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Item SC132 - Surgical quality of robotic vs laparoscopic radical nephroureterectomy for upper tract urothelial carcinoma: a multicenter retrospective analysis (ROBUUST collaborative group)(Elsevier, 2021) Veccia, A.; Carbonara, U.; Tellini, R.; Meherazin, R.; Eun, D.; Margulis, V.; Uzzo, R.; Porter, J.; Sundaram, C.; Abdollah, F.; Mottrie, A.; Minervini, A.; Mari, A.; Rha, K.; Cacciamani, G.; Simone, G.; Ferro, M.; Wu, Z.; Djaladat, H.; Derweesh, I.; Autorino, R.; Urology, School of MedicineAuthor of the Study: to evaluate the predictors of surgical quality (bladder cuff excision-lymph-node dissection-no complications-negative surgical margins) of robotic (RRNU) vs laparoscopic radical nephroureterectomy (LRNU) within a large multicenter study (ROBUUST collaborative group). Materials and Methods: the ROBUUST includes data of 17 centers worldwide regarding patients who underwent either RRNU or LRNU between 2015 and 2019. T≥2 any N, non-metastatic patients were assessed. An univariable and a multivariable logistic regression model including ASA≥3, multifocal tumor, pre-operative biopsy, history of bladder tumor, ureteroscopy, neoadjuvant chemotherapy, estimated blood loss, intraoperative complications and surgical approach to evaluate the predictors of surgical quality. Results: overall, 307 RRNU and 83 LRNU were included. In terms of baseline features, patients in the RRNU were more likely to have intrarenal cavities tumors (p < 0.001), lower hydronephrosis rate (p < 0.001), and lower cN+ (p = 0.02) compared to LRNU group. In terms of operative outcomes, patients in the RRNU had higher rate of bladder cuff excision (82.3% vs 57.8%; p < 0.001), lower rate of adjuvant bladder instillation (15% vs 33.7%; p < 0.001), higher major complications (18.6% vs 6.1%; p = 0.02), and shorter length of stay (p < 0.001).At multivariable analysis, LRNU showed to be not associated to surgical quality (OR: 0.22; p = 0.02) compared to RRNU. Conclusions: Within a large multi-institutional dataset worldwide, RRNU showed to present better surgical outcomes in terms of complications and length of stay compared to LRNU. In addition, laparoscopic approach seems to provide poorer surgical quality in terms of bladder cuff excision, lymphnode dissection, no complications and negative surgical margins.Item The impact of sestamibi scan on clinical decision-making for renal masses: An observational single-center study(Wolters Kluwer, 2024) Yong, Courtney; Tong, Yan; Tann, Mark; Sundaram, Chandru P.; Urology, School of MedicineIntroduction: We aimed to determine whether sestamibi scan changes management of renal masses. Methods: All patients undergoing sestamibi scan for renal masses between 2008 and 2022 at a single center were retrospectively reviewed. Data were gathered on patient demographics, pre- and postoperative creatinine, sestamibi scan parameters, and cross-sectional imaging characteristics. Outcomes included whether the patient underwent renal mass biopsy or surgical resection and the final pathological diagnosis if tissue was obtained from biopsy or resection. Data regarding postbiopsy as well as postoperative complications were also collected. The odds ratio (OR) for surgery or biopsy based on sestamibi result was calculated. Results: Forty-three patients underwent sestamibi scan from 2008 to 2022, with 10 scans consistent with oncocytoma and 33 with nononcocytoma. The mean tumor size at initial presentation was 4.0 ± 1.8 cm with a median RENAL score of 7 (range: 4-11). For patients with sestamibi scans negative for oncocytoma, the OR for surgery was 12.5 (95% confidence interval [CI]: 2.1-71.2, P = 0.005), and the OR for biopsy was 0.04 (95% CI: 0.005-0.39, P = 0.005). Conversely, for patients with sestamibi scans positive for oncocytoma, the OR for surgery was 0.28 (95% CI: 0.03-2.4, P = 0.24) and the OR for biopsy was 24.0 (95% CI: 2.6-222.7, P = 0.005). Creatinine at the last follow-up was similar between patients with positive and negative sestamibi scans. No patients experienced complications from surgery or biopsy. The median follow-up was 19 months (range: 2-163). Conclusions: A sestamibi scan positive for oncocytoma led to increased use of renal mass biopsy for confirmation. Sestamibi scans that were negative for oncocytoma were more likely to result in surgical resection without biopsy.Item Quality of Life and Health State Utilities in Bladder Cancer(IOS Press, 2022-03-11) Smith, Angela B.; McCabe, Sean; Deal, Allison M.; Guo, Amy; Gessner, Kathryn H.; Lipman, Robert; Chisolm, Stephanie; Ahlschlager, Lauren; Gore, John L.; Urology, School of MedicineBackground: Bladder cancer treatments may variably impact health-related quality of life (QOL). Objective: To characterize the quality of life of patients with bladder cancer at various time points across the continuum of bladder cancer care from non-muscle-invasive disease to metastatic bladder cancer and develop utility scores to inform cost-effective analyses. Methods: We performed a cross-sectional survey of bladder cancer patients in the Bladder Cancer Advocacy Network Patient Survey Network. Participants were classified into mutually exclusive health states based upon non-muscle invasive (NMIBC), muscle-invasive (MIBC), or metastatic bladder cancer and completed surveys of generic cancer and bladder cancer-specific quality of life, financial toxicity, and work impairment. We constructed generalized linear mixed models to identify patient, clinical, and treatment factors associated with quality of life over time and derived health state utilities. Results: Among 911 self-identified patients with bladder cancer, overall QOL scores and function domains were worse among those with advanced cancer. Financial toxicity was similar among non-metastatic disease states. Work and activity impairment increased with advancing disease (13%and 12%among non-recurrent NMIBC to 63%and 31%for metastatic disease respectively; p < 0.01). On multivariable analysis, bowel-related QOL was diminished among patients with MIBC, with urinary symptoms and physical function most diminished among patients with metastatic disease. Patients with metastatic and MIBC experienced worse emotional functioning (p = 0.04; p = 0.048). Health state utilities were calculated, highest among those with non-recurrent NMIBC and lowest among those with metastatic disease. Conclusion: Generic and bladder cancer-specific QOL diminishes with advancing disease. Health state utility estimates derived from this study can inform shared decision making with patients and may be used to inform future cost-effective analyses.Item The Uniform grading tooL for flexIble ureterorenoscoPes (TULIP-tool): a Delphi consensus project on standardised evaluation of flexible ureterorenoscopes(Wiley, 2023) Henderickx, Michaël M. E. L.; Hendriks, Nora; Baard, Joyce; Wiseman, Oliver J.; Scotland, Kymora B.; Somani, Bhaskar K.; Şener, Tarik E.; Emiliani, Esteban; Dragos, Laurian B.; Villa, Luca; Talso, Michele; Hamri, Saeed Bin; Proietti, Silvia; Doizi, Steeve; Traxer, Olivier; Chew, Ben H.; Eisner, Brian H.; Monga, Manoj; Hsi, Ryan S.; Stern, Karen L.; Leavitt, David A.; Rivera, Marcelino; Wollin, Daniel A.; Borofsky, Michael; Canvasser, Noah E.; Ingimarsson, Johann P.; El Tayeb, Marawan M.; Bhojani, Naeem; Gadzhiev, Nariman; Tailly, Thomas; Durutovic, Otas; Nagele, Udo; Skolarikos, Andreas; Schout, Barbara M. A.; Beerlage, Harrie P.; Pelger, Rob C. M.; Kamphuis, Guido M.; Urology, School of MedicineObjective: To develop a standardised tool to evaluate flexible ureterorenoscopes (fURS). Materials and methods: A three-stage consensus building approach based on the modified Delphi technique was performed under guidance of a steering group. First, scope- and user-related parameters used to evaluate fURS were identified through a systematic scoping review. Then, the main categories and subcategories were defined, and the expert panel was selected. Finally, a two-step modified Delphi consensus project was conducted to firstly obtain consensus on the relevance and exact definition of each (sub)category necessary to evaluate fURS, and secondly on the evaluation method (setting, used tools and unit of outcome) of those (sub)categories. Consensus was reached at a predefined threshold of 80% high agreement. Results: The panel consisted of 30 experts in the field of endourology. The first step of the modified Delphi consensus project consisted of two questionnaires with a response rate of 97% (n = 29) for both. Consensus was reached for the relevance and definition of six main categories and 12 subcategories. The second step consisted of three questionnaires (response rate of 90%, 97% and 100%, respectively). Consensus was reached on the method of measurement for all (sub)categories. Conclusion: This modified Delphi consensus project reached consensus on a standardised grading tool for the evaluation of fURS - The Uniform grading tooL for flexIble ureterorenoscoPes (TULIP) tool. This is a first step in creating uniformity in this field of research to facilitate future comparison of outcomes of the functionality and handling of fURS.Item A Simplified Diagnostic Approach on TFE3 Gene Fusion-Associated Renal Cell Carcinoma(Allen Press, 2020-11-04) Akgul, Mahmut; Cheng, Liang; Idrees, Muhammad; Urology, School of MedicineItem Differences in preoperative frailty assessment of surgical candidates by sex, age, and race(Elsevier, 2024-05-11) Nicaise, Edouard H.; Palmateer, Gregory; Schmeusser, Benjamin N.; Futral, Cameron; Liu, Yuan; Goyal, Subir; Nabavizadeh, Reza; Kooby, David A.; Maithel, Shishir K.; Sweeney, John F.; Sarmiento, Juan M.; Ogan, Kenneth; Master, Viraj A.; Urology, School of MedicineIntroduction: Surgical decision-making often relies on a surgeon's subjective assessment of a patient's frailty status to undergo surgery. Certain patient demographics can influence subjective judgment when compared to validated objective assessments. In this study, we explore the relationship between subjective and objective frailty assessments according to patient age, sex, and race. Methods: Patients were prospectively enrolled in urology, general surgery, and surgical oncology clinics. Using a visual analog scale (0-100), operating surgeons independently rated the patient's frailty status. Objective frailty was classified using the Fried Frailty Criteria ranging from 0 to 5. Multivariable proportional odds models were conducted to examine the potential association of factors with objective frailty, according to surgeon frailty rating. Subgroup analysis according to patient sex, race, and age was also performed. Results: Seven male surgeons assessed 203 patients preoperatively with a median age of 65. A majority of patients were male (61 %), white (67 %), and 60 % and 40 % underwent urologic and general surgery/surgical oncology procedures respectively. Increased subjective surgeon rating (OR 1.69; p < 0.001) was significantly associated with the presence of objective frailty. On subgroup analysis, a higher magnitude of such association was observed more in females (OR 1.86; p = 0.0007), non-white (OR 1.84; p = 0.0019), and older (>60, OR 1.75; p = 0.0001) patients, compared to male (OR 1.45; p = 0.0243), non-white (OR 1.48; p = 0.0109) and patients under 60 (OR 1.47; p = 0.0823). Conclusion: The surgeon's subjective assessment of frailty demonstrated tendencies to rate older, female, and non-white patients as frail; however, differences in patient sex, age, and race were not statistically significant.Item Checkpoint kinase 2 controls insulin secretion and glucose homeostasis(Springer Nature, 2024) Chong, Angie Chi Nok; Vandana, J. Jeya; Jeng, Ginnie; Li, Ge; Meng, Zihe; Duan, Xiaohua; Zhang, Tuo; Qiu, Yunping; Duran-Struuck, Raimon; Coker, Kimberly; Wang, Wei; Li, Yanjing; Min, Zaw; Zuo, Xi; de Silva, Neranjan; Chen, Zhengming; Naji, Ali; Hao, Mingming; Liu, Chengyang; Chen, Shuibing; Urology, School of MedicineAfter the discovery of insulin, a century ago, extensive work has been done to unravel the molecular network regulating insulin secretion. Here we performed a chemical screen and identified AZD7762, a compound that potentiates glucose-stimulated insulin secretion (GSIS) of a human β cell line, healthy and type 2 diabetic (T2D) human islets and primary cynomolgus macaque islets. In vivo studies in diabetic mouse models and cynomolgus macaques demonstrated that AZD7762 enhances GSIS and improves glucose tolerance. Furthermore, genetic manipulation confirmed that ablation of CHEK2 in human β cells results in increased insulin secretion. Consistently, high-fat-diet-fed Chk2-/- mice show elevated insulin secretion and improved glucose clearance. Finally, untargeted metabolic profiling demonstrated the key role of the CHEK2-PP2A-PLK1-G6PD-PPP pathway in insulin secretion. This study successfully identifies a previously unknown insulin secretion regulating pathway that is conserved across rodents, cynomolgus macaques and human β cells in both healthy and T2D conditions.Item A Cost Comparison of Holmium Laser Enucleation of the Prostate with and without Moses(American Urological Association, 2021) Lee, Matthew S.; Assmus, Mark; Agarwal, Deepak; Large, Tim; Krambeck, Amy; Urology, School of MedicineIntroduction: Holmium laser enucleation of the prostate (HoLEP) is a size-independent treatment option for the treatment of benign prostatic hyperplasia. HoLEP has been shown to have excellent improvements in prostate symptom scores and maximum flow rates that have been durable for 2 decades. However, the steep learning curve associated with HoLEP has prevented its widespread adoption. New advancements in lasers, specifically the Moses™ pulse-modulation technology, have resulted in improvements in hemostasis and achieving same-day discharges and catheter removals. We aimed to perform a cost-comparison to analyze if Moses-augmented HoLEP (m-HoLEP) resulted in cost-savings. Methods: A retrospective review was performed of a single expert surgeon's experience from May 2018 to November 2020, comparing m-HoLEP with HoLEP. Perioperative and postoperative variables were abstracted from the medical record. Univariate and multivariate analyses were performed using SAS® 9.4. Two-sided significance was set at p <0.05. Results: A total of 312 men underwent HoLEP during the study period (192 in m-HoLEP group and 120 in HoLEP group). The m-HoLEP group had more same-day discharges (p <0.001) and emergency department visits (6.3% vs 1.7%, p=0.0071). m-HoLEP resulted in hospital cost savings of $840 for the initial surgical episode (p=0.0297). When factoring in emergency department visits/readmissions, the cost savings decreased to $747 per case (p=0.0574). Conclusions: m-HoLEP was associated with same-day discharge and hospital cost savings of $840 for the initial surgical episode. Further study in other institutions with surgeons of varying experience levels will need to be performed to see if these findings can be replicated.Item Racial Differences in the Detection Rate of Bladder Cancer Using Blue Light Cystoscopy: Insights from a Multicenter Registry(MDPI, 2024-03-24) Ladi-Seyedian, Seyedeh-Sanam; Ghoreifi, Alireza; Konety, Badrinath; Pohar, Kamal; Holzbeierlein, Jeffrey M.; Taylor, John; Kates, Max; Willard, Brian; Taylor, Jennifer M.; Liao, Joseph C.; Kaimakliotis, Hristos Z.; Porten, Sima P.; Steinberg, Gary D.; Tyson, Mark D.; Lotan, Yair; Daneshmand, Siamak; Blue Light Cystoscopy with Cysview Registry Group; Urology, School of MedicineThe use of blue light cystoscopy (BLC) has been shown to improve bladder tumor detection. However, data demonstrating the efficacy of BLC across different races are limited. Herein, we aim to evaluate heterogeneity in the characteristics of BLC for the detection of malignant lesions among various races. Clinicopathologic information was collected from patients enrolled in the multi-institutional Cysview® registry (2014-2021) who underwent transurethral resection or biopsy of bladder tumors. Outcome variables included sensitivity and negative and positive predictive values of BLC and white light cystoscopy (WLC) for the detection of malignant lesions among various races. Overall, 2379 separate lesions/tumors were identified from 1292 patients, of whom 1095 (85%) were Caucasian, 96 (7%) were African American, 51 (4%) were Asian, and 50 (4%) were Hispanic. The sensitivity of BLC was higher than that of WLC in the total cohort, as well as in the Caucasian and Asian subgroups. The addition of BLC to WLC increased the detection rate by 10% for any malignant lesion in the total cohort, with the greatest increase in Asian patients (18%). Additionally, the positive predictive value of BLC was highest in Asian patients (94%), while Hispanic patients had the highest negative predictive value (86%). Our study showed that regardless of race, BLC increases the detection of bladder cancer when combined with WLC.Item Using mid infrared to perform investigations beyond the diffraction limits of microcristalline pathologies: advantages and limitation of Optical PhotoThermal IR spectroscopy(Academie des Sciences, 2022) Bazin, Dominique; Bouderlique, Elise; Tang, Ellie; Daudon, Michel; Haymann, Jean-Philippe; Frochot, Vincent; Letavernier, Emmanuel; Van de Perre, Els; Williams, James C.; Lingeman, James E.; Borondics, Ferenc; Urology, School of MedicineUnderstanding the physico-chemistry related to cristalline pathologies constitutes a challenge in several medical specialities such as nephrology, dermatology or oncology. Regarding nephrology, the chemical diversity of concretions such as kidney stones calls for characterization techniques to determine the chemical composition of concretions. The starting point of this contribution is given by Fourier Transform InfraRed (FTIR) spectroscopy which is routinely used at the hospital to determine the chemical composition of kidney stones as well as ectopic calcifications present in kidney biopsy. For kidney stones, the quantity of sample is sufficient to perform a significant analysis through classical FTIR. For ectopic calcifications, FTIR can be inefficient in the case of calcification in the tissue when their size is less than 10 m. For such samples, Optical PhotoThermal IR (OPT-IR) spectroscopy may constitute a way to overcome this experimental difficulty through the acquisition of IR spectrum with a spatial resolution close to 500 nm. To illustrate such opportunity, we first compare the IR spectrum acquired with a classical experimental set-up related to classical IR spectroscopy to IR spectrum collected with a OPT-IR one for different compounds namely calcium oxalate monohydrate, calcium oxalate dehydrate, calcium phosphate apatite and magnesium ammonium phosphate hexahydrate. Such comparison helps us to assess specificity of OPT-IR. Then, we consider several pathological calcifications associated to hyperoxaluria, adenine phosphoribosyltransferase (APRT) deficiency or the presence of Randall’s plaque. We will see that the nanometer spatial resolution constitutes a major advantage versus a micrometre one. Also, in the case of Randall’s plaque, we show that OPT-IR can determine the chemical composition of microscopic concretion without any kind of preparation. Such experimental fact is clearly a major advantage. Finally, we also extended this first investigation in nephrology by considering breast calcifications. In that case, if the number of chemical phases is quite low compared to the number of chemical phases identified in ectopic calcifications present in kidney (four instead of 24), the challenge is related to the possibility to distinguish between the different calcium phosphate namely amorphous carbonated calcium phosphate, CA and whitlockite. The complete set of data indicates the limitations and the advantages of OPT-IR spectroscopy.