Advances in Urology

Background: Although clinical trials should be accessible to all patients, persistent racial and ethnic disparities in clinical trial enrollment exist. Herein, we examine racial disparities in clinical trial enrollment among prostate cancer patients from a large population‐based cohort of oncology practices in the United States. Methods: Using CancerLinQ Discovery, we identified men with regional (N1+) and/or metastatic (M1) prostate cancer diagnosed from 2011 to 2023. Enrollment into a clinical trial for prostate cancer was the primary outcome. Multivariable logistic regression and Cox proportional hazard regression were used for analysis. Results: Within our dataset, we identified 17,028 patients with advanced prostate cancer, of which only 2.6% of patients were enrolled in a clinical trial ( n = 450). There was variance in the proportion of patients accrued over time with a low of 0.30% in 2011 to a high of 3.94% in 2018 and decreasing to 2.37% in 2023. On multivariable analysis, older age was associated with lower odds of clinical trial enrollment ( p &lt; 0.001). Compared to White patients, Hispanics/Latino (OR: 0.35; CI: 0.161–0.744, p = 0.04) and patients with self‐identified other race or ethnicity (OR: 0.23; CI: 0.295–0.931, p &lt; 0.01) had lower odds of clinical trial enrollment on multivariable analysis. Black men with prostate cancer did not have a statistically significant difference compared to White men for clinical trial enrollment. (OR: 1.033; CI: 0.771–1.384, p = 0.828). Conclusion: While clinical trial enrollment remains low for men with advanced prostate cancer in this contemporary population‐based cohort, rates of participation for Hispanic/Latino men, but not Black men, are significantly lower. Increased attention is needed to better understand the reasons behind these racial disparities and to develop effective interventions to promote access.

Brett M. Wiesen

Thomas W. Flaig

Boris Gershman

Badrinath Konety

Adam Warren

Elizabeth Molina Kuna

Tyler Robin

Elizabeth R. Kessler

Corbin J. Eule

Benjamin N. Breyer

Justin Achua

Simon P. Kim

Racial Disparities in Clinical Trial Enrollment Among Patients Diagnosed With Prostate Cancer: A Population‐Based Cohort of Oncology Practices

前列腺癌患者临床试验入组中的种族差异：基于肿瘤诊疗实践的人群队列研究

Introduction: Since contact laser vaporization of the prostate (CVP) was approved by the Japanese insurance system in 2016, the use of a 980 nm diode laser system for CVP has become widespread for treating benign prostate hyperplasia (BPH) patients. Our institute has been implementing CVP for BPH since 2018, treating a total of 93 patients, including 28 with a risk of hemorrhage. This study examines the safety and efficacy of CVP treatment for BPH patients with a hemorrhagic risk. Patient and Methods: A total of 93 BPH patients with lower urinary tract symptoms (LUTS) underwent CVP between February 2018 and September 2022. All patients were on medications for BPH and were refractory to these medications. The median (mean ± SD) age was 72 (72.9±6.27), and the prostate volume was 64 (68.9±32.5). IPSS, QOL index, and OABSS scores for patients not requiring catheterization were 22 (22.1±6.38), 5 (5.24±0.74), and 6 (7±3.29), respectively. The CVP treatment was performed using a 980 nm diode laser. Of the 93 patients, 28 (30.1%) had a hemorrhage risk. This group included 13 (14.0%) who were continuously receiving anticoagulant and/or antiplatelet agents, 13 (14.0%) who temporarily stopped these medications, and 2 (2.1%) who had a hemorrhage risk due to low platelet counts (&lt; 5.0 × 10 4 / μ L). Results: Postoperatively, 15 (16.1%) patients, including 11 who were catheterized preoperatively, needed temporary catheterization after CVP treatment. Of these, 14 had their catheters successfully removed. The IPSS score significantly decreased from 22 (22.1±6.38) to 8 (9.02±6.07) ( p &lt; 0.0001). In patients with hemorrhagic risk on anticoagulant and/or antiplatelet agents, the change in hemoglobin level before and after surgery was 0.6 g/dL, a difference that was not significant. Two of the 15 patients with hemorrhagic risk experienced hemorrhage 23 and 26 days postoperatively and underwent transurethral coagulation. Other perioperative complications classified as Clavien–Dindo Grade 2 or higher occurred in 4 (4.3%) patients. Conclusion: CVP treatment appears to be acceptable for BPH patients with hemorrhagic risk. In this study, late‐onset hemorrhage occurred approximately 1 month postoperatively. Close postoperative follow‐up is required.

Yushi Araki

Takashi Kawahara

Teppei Takeshima

Kazuhide Makiyama

Hiroji Uemura

Initial Experience of Contact Laser Vaporization of the Prostate (CVP) for Benign Prostate Hyperplasia Patients With Hemorrhagic Risk

接触式激光前列腺汽化术（CVP）治疗伴有出血风险的前列腺增生患者的初步经验

Purpose . The workup and surveillance strategies for infant hydronephrosis (HN) vary, although this could be due to grade-dependent differences in imaging intensity. We aimed to describe the frequency of imaging studies for HN within the first year of life, stratified by initial HN grade, within a large regional healthcare system. Study Design and Data Source . Retrospective cohort using Intermountain Healthcare Data Warehouse. Inclusion criteria: (1) birth between 1/1/2005 and 12/31/2013, (2) CPT code for HN, and (3) ultrasound (U/S) confirmed HN within four months of birth. Data Collection . Grade of HN on initial postnatal U/S; number of HN-associated radiologic studies (renal U/Ss, voiding cystourethrograms (VCUGs), and diuretic renal scans); demographic and medical variables. Primary Outcome . Sum of radiologic studies within the first year of life or prior to pyeloplasty. Statistical Analysis . Multivariate poisson regression to analyze association between the primary outcome and the initial HN grade. Results . Of 1,380 subjects (993 males and 387 females), 990 (72%), 230 (17%), and 160 (12%) had mild, moderate, and severe HN, respectively. Compared with those with mild HN, patients with moderate (RR: 1.57; 95% CI: 1.42–1.73) and severe (RR: 2.09; 95% CI: 1.88–2.32) HN had a significantly higher rate of imaging use over 12 months (or prior to surgery) after controlling for potential confounders. Conclusions . In a large regional healthcare system, imaging use for HN is proportional to its initial grade. This suggests that within our system, clinicians treating this condition are using a risk-stratified approach to imaging.

Anthony J. Schaeffer

Patrick C. Cartwright

Glen A. Lau

Mark D. Ebert

Nora F. Fino

Flory L. Nkoy

Rachel Hess

Utilization of Radiographic Imaging for Infant Hydronephrosis over the First 12 Months of Life

婴儿生命头12个月肾积水的放射影像学应用

Agenesis of the bladder and urethra is a rare congenital anomaly, with a very few living cases reported in the literature so far. Case Presentation. We are reporting two female patients (3 and 6 years old) with bladder and urethral agenesis who presented with urinary incontinence. In both patients, magnetic resonant imaging (MRI) revealed a case of bladder and urethral agenesis with normal ureters draining into the vagina. Patients underwent a neobladder and conduit creation surgery. The neobladder was constructed from the whole cecum and a part of the ascending colon, followed by an anastomose of the ureters into the neobladder in a nonrefluxing fashion; the appendix was used simultaneously as a continent catheterizable conduit. The two patients attained urinary continence postoperatively.We reported two cases of bladder agenesis, and for the first time, we have performed neobladder creation surgery using the cecum and ascending colon. One-year follow-up did not reveal any complications.

Salahaddin Delshad

Hadith Rastad

Parham Mardi

Congenital Bladder and Urethral Agenesis: Two Case Reports and Management

先天性膀胱和尿道发育不全：两例报告及处理

Background. Under the name of uncommon bladder cancers are gathered rare histological entities which represent less than 5% of bladder tumors. There is not a clear and consensual therapeutic management for these entities. Purpose. To review a single-institution 10-year experience with rare form of bladder cancers detailing the diagnosis, treatment, and patient outcome. Materials and Methods. We performed a retrospective review of 27 medical records of rare bladder cancer form treated at our center between February 2006 and February 2015. The clinicopathologic features are reported with emphasis on treatment and survival. Results. Mean patient age was 65.5 ± 20 yr and 70% of patients were males. Smoking background was found in 16 cases, chronic bladder irritation factors were found in 12 cases, and past urinary tract infection was found in 11 cases. The main symptom was total hematuria (93%) causing an anemia in 16 cases. The two mean histological forms were epidermoid carcinoma (37%) and adenocarcinoma (22%). 26% of patients were found to have extended invasive tumors (T4) at diagnosis. Metastatic disease was confirmed in 8 cases. Our patients were managed by a wide range of therapeutic modalities as total cystectomy with bilateral lymph node dissection (63%), palliative chemotherapy (30%), or concomitant radiochemotherapy (7%). 55.6% of patients were alive one year after diagnosis. Epidermoid carcinoma has the best prognosis followed by leiomyosarcoma and sarcomatoid carcinoma. Neuroendocrine carcinoma has the worst outcome. The overall 5-year survival rate is 33.3%. Conclusion. The rarity and small size of these tumors justify the absence of clear and consensual therapeutic management. No role of total cystectomy concerning the conclusions could be drawn but elements suggest this may be the treatment of choice. The highly aggressive nature of those lesions justifies an aggressive and fast therapy when feasible which gives the best outcomes.

Youssef Kadouri

Salim Lachkar

Hamza Dergamoun

Hachem El Sayegh

Lounis Benslimane

Yassine Nouini

Management of the Uncommon Bladder Cancers: A Single-Center Experience over 10 Years

罕见膀胱癌的管理：10年单中心经验

Although routine surveillance imaging to examine upper urinary tract urothelial cancer recurrence during follow-up of nonmuscle invasive bladder cancer is recommended, its necessity remains invalidated. A single-institute long-term follow-up cohort study to evaluate the clinical impact of routine surveillance imaging and identify risk factors for upper urinary tract urothelial cancer recurrence after nonmuscle invasive bladder cancer treatment was conducted.

Nobutaka Nishimura

Makito Miyake

Tatsuki Miyamoto

Takuto Shimizu

Tomomi Fujii

Yosuke Morizawa

Shunta Hori

Daisuke Gotoh

Yasushi Nakai

Kazumasa Torimoto

Nobumichi Tanaka

Kiyohide Fujimoto

Routine Surveillance of Upper Urinary Tract Imaging for Diagnosing Upper Urinary Tract Urothelial Cancer Recurrence in Patients with Nonmuscle Invasive Bladder Cancer

非肌层浸润性膀胱癌患者上尿路影像学常规监测诊断上尿路尿路上皮癌复发的研究

Introduction and Objectives. ESWL is a popular treatment modality for small to medium sized renal calculi; however, the reported clearance rates especially in the lower pole have been poor. Mechanical percussion and inversion (MPI) therapy can be used as an adjunct to ESWL and has been shown to significantly improve stone clearance rates in several studies. In these studies, MPI therapy was administered in hospital by medical staff, requiring further hospital appointments with increased clinician and financial resources. Our objective was to evaluate whether patient-directed mechanical percussion and inversion (MPI) therapy performed at home after ESWL can improve stone-free rates compared with ESWL alone. Methods. We conducted a prospective randomised control trial. Included patients were males and females greater than 18 years of age with single or multiple ipsilateral renal calculi of total ≤10 mm on plain X-ray and noncontrast CT KUB. ESWL was performed at a single centre, at supine position under general anaesthesia with maximum 3000 shocks at a rate of 100 shocks per minute. Patients were discharged and randomised to either the control arm or MPI therapy. MPI therapy was self-directed in a home setting for 10 minutes a day, three times per week. Both arms had standard follow-up at 12 weeks with a plain X-ray KUB. Patients in the control group were offered cross over to the MPI arm after 12 weeks if residual stone fragments were detected. Statistical analysis was performed using SPSS software via Chi squared and Fisher’s exact tests. Ethical approval was obtained via the Prince Charles Hospital HREC Committee, HREC/2022/QPCH/84961. Results. 70 patients met inclusion criteria and underwent ESWL, and 5 were withdrawn. 33 patients were randomised to the MPI group and 32 to the control group. MPI significantly increased the stone clearance rate anywhere in the kidney (87.9% in the MPI group versus 59.4% in the control group, <math xmlns="http://www.w3.org/1998/Math/MathML" id="M1"><mi>p</mi><mo>=</mo><mn>0.089</mn></math> ), as well as the clearance rate in the lower pole (91.7% in the MPI group versus 63.2% in the control group, <math xmlns="http://www.w3.org/1998/Math/MathML" id="M2"><mi>p</mi><mo>=</mo><mn>0.022</mn></math> ). Delayed percussion did not improve the clearance rate over primary percussion <math xmlns="http://www.w3.org/1998/Math/MathML" id="M3"><mfenced open="(" close=")" separators="|"><mrow><mi>p</mi><mo>=</mo><mn>0.835</mn></mrow></mfenced></math> . Conclusion. This study has shown that MPI can be effectively performed in a home setting without the need for medical supervision and results in improved stone clearance rates post ESWL. The main limitations to the study were the use of X-ray over CT during the follow-up and variability in MPI compliance and administration. Further research is warranted into standardising home MPI protocols. This trial is registered with ANZCTR387061.

Nishal Patel

Adrian Roe

Donna Stanton

Jay Roberts

Akshay Kothari

SLAP Trial: Shock Wave Lithotripsy and Mechanical Percussion Therapy Post ESWL for Renal Calculi

SLAP试验：肾结石体外冲击波碎石术后冲击波碎石与机械叩击疗法

Introduction. Women with lower urinary tract symptoms (LUTS) and high-tone pelvic floor often experience pain and have positive trigger points upon pelvic floor examination. However, the correlation of these findings has not yet been systematically examined and sufficiently understood. The aim of this cross-sectional study is to examine the correlation of pelvic myofascial pain with LUTS and pelvic floor tone. Materials and Methods. All participants filled a standardized pelvic floor questionnaire to assess LUTS, which consists of a total of 43 questions regarding bladder, bowel, and sexual function as well as prolapse symptoms. Myofascial trigger points in different muscle groups including pubococcygeus, iliococcygeus, and obturator as well as pelvic floor muscle tone were assessed using a standardized digital examination technique. Results. 110 women were included in the study. There was a significant correlation between pain in various muscle groups and LUTS as well as high-tone pelvic floor muscle. A significant correlation could also be found between high pelvic floor muscle tone and the overall questionnaire score ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"><a:mi>p</a:mi><a:mo>&lt;</a:mo><a:mn>0.001</a:mn></a:math> ) as well as the bladder function score ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"><c:mi>p</c:mi><c:mo>&lt;</c:mo><c:mn>0.001</c:mn></c:math> ) and various pain scores of the different groups. Individuals with high-tone pelvic floor were more likely to have more LUTS and higher pain scores. Conclusions. The existence of myofascial pelvic floor trigger points and high pelvic floor muscle tone seem to be reflective of pelvic floor symptoms, as assessed with a standardized pelvic floor questionnaire.

Sabrina Einig

Esther Ruess

Andreas Schoetzau

Kerstin Ayllon Bartet

Viola Heinzelmann-Schwarz

Francesco Vigo

Tilemachos Kavvadias

Pelvic Pain of Myofascial Origin in Women: Correlation with Lower Urinary Tract Symptoms

女性肌筋膜源性盆腔疼痛与下尿路症状的相关性研究

Objectives. In Japan, caudal block with 1% lidocaine is commonly used for transrectal prostate biopsy. Although 10 mL of 1% lidocaine is commonly used, the appropriate dosage of 1% lidocaine has not been studied. Our hospital routinely uses two different doses (5 or 10 mL) of 1% lidocaine for caudal block for transrectal prostate biopsy. Herein, we retrospectively evaluated the efficacy and safety of both doses of 1% lidocaine. Methods. This retrospective study included 869 patients who underwent transrectal prostate biopsy with caudal block at our hospital. The amount of 1% lidocaine was determined by the day of the week on which the biopsy was performed, and the patient voluntarily chose the day of the biopsy, unaware of the dose of 1% lidocaine used on that day. Pain, anal sphincter tonus, cancer diagnosis rate, and early complications were compared. Results. In total, 466 and 403 patients received 5 and 10 mL of 1% lidocaine for a caudal block, respectively. After propensity-score matching for patient characteristics, each group contained 395 patients. The pain score, anal sphincter tonus score, or prostate cancer diagnosis rate were not significantly different between the two groups. However, rectal bleeding was significantly more frequent and severe in the 10-mL than the 5-mL group ( <math xmlns="http://www.w3.org/1998/Math/MathML" id="M1"><mi>p</mi><mo>=</mo><mn>0.018</mn></math> and <math xmlns="http://www.w3.org/1998/Math/MathML" id="M2"><mi>p</mi><mo>=</mo><mn>0.0036</mn></math> , respectively). The incidence of other complications was not significantly different between the groups. Conclusions. Our results suggest that 5 mL of 1% lidocaine may be more suitable than 10 mL for caudal block during transrectal prostate biopsy.

Norichika Ueda

Mototaka Sato

Shunsuke Mori

Atsuki Matsukawa

Yuta Oki

Yuma Kujime

Ryoya Mizuno

Hiromu Horitani

Tetsuya Yamamoto

Shota Fukae

Mitsuhiro Yoshinaga

Makoto Matsushita

Mai Akiyama

Satoshi Kamido

Ayako Honda

Jiro Nakayama

Norihide Tei

Osamu Miyake

Lower Dose of 5 mL of 1% Lidocaine is More Suitable than the Conventional 10 mL for Caudal Block in Transrectal Prostate Biopsy: A Retrospective Cohort Study

5 mL 1% 利多卡因低剂量比传统 10 mL 更适合经直肠前列腺活检的骶管阻滞：一项回顾性队列研究

Abbreviation	Adv. Urol.
Journal Impact	1.82
Quartiles(Global)	UROLOGY & NEPHROLOGY(Q3)

ISSN	1687-6369, 1687-6377
h-index	38

Publication Information	Publisher: Hindawi Publishing Corporation，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2009，Proportion of original research papers: 80.00%，Self Citation Rate:0.00%， Gold OA Rate: 97.06%
Journal Fees	$950Details
Average review cycle	网友分享经验：15 Weeks

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Racial Disparities in Clinical Trial Enrollment Among Patients Diagnosed With Prostate Cancer: A Population‐Based Cohort of Oncology Practices

Initial Experience of Contact Laser Vaporization of the Prostate (CVP) for Benign Prostate Hyperplasia Patients With Hemorrhagic Risk

Utilization of Radiographic Imaging for Infant Hydronephrosis over the First 12 Months of Life

Congenital Bladder and Urethral Agenesis: Two Case Reports and Management

Management of the Uncommon Bladder Cancers: A Single-Center Experience over 10 Years

Routine Surveillance of Upper Urinary Tract Imaging for Diagnosing Upper Urinary Tract Urothelial Cancer Recurrence in Patients with Nonmuscle Invasive Bladder Cancer

SLAP Trial: Shock Wave Lithotripsy and Mechanical Percussion Therapy Post ESWL for Renal Calculi

Pelvic Pain of Myofascial Origin in Women: Correlation with Lower Urinary Tract Symptoms

Lower Dose of 5 mL of 1% Lidocaine is More Suitable than the Conventional 10 mL for Caudal Block in Transrectal Prostate Biopsy: A Retrospective Cohort Study

Racial Disparities in Clinical Trial Enrollment Among Patients Diagnosed With Prostate Cancer: A Population‐Based Cohort of Oncology Practices