Open Access

EDITORIAL

Leonard G. Gomella
Canadian Journal of Urology, Vol.28, No.2, pp. 10574-10575, 2021
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LEGENDS IN UROLOGY

Fredric L. Coe
Canadian Journal of Urology, Vol.28, No.2, pp. 10576-10579, 2021
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EXPERT OPINION

Dean S. Elterman¹, Kevin C. Zorn², Bilal Chughtai³, Naeem Bhojani²
Canadian Journal of Urology, Vol.28, No.2, pp. 10580-10583, 2021
Abstract Introduction: The options for treating benign prostatic hyperplasia (BPH) beyond medication and traditional transurethral surgery continue to expand. Undesirable side effects of medication and surgeries have driven interest toward minimally invasive surgical therapies (MISTs), including convective water vapor ablation (Rezum) and prostatic urethral lift (UroLift). While these treatments can be performed outside of the operating room, they do require special equipment and the use of rigid cystoscopy. A new class of treatments, which utilize no special equipment beyond a flexible cystoscope, is emerging, the first of which, the temporary implantable nitinol device (iTind), is already FDA… More >

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REVIEW

Kevin R. Loughlin
Canadian Journal of Urology, Vol.28, No.2, pp. 10584-10588, 2021
Abstract Introduction: Five-alpha reductase (5-AR) deficiency was first identified by Imperato-McGinley and Walsh as the cause of pseudohermaphroditism in two separate studies. The discoveries led to the development of finasteride (inhibitor of type 2 isoenzyme of 5-AR) and dutasteride (inhibitor of type 1 and type 2 isoenzymes of 5-AR).
Both drugs have been proven effective for the treatment of benign prostatic hyperplasia, improving voiding symptoms, reducing the risk of urinary retention, and decreasing the need for prostate surgery.
Five-alpha reductase inhibitors (5-ARIs) have also been demonstrated to be chemopreventive agents, reducing the risk of prostate cancer, although the… More >

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ARTICLE

Avery R. Wolfe, Roger K. Khouri Jr., Raj R. Bhanvadia, Benjamin M. Dropkin, Gregory A. Joice, Sarah C. Sanders, Steven J. Hudak, Allen F. Morey
Canadian Journal of Urology, Vol.28, No.2, pp. 10589-10594, 2021
Abstract Introduction: Patient-reported pads per day use is a widely used metric in grading the severity of stress urinary incontinence and guiding surgical decision-making, particularly in mild-to-moderate cases. We sought to compare patient-reported stress urinary incontinence severity by pads per day with objective findings on standing cough test. We hypothesize that patient-reported pads per day often underestimates stress urinary incontinence severity.
Materials and methods: We retrospectively reviewed our male stress urinary incontinence surgical database and identified 299 patients with self-reported mild-to-moderate stress urinary incontinence who were evaluated with standing cough test prior to surgical intervention between 2007 and… More >

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COMMENTARY

David E. Rapp, Hamza Beano
Canadian Journal of Urology, Vol.28, No.2, pp. 10595-10595, 2021
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ARTICLE

Mathew L. Thakur^1,2,3,4, Sushil K. Tripathi¹, Leonard G. Gomella^3,4, Ebru Salmanoglu⁵, Sung Kim¹, William K. Kelly^4,6, Scott W. Keith⁷, Charles Intenzo¹, Peter McCue⁸, Jean Hoffman-Censits⁹, Edouard J. Trabulsi^3,4
Canadian Journal of Urology, Vol.28, No.2, pp. 10596-10602, 2021
Abstract Introduction: Accurate staging of urothelial bladder cancer (UBC) with imaging, which guides effective bladder cancer treatment, remains challenging. This investigation is to validate a hypothesis that targeting vasoactive intestinal and pituitary adenylate cyclase activating peptide (VPAC) receptors using ⁶⁴Cu-TP3805 can PET image UBC efficiently.
Materials and methods: Nineteen patients (aged 44-84 years) scheduled for radical cystectomy underwent VPAC positron emission tomography (PET) imaging prior to surgery. Sixteen had completed neoadjuvant chemotherapy before imaging. All 19 received ⁶⁴Cu-TP3805 (148% ± 10% MBq) intravenously and were imaged 60 to 90 minutes later. Standard uptake value (SUV)max for malignant lesions and… More >

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ARTICLE

Kassem S. Faraj¹, Nathanael Judge¹, Gail Blodgett², Mark D. Tyson II¹
Canadian Journal of Urology, Vol.28, No.2, pp. 10603-10609, 2021
Abstract Introduction: Prolonged operative times have been associated with an increased risk of complications in other major abdominal surgeries. This study tests the hypothesis that longer operative times will be associated with an increased risk of perioperative complications after radical cystectomy (RC).
Materials and methods: Adult patients who underwent RC from January 1, 2012, through December 31, 2016, were identified from the National Surgical Quality Improvement Program (NSQIP) database. A natural log transformation was used to determine cutoff points for operative times at the 33rd, 67th, and 90th percentiles: 272, 371, and 479 minutes, respectively. Cohorts were divided… More >

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ARTICLE

Dean S. Elterman¹, Susan Foller², Burkhard Ubrig³, Alexander Kugler⁴, Vincent Misrai⁵, Angelo Porreca⁶, Dominik Abt⁷, Kevin C. Zorn⁸, Naeem Bhojani⁸, Lewis Kriteman⁹, Rahul Mehan¹⁰, Michael McDonald¹¹, Steven A. Kaplan¹²
Canadian Journal of Urology, Vol.28, No.2, pp. 10610-10613, 2021
Abstract Introduction: To determine if focal bladder neck cautery is effective in reducing bleeding following prostate tissue resection for benign prostatic hyperplasia using Aquablation.
Materials and methods: Consecutive patients from 11 countries in Asia, Europe, and North America who underwent Aquablation for symptomatic benign prostatic hyperplasia between late 2019 and January 2021 were included in the analysis. All patients received post-Aquablation non-resective focal cautery at the bladder neck.
Results: A total of 2,089 consecutive Aquablation procedures were included. Mean prostate size was 87 cc (range 20 cc to 363 cc). Postoperative bleeding requiring transfusion occurred in 17 cases (0.8%, More >

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ARTICLE

Zoe S. Gan, Cheyenne Williams, Olivia O. Familusi, Ayah El-Fahmawi, Rayan Kabaha, Daniel J. Lee, David I. Lee
Canadian Journal of Urology, Vol.28, No.2, pp. 10614-10619, 2021
Abstract Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, decreased presentations for various emergent conditions have been observed. Our objective was to compare the volume of patients with urologic emergencies presenting to emergency departments (EDs) within a single health system before and after the onset of the COVID-19 pandemic. Materials and methods: A retrospective chart review was performed for 3 EDs within a single health system in the United States to identify all ED consults to urology from January 1, 2019 to May 31, 2020. For emergent consults, covariates were extracted, including demographic information, insurance status,… More >

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ARTICLE

Aeen M. Asghar¹, Andrew G. McIntosh¹, Zachary L. Smith², Neil J. Kocher³, Ziho Lee¹, Nimrod N. Barashi², Tianyu Li¹, Jay D. Raman³, Scott E. Eggener², Robert G. Uzzo¹, Alexander Kutikov¹
Canadian Journal of Urology, Vol.28, No.2, pp. 10620-10624, 2021
Abstract Introduction: To assess whether patients with a large renal mass, treated by radical nephrectomy (RN), could have benefited from preoperative renal mass biopsy (RMB). The decision to perform partial nephrectomy (PN) for an organ-confined > 4 cm renal mass can be complex. Although often feasible, the oncologic safety of PN in this cohort is debated. Yet, a significant portion of large renal masses that undergo RN prove benign or indolent, indicating a potential role for RMB to guide nephron preservation.
Materials and methods: We queried prospectively maintained databases from three institutions to identify patients who underwent RN… More >

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ARTICLE

David Abramowitz¹, Andre-Philippe Sam², Mark Pachorek³, Jim Shen¹, Nora Ruel⁴, Jonathan N. Warner¹
Canadian Journal of Urology, Vol.28, No.2, pp. 10625-10630, 2021
Abstract Introduction: To report outcomes of our Virtue male sling series and evaluate predictors of surgical success and failure. We also retrofit the Male Stress Incontinence Grading Scale (MSIGS) refined nomogram, including the standing cough test (SCT), to assess its application to our cohort.
Materials and methods: A retrospective review was completed at a single institution over a 4-year period of all Virtue male slings implanted for stress urinary incontinence (SUI). Patient demographics including pad usage per day (PPD) and MSIGS were obtained on all patients after their bladders were filled cystoscopically. Failure was defined as >1 PPD… More >

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COMMENTARY

Jack M. Zuckerman
Canadian Journal of Urology, Vol.28, No.2, pp. 10631-10631, 2021
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ARTICLE

Mohammed Shahait^1,3, Daniel Lee^1,2, Jessica L. Kim¹, Suzy Na¹, David I. Lee¹
Canadian Journal of Urology, Vol.28, No.2, pp. 10632-10637, 2021
Abstract Introduction: It is unknown whether a family history of prostate cancer confers additional risk among men who are candidates for active surveillance (AS).
Materials and methods: Using a prospectively maintained database of men who underwent radical prostatectomy (RP) (2010-2018), candidates for AS were identified according to the expanded criteria. Pathological upgrading was defined as a pathologic Gleason score (pGS) of 3+4 or higher for patients with a biopsy GS of 3+3 and a pGS of 4+3 or higher for patients with a biopsy GS of 3+4. Major upgrading was defined as a pGS of 4+4 or higher.… More >

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RESIDENT’S CORNER

Mark G. Biebel¹, Wesley R. Pate¹, Toby C. Chai¹
Canadian Journal of Urology, Vol.28, No.2, pp. 10638-10642, 2021
Abstract Prostateabscess(PA)isanuncommonprostaticinfection, with risk factors including indwelling catheters, acute or chronic prostatitis, bladder outlet obstruction, voiding dysfunction, recent urologic instrumentation (especially transrectalprostatebiopsy),chronickidneydisease(CKD), diabetes mellitus (DM), human immunodefciency virus (HIV), intravenous drug use (IVDU), and hepatitis C. Treatment of PA consists of antibiotics and abscess drainage via transurethral resection (TUR) or image-guided transrectal or transperineal drainage. Numerous studies have demonstrated that TUR of PA has a higher success rate and shorter hospital length of stay when compared to image-guided drainage. Despite this, TUR of PA is a relatively uncommon surgery with few useful recommendations on how to… More >

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RESIDENT’S CORNER

Blair Stocks¹, Hunter Fuentes¹, Zachary McDowell¹, Michael Brooks^1,2, Jeffrey A. Jones^1,2
Canadian Journal of Urology, Vol.28, No.2, pp. 10643-10647, 2021
Abstract Primary scrotal melanoma represents the rarest genitourinary malignancy. We describe the 25th reported case. The 79-year-old patient presented with a rapidly enlarging right cutaneous scrotal mass which after local excision demonstrated pT4b nodular malignant melanoma (BRAF V600E mutation positive). The patient underwent wide local excision of his hemiscrotum and inguinal lymph node dissection demonstrating nodes positive for melanoma (pN2b). Postoperatively, the patient developed a left sided malignant pleural effusion (M1b). Per American Joint Commission Cancer staging, BRAF mutant targeted therapy (dabrafenib) was initiated. This case documents the first instance in which metastatic scrotal melanoma will More >

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HOW I DO IT

Blair Stocks¹, Hunter Fuentes¹, Zachary McDowell¹, Michael Brooks^1,2, Jeffrey A. Jones^1,2
Canadian Journal of Urology, Vol.28, No.2, pp. 10648-10651, 2021
Abstract Regional analgesia is an important adjunct for perioperative pain management in the setting of pediatric penile surgeries. Caudal epidural analgesia (CEA) is the most common analgesic technique performed, but it has limitations and associated morbidity. The pudendal nerve block (PNB) is an effective alternative to CEA with a lower risk profile; in prior examination of the approach, PNB has been demonstrated to have similar postoperative pain control outcomes. We describe our technique and highlight observations made as we have transitioned from CEA to PNB for many patients. More >

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