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Purpose: In patients with prostate cancer (PCa), focal therapy with High-Intensity Focused Ultrasound (HIFU) combined with benign prostatic hyperplasia (BPH) surgery has been used to improve immediate post-operative voiding symptoms. Our study aimed to evaluate the functional outcomes of patients undergoing simultaneous holmium laser enucleation of the prostate (HoLEP) + HIFU and compare them to those who underwent HoLEP for bladder outlet obstruction secondary to BPH. Methods: We performed retrospective review of patients who underwent HoLEP + HIFU or HoLEP between June 2017 and May 2024. The nearest neighbor method with age and prostate volume were used to propensity match HoLEP + HIFU patients with HoLEP only patients in a 1:2 ratio. Demographics, functional characteristics, and complications of patients who underwent HoLEP + HIFU were compared with patients undergoing only HoLEP for BPH. Results: A total of 99 patients were analyzed, of which 33 patients underwent combined HIFU with HoLEP. Patients undergoing HIFU + HoLEP experienced higher rates of acute urinary retention (p = 0.016) and transient urinary incontinence, along with a delayed recovery of full continence, compared to those who underwent HoLEP alone. Postoperative urinary tract infection (UTI), urethral stricture, bladder neck stenosis (BNS), and continence rate were similar between the groups. Conclusion: Patients undergoing HoLEP + HIFU seems to have a higher risk of post-operative acute urine retention and delayed recovery from transient urinary incontinence, compared to HoLEP alone. The addition of HIFU to HoLEP does not influence the rate of UTI, urethral stricture, BNS, or improvement of voiding parameters up to one year follow up. [ABSTRACT FROM AUTHOR]

Objective: Digital flexible ureteroscopes (DFUs) play a crucial role in endourological procedures, and scope breakages are often avoidable with proper measures in place. We aimed to evaluate the effect of mandatory training on DFU durability and to assess the influence of various factors on instrument damage. Materials and Methods: Mandatory training involving instructional videos on DFU care was introduced for all processing and operating room staff handling DFUs. Only certified personnel were allowed to handle DFUs, with meticulous usage documentation. The average annual usage of each DFU was compared pre and post program implementation. We examined factors such as patient demographics, procedure details, and operator experience impacting scope life using negative binomial regression. Results: The average usage of DFU increased by 21%, from 6.38 to 7.74 cases. We found that post-graduate year stood out as a significant predictive factor (estimate = 3.28, p = 0.04). Moreover, the streamlined model revealed that previous ureteral-stent use (estimate = 0.94, p < 0.001), struvite stones (estimate = 3.08, p = 0.01), and a higher number of stones (estimate = 0.11, p = 0.04) were associated with an increased number of procedures before DFU breakage, whreas in situ lithotripsy in the lower calyx was associated with a reduced number of procedures before DFU breakage (estimate = −1.11, p = 0.003). Conclusion: Implementing a mandatory training program showed an increase in DFU durability by 21%, suggesting a potential reduction in annual repair and replacement costs by the same percentage. Furthermore, outcomes were more favorable when experienced practitioners conducted treatments, especially in cases involving struvite stones. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous nephrolithotomy (PCNL) remains the gold standard treatment for patients with complete staghorn stones, for which multiple access tracts may be required. In this study, we describe a series of patients undergoing PCNL with a minimum of five dilated access tracts. Materials and Methods: We performed a multi-institutional retrospective review of 10 patients with complete staghorn stones who underwent PCNL requiring five or more access tracts. We recorded patient demographics, stone characteristics postoperative complications, and stone-free rates (SFRs). The primary endpoint was any postoperative complication. Secondary endpoints included SFR, operative time, and length of stay. SFR was defined as absence of stones or residual fragments <4 mm. Results: A total of 10 patients from two institutions were included. Access tract number ranged from 5 to 11, and median stone volume was 233,042 mm3. Seven patients (70%) experienced postoperative complications, ranging from Clavien II to IVa. Three patients (30%) required blood transfusions. Median operative time was 312 minutes ranging from 180 to 560 minutes. Five patients (50%) were stone-free after the initial procedure. Of those with residual fragments, 4 (40%) required reoperation to be rendered stone-free. Median length of stay was 2.5 days, with a range of 1–6 days. Conclusion: To our knowledge, this is the largest series of patients undergoing PCNL with five or more access tracts reported to date. This study confirms that PCNL with five or more tracts is feasible and relatively safe, albeit with a high rate of complications in the immediate postoperative period. [ABSTRACT FROM AUTHOR]

Introduction: Natural language processing (NLP)-based data extraction from electronic health records (EHRs) holds significant potential to simplify clinical management and aid research. This review aims to evaluate the current landscape of NLP-based data extraction in prostate cancer (PCa) management. Materials and Methods: We conducted a literature search of PubMed and Google Scholar databases using the keywords: "Natural Language Processing," "Prostate Cancer," "data extraction," and "EHR" with variations of each. No language or time limits were imposed. All results were collected in a standardized manner, including country of origin, sample size, algorithm, objective of outcome, and model performance. The precision, recall, and the F1 score of studies were collected as a metric of model performance. Results: Of the 14 studies included in the review, 2 articles focused on documenting digital rectal examinations, 1 on identifying and quantifying pain secondary to PCa, 8 on extracting staging/grading information from clinical reports, with an emphasis on TNM-classification, risk stratification, and identifying metastasis, 2 articles focused on patient-centered post-treatment outcomes such as incontinence, erectile, and bowel dysfunction, and 1 on loneliness/social isolation following PCa diagnosis. All models showed moderate to high data annotation/extraction accuracy compared with the gold standard method of manual data extraction by chart review. Despite their potential, NLPs face challenges in handling ambiguous, institution-specific language and context nuances, leading to occasional inaccuracies in clinical data interpretation. Conclusion: NLP-based data extraction has effectively extracted various outcomes from PCa patients' EHRs. It holds the potential for automating outcome monitoring and data collection, resulting in time and labor savings. [ABSTRACT FROM AUTHOR]

The study aims to determine whether body mass index (BMI), metabolic syndrome (MS) or its individual components (primary hypertension, type 2 diabetes mellitus and dyslipidemias) are risk factors for common urological diseases. Cross-sectional study with data collected on February 28, 2022 from the TriNetX Research Network. Patients were divided in cohorts according to their BMI, presence of MS (BMI > 30 kg/m2, type 2 diabetes mellitus, primary hypertension and disorders of lipoprotein metabolism) and its individual components and its association with common urological conditions was determined. For each analysis, odds ratio (OR) with 95% confidence intervals were calculated. Statistical significance was assessed at p <.05. BMI > 30 kg/m2 was associated with increased risk of lithiasis, kidney cancer, overactive bladder, male hypogonadism, benign prostatic hyperplasia, and erectile dysfunction (p <.05). On the contrary, BMI was inversely associated with ureteral, bladder and prostate cancer (p <.05). In all urological diseases, MS was the strongest risk factor, with prostate cancer (OR = 2.53) showing the weakest and male hypogonadism the strongest (OR = 13.00) associations. MS and its individual components were significant risk factors for common urological conditions. Hence holistic approaches with lifestyle modification might prevent common urological disease. Overall, metabolic syndrome is the strongest risk factor for all the analysed urological diseases. Abnormally high body mass index can be a risk or protective factor depending on the threshold and urological disease that are being evaluated. Metabolic syndrome and increased BMI should be considered important factors associated to the prevalence of common urological diseases. [ABSTRACT FROM AUTHOR]

The article "Comment on: 'Initial Postoperative Prostate Specific Antigen and PSA Velocity Are Important Indicators of Underlying Malignancy After Simple Prostatectomy' by Livingston et al." discusses the importance of prostate-specific antigen (PSA) velocity after simple prostatectomy (SP) in determining prostate cancer (PCa) risk. The authors raise concerns about the theoretical background and methodology used in the study, particularly regarding the relationship between prostate zones and size, as well as the inclusion of all PCa patients regardless of Gleason's Grade group. They recommend caution when interpreting the study's findings and highlight the need for further research in this area. [Extracted from the article]