Urology Commons^™

Progesterone Receptors Drive Advanced Breast Cancer Phenotypes Including Circulating Tumor- And Stem-Like Cell Expansion In The Context Of Esr1 Mutation, Thu H. Truong, Noelle E. Gillis, Amy R. Dwyer, Rosemary J. Huggins, Kyla M. Hagen, Sai Harshita Posani, Nuri A. Temiz, Carlos Perez Kerkvliet, Ellie M. Piepgras, Julie H. Ostrander, Geoffrey L. Greene, Carol A. Lange

Department of Urology Faculty Papers

Endocrine therapy resistance remains a major challenge in the treatment of advanced estrogen receptor positive (ER+) breast cancer. This can be driven by acquired mutations in the estrogen receptor gene (ESR1), such as Y537S or D538G, that results in constitutive estrogen-independent ER activity. Progesterone receptors (PR) are important modifiers of ER activity, in part via direct binding. We previously showed that PR mediates expansion of cancer stem-like cell (CSC) populations. In this study, we sought to define whether PR function changes in the context of ESR1 mutations. PR readily interacted with wild type (WT), but not Y537S or D538G ERs. …

Metastatic Castrate-Resistant Prostate Cancer To The Penis Resulting In Malignant Priapism And Urethral Obstruction, Courtney Stewart, Joon Yau Leong, William Kevin Kelly, Mihir Shah

Department of Urology Faculty Papers

A 76-year-old male with metastatic castrate-resistant prostate cancer was found to have metastatic disease to the urethra and penis on PSMA PET scan. This resulted in constant pain due to obstruction of blood flow through the corpora cavernosum resulting in priapism and urethral obstruction. The patient underwent a radical penectomy, partial urethrectomy and perineal urethrostomy creation. Final pathology confirmed metastatic prostatic adenocarcinoma. Although rare, prostate cancer can metastasize to the corpora spongiosum or cavernosa. Treatment options are limited, and surgical excision with urinary diversion is likely to provide the most durable outcomes for one's quality of life.

Evolving Strategies In Prostate Cancer: Emerging Approaches And Unmet Needs From The Bridging The Gaps In Prostate Cancer Expert Panel, Rana Mckay, Benjamin Maughan, Alicia Morgans, Neal Shore, Evan Yu, Ravi Madan, Jacob Berchuck, Bradley Carthon, Steven Finkelstein, Leonard Gomella, Michael Gorin, Andrew Hahn, Stacy Loeb, Vivek Narayan, Daniel Petrylak, Charles Ryan, Karine Tawagi, Phuoc Tran, Tanya Dorff

Department of Urology Faculty Papers

BACKGROUND: The expansion of treatment options for prostate cancer (PC) has improved disease-specific and overall survival outcomes but has also raised questions about the optimal level of treatment needed for patients based on their individual prognosis and accounting for potential toxicity, incorporating quality of life considerations.

METHODS: A panel of experts met to discuss current controversies in the care of patients with PC across the disease continuum. Multidisciplinary experts review advances and persistent uncertainties in biomarker-guided assessment, imaging, and systemic therapy for prostate cancer. The discussion outlines priority gaps in evidence that must be addressed to optimize individualized patient care. …

The Effects Of Bone-Remodeling Therapy On Survival, Pain, And Skeletal Related Events In The Setting Of Renal Cell Carcinoma With Bone Metastases: A Multicenter Investigation From A Large Global Health Research Network (Trinetx), Brian H. Im, Kevin K. Zarrabi, Aaron R. Hochberg, Mihir M. Shah, Md, James R. Mark, Joseph K. Izes, Patrick T. Gomella, Costas D. Lallas, Leonard G. Gomella, Adam R. Metwalli

Department of Urology Faculty Papers

INTRODUCTION: Renal cell carcinoma (RCC) is the most common renal malignancy-bone metastases (BM) are indicative of aggressive disease with a poor prognosis. We aim to evaluate the overall mortality of patients with RCC with and without BM, and to elucidate the effects of bone-remodeling therapy on mortality, incidence of skeletal-related events, and opioid usage patterns in patients with BM.

METHODS: A retrospective cohort study was conducted using TriNetX, a large, collaborative network sourced from electronic medical records of over 110 million patients from over 100 healthcare organizations. All adult patients with RCC and RCC with BM were queried.

RESULTS: There …

Treatment Patterns For Genitourinary Syndrome Of Menopause: A Trinetx Analysis, Anushka Ghosh, Maria D'Amico, Yash B. Shah, Whitney R. Smith, Mihir S. Shah, Costas D. Lallas, Alana M. Murphy

Department of Urology Faculty Papers

BACKGROUND: Genitourinary syndrome of menopause (GSM) is a highly prevalent, underdiagnosed condition that can significantly impair quality of life (QoL). This study evaluates real-world treatment trends for GSM to better understand current management practices and highlight ongoing gaps in care. The background is in a different font than the rest of the abstract.

METHODS: We queried the TriNetX database for patients with a diagnosis of postmenopausal atrophic vaginitis (ICD N95.2) and treatment information from 2004-2024. A combination of RxNorm and International Classification of Diseases-10 (ICD) codes was used to classify disease and treatment type, including topical estrogen (RxNorm 4083, 4099), …

Low Utilization Of Intracavernosal Injection And Penile Doppler Ultrasound In The Evaluation Of Erectile Dysfunction And Peyronie's Disease, Joon Yau Leong, Tyler Gaines, Zachary J. Prebay, David Ebbott, Paul H. Chung

Department of Urology Faculty Papers

INTRODUCTION: Despite the diagnostic value of intracavernosal injections (ICI) and penile Doppler ultrasound (PDUS), there remain barriers to widespread clinical adaptation of these methods. The study aimed to evaluate the practice patterns of utilization of ICI and PDUS in the assessment of erectile dysfunction (ED) and Peyronie's disease (PD).

METHODS: Using the TriNetX database (Cambridge, MA, USA), adult (≥18 years) male patients with a diagnosis of ED on oral phosphodiesterase-5 (PDE5) inhibitors were identified. Current Procedural Terminology codes were utilized to identify patients who underwent further evaluation with ICI or PDUS, as well as penile prosthesis placement after PDUS. A …

Surgical Success Following Robotic Upper Urinary Tract Reconstruction, Results From A Global Network Of Healthcare Organizations, Zachary Prebay, Adam Schneider, Sohan S. Shah, Mauro Dispagna, Mihir S. Shah

Department of Urology Faculty Papers

INTRODUCTION: Available data on robotic ureteral reconstruction procedures is concentrated from high volume centers. To better understand generalizability of success, we used a network of healthcare organizations (HCOs) to evaluate surgical success following robotic-assisted pyeloplasty (RP), ureteral reimplantation (RR), and ureteroureterostomy/ureteroplasty (RU).

METHODS: We searched the TriNetX database for adult (>18 years old) patients undergoing RP, RR and RU. Our primary outcome was need for drain placement (nephrostomy or ureteral stent) from 4 weeks to 10 years postoperatively. We evaluated risk factors (RF) for drain placement (vascular disease, kidney disease, diabetes (DM), smoking history, radiation history, age, body mass …

Artificial Intelligence Use In Medical Education: Best Practices And Future Directions, Rasheed A. M. Thompson, Yash B. Shah, Francisco Aguirre, Courtney Stewart, Costas D. Lallas, Mihir S. Shah

Department of Urology Faculty Papers

PURPOSEOF REVIEW: This review examines the various ways artificial intelligence (AI) has been utilized in medical education (MedEd)and presents ideas that will ethically and effectively leverage AI in enhancing the learning experience of medical trainees.

RECENT FINDINGS: AI has improved accessibility to learning material in a manner that engages the wider population. It has utility as a reference tool and can assist academic writing by generating outlines, summaries and identifying relevant reference articles. As AI is increasingly integrated into MedEd and practice, its regulation should become a priority to prevent drawbacks to the education of trainees. By involving physicians in …

Port Site Metastasis After Robotic Assisted Laparoscopic Radical Prostatectomy: Diagnosis Via Prostate-Specific Membrane Antigen (Psma)-Targeted 18f-Dcfpyl Pet/Ct, Joon Yau Leong, Maria D'Amico, Courtney Capella, Leonard Gomella, Joseph Izes

Department of Urology Faculty Papers

We present a case of port site metastasis (PSM) that was identified in an 82-year-old man with an elevated prostate-specific antigen (PSA) to 3.9 ng/mL, concerning for biochemical recurrence after robotic-assisted radical prostatectomy, adjuvant radiation, and six months of androgen deprivation therapy with an undetectable PSA post-treatment over 10 years ago. A 2.1 cm solitary tracer avid nodule on the right lateral abdominal wall with no other evidence of recurrence or metastatic disease was found on prostate-specific membrane antigen (PSMA)–targeted ¹⁸F-DCFPyL PET/CT scan. The patient underwent local excision of this metastatic lesion, and final pathology revealed metastatic prostatic adenocarcinoma.

Real-World Management Of High-Risk Prostate Cancer Post-Radical Prostatectomy: Insights From A Regional Quality Collaborative, Aaron R. Hochberg, Annie H. Ho, Rasheed A. M. Thompson, Matthew B. Buck, Costas D. Lallas, Christine Ibilibor, Jeffrey J. Tomaszewski, Serge Ginzburg, Andres Correa, Robert Uzzo, Marc C. Smaldone, John F. Danella, Thomas J. Guzzo, Daniel J. Lee, Laurence Belkoff, Jeffrey Walker, Jay D. Raman, Roderick K. Clark, Adam Reese, Bruce Jacobs, Thomas Jang, Keith J. Kowalczyk, Meghan Smith, Mihir S. Shah

Department of Urology Faculty Papers

Background/Objectives: Data from clinical trials showing the non-inferiority of early salvage radiotherapy were recently incorporated into societal guideline statements. However, questions remain regarding ideal prostate-specific antigen (PSA) criteria for salvage, and how to apply these findings to pathologic lymph node-positive (pN+) disease. We investigated variance in management of clinically localized prostate cancer found to have high-risk features after radical prostatectomy. Methods: We retrospectively identified patients from May 2015 to January 2024 utilizing a multi-institutional, regional collaborative database. The primary outcome was identifying factors associated with the receipt of adjuvant versus salvage therapy. Factors associated with secondary treatment were assessed via …

Non-Dre Voided Urine Test To Diagnose Prostate Cancer: Updated Results, Patrick T. Gomella, Joon Yau Leong, Leonard G. Gomella, Vivek S. Tomar, Hector Teran, Edouard J. Trabulsi, Mathew L. Thakur

Department of Urology Faculty Papers

Background: The standard diagnostic approach for prostate cancer (PCa) diagnosis consists of serum prostate-specific antigen (PSA) testing, digital rectal examination (DRE) and image-guided targeted biopsies. Given the invasive nature, potential adverse events and costs associated with these techniques, alternative approaches have been investigated, specifically with serum and urine assays. The work presented here is intended to further validate a novel noninvasive optical technique for PCa detection, targeting the VPAC genomic receptors that are overexpressed on prostate cancer's malignant cells (MC), in non-DRE voided urine. Methods: Patients (N = 62) who had image-guided biopsy and histologically confirmed localized PCa, and …

Complications And Influential Perioperative Factors Associated With Spaceoar Hydrogel Placement, Kerith Wang, Rishabh Simhal, Cassra Clark, Mark Mann, James Mark, Costas Lallas, Robert Den, Edouard Trabulsi

Department of Urology Faculty Papers

OBJECTIVE: To examine one academic institution's experiences with SpaceOAR placement, its associated complications, and periprocedural characteristics that affect outcomes for the purpose of quality improvement.

MATERIALS AND METHODS: We conducted a retrospective review of 233 patients who received SpaceOAR from four surgeons and one radiation oncologist between 2018 and 2021. Variables such as demographics, oncologic parameters, radiation plan, and radiographic assessment of hydrogel placement were recorded. The Charlson Comorbidity Index (CCI) was used to assess comorbidity risk. Mann-Whitney and Fisher's exact tests were performed to compare patients with and without complications.

RESULTS: Of the 233 patients who received SpaceOAR, 24 …

A Global, Propensity-Score Matched Analysis Of Patients Receiving Inflatable Penile Prostheses And The Risk Of Complications, Infections, And Re-Interventions, Halle E. Foss, Zachary J. Prebay, David Ebbott, Matthew B. Buck, Michael Li, Paul H. Chung

Department of Urology Faculty Papers

Background: Over 25,000 men undergo inflatable penile prosthesis (IPP) placement yearly to treat erectile dysfunction (ED). Although various comorbidities are hypothesized risk factors for complications, this remains incompletely understood. Our objective was to utilize multi-institutional data to characterize risk for reintervention, complications, and infections in patients with common suspected risk factors undergoing IPP placement.

Methods: We queried the TriNetX database for adult men who underwent IPP placement from 2003–2023 utilizing Current Procedural Terminology (CPT) codes. We examined the impact of diabetes mellitus (DM), hypertension (HTN), nicotine use, radiation therapy (RT), radical prostatectomy (RP), and urethral surgery [urethroplasty, artificial urinary sphincter …

Practical Guidance On Establishing A Molecular Testing Pathway For Alterations In Homologous Recombination Repair Genes In Clinical Practice For Patients With Metastatic Prostate Cancer, Martin Schostak, Angela Bradbury, Alberto Briganti, David Gonzalez, Leonard Gomella, Joaquin Mateo, Frédérique Penault-Llorca, Albrecht Stenzinger, Alexander Wyatt, Anders Bjartell

Department of Urology Faculty Papers

CONTEXT: Prostate cancer is a molecularly heterogeneous disease that is amenable to diagnostic testing to identify patients potentially eligible for personalised treatments inform familial risk and provide relevant information about potential prognosis. Several guidelines support the integration of genomic testing in a shared decision-making framework so that both health care professionals (HCPs) and patients are involved in determining the best treatment approach.

OBJECTIVE: To review current guidelines on molecular diagnostic testing for homologous recombination repair (HRR) gene alterations in patients with metastatic prostate cancer, with the aim of providing practical considerations for effective guideline implementation and establishment of an appropriate …

Efficacy Of Intravesical Nadofaragene Firadenovec For Patients With Bacillus Calmette-Guérin-Unresponsive Nonmuscle-Invasive Bladder Cancer: 5-Year Follow-Up From A Phase 3 Trial, Vikram M. Narayan, Stephen A. Boorjian, Mehrdad Alemozaffar, Badrinath R. Konety, Neal D. Shore, Leonard G. Gomella, Ashish M. Kamat, Trinity J. Bivalacqua, Jeffrey S. Montgomery, Seth P. Lerner, Joseph E. Busby, Michael Poch, Paul L. Crispen, Gary D. Steinberg, Anne K. Schuckman, Tracy M. Downs, Joseph Mashni, Brian R. Lane, Thomas J. Guzzo, Gennady Bratslavsky, Lawrence I. Karsh, Michael E. Woods, Gordon Brown, Daniel Canter, Adam Luchey, Yair Lotan, Brant A. Inman, Michael B. Williams, Michael S. Cookson, Sam S. Chang, Alexander I. Sankin, Michael A. O'Donnell, David Sawutz, Richard Philipson, Nigel R. Parker, Seppo Yla-Herttuala, Dorte Rehm, Jørn S. Jakobsen, Kristian Juul, Colin P.N. Dinney

Department of Urology Faculty Papers

Purpose: Nadofaragene firadenovec-vncg is a nonreplicating adenoviral vector–based gene therapy for bacillus Calmette-Guérin (BCG)–unresponsive carcinoma in situ (CIS) with/without high-grade Ta/T1. We report outcomes following 5 years of planned follow-up.

Materials and Methods: This open-label phase 3 trial (NCT02773849) enrolled patients with BCG-unresponsive nonmuscle-invasive bladder cancer in 2 cohorts: CIS ± Ta/T1 (CIS; n = 107) and Ta/T1 without CIS (Ta/T1 cohort; n = 50). Patients received 75 mL (3 × 1011 vp/mL) nadofaragene firadenovec intravesically once every 3 months with cystoscopy and cytology assessments, with continued treatment offered to those remaining high grade recurrence–free (HGRF).

Results: One hundred fifty-seven …

Parp-Ish: Gaps In Molecular Understanding And Clinical Trials Targeting Parp Exacerbate Racial Disparities In Prostate Cancer, Moriah L. Cunningham, Matthew J. Schiewer

Department of Urology Faculty Papers

PARP is a nuclear enzyme with a major function in the DNA damage response. PARP inhibitors (PARPi) have been developed for treating tumors harboring homologous recombination repair (HRR) defects that lead to a dependency on PARP. There are currently three PARPi approved for use in advanced prostate cancer (PCa), and several others are in clinical trials for this disease. Recent clinical trial results have reported differential efficacy based on the specific PARPi utilized as well as patient race. There is a racial disparity in PCa, where African American (AA) males are twice as likely to develop and die from the …

Risk Of Secondary Malignancies After Pelvic Radiation: A Population-Based Analysis, Connor Mcpartland, Andrew Salib, Joshua Banks, James R. Mark, Costas D. Lallas, Edouard J. Trabulsi, Leonard G. Gomella, Hannan Goldberg, Benjamin Leiby, Robert Den, Thenappan Chandrasekar

Department of Urology Faculty Papers

Background and objective

Radiation therapy has increasingly been used in the management of pelvic malignancies. However, the use of radiation continues to pose a risk of a secondary malignancy to its recipients. This study investigates the risk of secondary malignancy development following radiation for primary pelvic malignancies.

Methods

A retrospective cohort review of the Surveillance, Epidemiology, and End Results database from 1975 to 2016 was performed. Primary pelvic malignancies were subdivided based on the receipt of radiation, and secondary malignancies were stratified as pelvic or nonpelvic to investigate the local effect of radiation.

Key findings and limitations

A total of …

Target: A Randomized, Noninferiority Trial Of A Pretest, Patient-Driven Genetic Education Webtool Versus Genetic Counseling For Prostate Cancer Germline Testing, Stacy Loeb, Scott Keith, Heather Cheng, Amy Leader, Laura Gross, Tatiana Sanchez Nolasco, Nataliya Byrne, Rebecca Hartman, Lauren Brown, Christopher Pieczonka, Leonard Gomella, William Kevin Kelly, Costas Lallas, Nathan Handley, Patrick Mille, James Mark, Gordon Brown, Sameer Chopra, Alexandra Mcclellan, David Wise, Lucas Hollifield, Veda Giri

Department of Urology Faculty Papers

PURPOSE: Germline genetic testing (GT) is important for prostate cancer (PCA) management, clinical trial eligibility, and hereditary cancer risk. However, GT is underutilized and there is a shortage of genetic counselors. To address these gaps, a patient-driven, pretest genetic education webtool was designed and studied compared with traditional genetic counseling (GC) to inform strategies for expanding access to genetic services.

METHODS: Technology-enhanced acceleration of germline evaluation for therapy (TARGET) was a multicenter, noninferiority, randomized trial (ClinicalTrials.gov identifier: NCT04447703) comparing a nine-module patient-driven genetic education webtool versus pretest GC. Participants completed surveys measuring decisional conflict, satisfaction, and attitudes toward GT at …

Evaluating The Management Trends For Priapism And Assessing The Risk Of Priapism After In-Office Intracavernosal Injections: A Cross-Sectional Analysis, Joon Yau Leong, Zachary J. Prebay, David Ebbott, Michael Li, Paul H. Chung

Department of Urology Faculty Papers

We describe the management trends of patients suffering from any priapism and evaluate the risks of developing priapism after intracavernosal injections (ICI) performed in office. We queried TriNetX for two separate male adult cohorts - those presenting with any priapism based on International Classification of Disease code, N48.3 (priapism) and those who underwent ICI in office based on Current Procedural Terminology code, 54235 (injection of corpora cavernosa with pharmacologic agent[s]). We evaluated treatment options for these patients after any priapism and described demographic risks for developing priapism after ICI performed in office. There were 17,545 priapism encounters and 26,104 usages …

Sigma1 Regulates Lipid Droplet-Mediated Redox Homeostasis Required For Prostate Cancer Proliferation, Halley Oyer, Alexandra Steck, Charles Longen, Sanjana Venkat, Konuralp Bayrak, Eleanor Munger, Dan Fu, Paola Castagnino, Christina Sanders, Nathalia Tancler, My Mai, Justin Myers, Matthew Schiewer, Nan Chen, Elahe Mostaghel, Felix Kim

Department of Urology Faculty Papers

UNLABELLED: Lipid droplets (LD) are dynamic organelles that serve as hubs of cellular metabolic processes. Emerging evidence shows that LDs also play a critical role in maintaining redox homeostasis and can mitigate lipid oxidative stress. In multiple cancers, including prostate cancer, LD accumulation is associated with cancer aggressiveness, therapy resistance, and poor clinical outcome. Prostate cancer arises as an androgen receptor (AR)-driven disease. Among its myriad roles, AR mediates the biosynthesis of LDs, induces autophagy, and modulates cellular oxidative stress in a tightly regulated cycle that promotes cell proliferation. The factors regulating the interplay of these metabolic processes downstream of …

Penile Prosthesis Implantation After Radiation Therapy For Prostate Cancer, Joon Yau Leong, Paul Chung

Department of Urology Faculty Papers

No abstract provided.

The Role Of Salvage Radical Prostatectomy In Patients With Radiation-Resistant Prostate Cancer, Jake Drobner, Alain Kaldany, Mihir S. Shah, Saum Ghodoussipour

Department of Urology Faculty Papers

There are multiple treatment strategies for patients with localized prostate adenocarcinoma. In intermediate- and high-risk patients, external beam radiation therapy demonstrates effective long-term cancer control rates comparable to radical prostatectomy. In patients who opt for initial radiotherapy but have a local recurrence of their cancer, there is no unanimity on the optimal salvage approach. The lack of randomized trials comparing surgery to other local salvage therapy or observation makes it difficult to ascertain the ideal management. A narrative review of existing prospective and retrospective data related to salvage radical prostatectomy after radiation therapy was undertaken. Based on retrospective and prospective …

Omitting The Systematic Prostate Biopsy: Ready For Prime Time?, Joon Yau Leong, Kerith R. Wang, Thenappan Chandrasekar

Department of Urology Faculty Papers

No abstract provided.

Impact Of An Expanded Definition Of Family History On Outcomes Of Active Surveillance For Prostate Cancer, Adam C. Schneider, Thenappan Chandrasekar, Nicholas Bowler, Ryan Fogg, Joon Yau Leong, Andrew Gusev, Linda H. Rodgers, Shelley R. Mccormick, Douglas M. Dahl, Jason A. Efstathiou, Michael L. Blute, Anthony L. Zietman, Chin-Lee Wu, Matthew R. Smith, Eliezer M. Van Allen, Adam S. Feldman, Keyan Salari

Department of Urology Faculty Papers

PURPOSE: Despite family history being an established risk factor for prostate cancer, the role of a broader definition of family history inclusive of not just prostate cancer but other genetically related malignancies has not been investigated in the active surveillance population. Here, we evaluate the impact of an expanded definition of family history on active surveillance outcomes.

MATERIALS AND METHODS: Patients undergoing active surveillance for prostate cancer at Massachusetts General Hospital from 1997-2019 with detailed data available on family cancer history were identified. Primary outcome was biopsy progression-free survival, and secondary outcomes were treatment-free survival, adverse pathological features at prostatectomy, …

The Risk Of Malignant Degeneration Of Müllerian Derivatives In Pmds: A Review Of The Literature, Federica Gagliardi, Augusto Lauro, Livia De Anna, Domenico Tripodi, Anna Esposito, Flavio Forte, Daniele Pironi, Eleonora Lori, Patrizia Alba Gentile, Ignazio R. Marino, Ernesto T. Figueroa, Vito D'Andrea

Department of Urology Faculty Papers

Persistent Müllerian Duct Syndrome (PMDS) is a rare autosomal recessive disorder of sex development characterized by the presence of fallopian tubes, uterus and upper one-third of the vagina in individuals with XY genotype and normal male phenotype. The main complications of PMDS are infertility and the rare risk of malignant degeneration of both testicular and Müllerian derivatives. We report the case of a 49-year-old man who, during repair of an incisional hernia, was incidentally found to have a uterine-like structure posterior to the bladder. In the past at the age of 18 months, he had undergone bilateral orchidopexies for bilateral …

Trends In Male And Female Urethral Endoscopic Management And Urethroplasty Using The Trinetx Database, Adam M. Ostrovsky, Zachary J. Prebay, Paul H. Chung

Department of Urology Faculty Papers

Background: How quickly providers adapt to new practice guidelines is not well known. The objective of this study was to evaluate temporal trends in the performance of urethral endoscopic management and urethroplasty surrounding the release of the American Urological Association (AUA) Male Urethral Stricture Guidelines in 2017. We also evaluate in parallel trends in female urethral stricture disease, where AUA guidelines are not present. We hypothesized that the ratio of urethroplasty versus urethral endoscopic management in both males and females is increasing and that guidelines do not result in immediate changes in management trends. Methods: Endoscopic management and urethroplasty data …

A Trinetx Registry Analysis Of The Need For Second Procedures Following Index Anterior And Posterior Urethroplasty, Zachary J. Prebay, Adam M. Ostrovsky, Matthew Buck, Paul H. Chung

Department of Urology Faculty Papers

Background: We queried a global database to understand re-intervention rates following urethroplasty with the goal of evaluating whether they align with previously published data. Methods: Using the TriNetX database and Common Procedural Terminology (CPT) and International Classification of Diseases-10 (ICD) codes, we identified adult male patients with urethral stricture disease (ICD N35) who underwent one-stage anterior (CPT 53410) or posterior urethroplasty (CPT 53415), with or without (substitution urethroplasty) a tissue flap (CPT 15740) or buccal graft (CPT 15240 or 15241). We set urethroplasty as the index event and used descriptive statistics to report the incidence of secondary procedures (using CPT …

Testing For Homologous Recombination Repair Or Homologous Recombination Deficiency For Poly (Adp-Ribose) Polymerase Inhibitors: A Current Perspective, Thomas J Herzog, Ignace Vergote, Leonard G Gomella, Tsveta Milenkova, Tim French, Raffi Tonikian, Christian Poehlein, Maha Hussain

Department of Urology Faculty Papers

Poly (ADP-ribose) polymerase inhibitors (PARPis) have demonstrated clinical activity in patients with BRCA1 and/or BRCA2 mutated breast, ovarian, prostate, and pancreatic cancers. Notably, BRCA mutations are associated with defects in the homologous recombination repair (HRR) pathway. This homologous recombination deficiency (HRD) phenotype can also be observed as genomic instability in tumour cells. Accordingly, PARPi sensitivity has been observed in various tumours with HRD, independent of BRCA mutations. Currently, four PARPis are approved by regulatory agencies for the treatment of cancer across multiple tumour types. Most indications are specific to tumours with a confirmed BRCA mutation, mutations in other HRR-related genes, …

Patient Factors Impacting Perioperative Outcomes For T1b-T2 Localized Renal Cell Carcinoma May Guide Decision For Partial Versus Radical Nephrectomy, Yash B Shah, Rishabh K Simhal, Kerith Wang, Hanan Goldberg, Costas D. Lallas, Thenappan Chandrasekar

Department of Urology Faculty Papers

There remains debate surrounding partial (PN) versus radical nephrectomy (RN) for T1b-T2 renal cell carcinoma (RCC). PN offers nephron-sparing benefits but involves increased perioperative complications. RN putatively maximizes oncologic benefit with complex tumors. We analyzed newly available nephrectomy-specific NSQIP data to elucidate predictors of perioperative outcomes in localized T1b-T2 RCC. We identified 2094 patients undergoing nephrectomy between 2019-2020. Captured variables include surgical procedure and approach, staging, comorbidities, prophylaxis, peri-operative complications, reoperations, and readmissions. 816 patients received PN while 1278 received RN. Reoperation rates were comparable; however, PN patients more commonly experienced 30-day readmissions (7.0% vs. 4.7%, p = 0.026), bleeds …

Genitourinary And Sexual Symptoms And Treatments In Transfeminine Individuals: A Qualitative Exploration Of Patients' Needs, Paul Chung, Vishal Swaminathan, Sabina Spigner, Joon Yau Leong, Jessica Bulafka, Rosemary Frasso

Department of Urology Faculty Papers

Introduction: Medical providers may not be familiar with the genitourinary and sexual symptoms of transgender and non-binary (TGNB) individuals. This lack of familiarity may hinder a provider's ability to address these issues as patients may hesitate to report symptoms due to fear of stigma, misgendering, and being treated disrespectfully.

Aim: To describe the array of genitourinary and sexual symptoms in transfeminine individuals.

Methods: Upon institutional review board approval, researchers used semi-structured interviews with 25 transfeminine individuals assigned male at birth to explore urinary and sexual symptoms on a sample of convenience. Participants were recruited and interviews were conducted until saturation …