluation and Therapy (MUSIC-KIDNEY) registry from April 2021 to March 2023.

Building a Roadmap for Surveillance of Renal Masses Using a Modified Delphi Method to Help Achieve Consensus.

Objective: To establish a consensus for initial evaluation and follow-up of patients on active surveillance (AS) for T1 renal masses (T1RM).

Methods: A modified Delphi method was used to gather information about AS of T1RM, with a focus on patient selection, timing/type of imaging modality, and triggers for intervention. A consensus panel of Michigan Urological Surgery Improvement Collaborative-affiliated urologists who routinely manage renal masses was formed.

Implementation of prostate cancer treatment decision aid in Michigan: a qualitative study.

Background: The American Urological Association White Paper on Implementation of Shared Decision Making (SDM) into Urological Practice suggested SDM represents the state of the art in counseling for patients who are faced with difficult or uncertain medical decisions. The Michigan Urological Surgery Improvement Collaborative (MUSIC) implemented a decision aid, Personal Patient Profile-Prostate (P3P), in 2018 to help newly diagnosed prostate cancer patients make shared decisions with their clinicians. We conducted a qualitative study to assess statewide implementation of P3P throughout MUSIC.

Early Oncologic Failure after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium.

Purpose: We sought to investigate the prevalence and variables associated with early oncologic failure.

Materials And Methods: We retrospectively reviewed the IRCC (International Radical Cystectomy Consortium) database of patients who underwent robot-assisted radical cystectomy since 2003. The final cohort comprised a total of 1,894 patients from 23 institutions in 11 countries.

Examining clinical outcomes utilizing low-pressure pneumoperitoneum during robotic-assisted radical prostatectomy.

The objective of the study was to assess the safety and clinical outcomes of performing RARP utilizing LPP 12 mmHg with locally confined adenocarcinoma of the prostate. Utilizing the Metro Health RALP database registry and the Michigan Urological Clinic records, we retrospectively reviewed the records of consecutive RALPs performed between December 2012 and March 2015 by a single robotic surgeon. 100 patients underwent RARP utilizing 15 mmHg of standard pressure pneumoperitoneum (SPP) and 100 patients underwent RALP utilizing 12 mmHg lower pressure pneumoperitoneum (LPP).

International Robotic Radical Cystectomy Consortium: A way forward.

Robot-assisted radical cystectomy (RARC) is an emerging operative alternative to open surgery for the management of invasive bladder cancer. Studies from single institutions provide limited data due to the small number of patients. In order to better understand the related outcomes, a world-wide consortium was established in 2006 of patients undergoing RARC, called the International Robotic Cystectomy Consortium (IRCC).

Postoperative hemorrhage following robotic-assisted laparoscopic prostatectomy controlled with external penile compression.

We report a postoperative hemorrhage of the dorsal vein complex after transperitoneal robotic-assisted laparoscopic prostatectomy managed with external penile compression. Control of the dorsal vein required two sutures, and the estimated blood loss due to the procedure was 400 ml. Severe gross hematuria developed on postoperative day 2, but this quickly subsided with external compression at the base of the penis.

Simplified management of post-prostate biopsy rectal bleeding.

Transrectal ultrasound-guided biopsy of the prostate is a common urologic procedure associated with low morbidity and mortality. On occasion, rectal bleeding occurs and can be effectively managed by temporarily inserting a tampon into the rectum.

Patient noncompliance after vasectomy.

Objective: To determine the postoperative instruction compliance rate in men undergoing bilateral vasectomy.

Design: Retrospective chart review.

Setting: Private practice urological office.

Comparative analysis of fluctuation of serum tumor markers in advanced cancer of prostate.

Serial serum prostate tumor markers (acid phosphatase, prostate-specific antigen-Yang, prostate-specific antigen-Hybritech, lipid-associated sialic acid in plasma, and tissue polypeptide antigen) were obtained every four hours during a twenty-four-hour interval from men with Stage D adenocarcinoma of the prostate. No therapeutic or diagnostic manipulations occurred during sample procurement, so that the amount of fluctuation in these serum prostate cancer markers could be determined. The average co-efficient of variation for acid phosphatase 28.