Benjamin I. Chung

All Publications

• Association of Robotic-Assisted vs Laparoscopic Radical Nephrectomy With Perioperative Outcomes and Health Care Costs, 2003 to 2015. JAMA Jeong, I. G., Khandwala, Y. S., Kim, J. H., Han, D. H., Li, S. n., Wang, Y. n., Chang, S. L., Chung, B. I. 2017; 318 (16): 1561–68

  Abstract

  Use of robotic surgery has increased in urological practice over the last decade. However, the use, outcomes, and costs of robotic nephrectomy are unknown.To examine the trend in use of robotic-assisted operations for radical nephrectomy in the United States and to compare the perioperative outcomes and costs with laparoscopic radical nephrectomy.This retrospective cohort study used the Premier Healthcare database to evaluate outcomes of patients who had undergone robotic-assisted or laparoscopic radical nephrectomy for renal mass at 416 US hospitals between January 2003 and September 2015. Multivariable regression modeling was used to assess outcomes.Robotic-assisted vs laparoscopic radical nephrectomy.The primary outcome of the study was the trend in use of robotic-assisted radical nephrectomy. The secondary outcomes were perioperative complications, based on the Clavien classification system, and defined as any complication (Clavien grades 1-5) or major complications (Clavien grades 3-5, for which grade 5 results in death); resource use (operating time, blood transfusion, length of hospital stay); and direct hospital cost.Among 23 753 patients included in the study (mean age, 61.4 years; men, 13 792 [58.1%]), 18 573 underwent laparoscopic radical nephrectomy and 5180 underwent robotic-assisted radical nephrectomy. Use of robotic-assisted surgery increased from 1.5% (39 of 2676 radical nephrectomy procedures in 2003) to 27.0% (862 of 3194 radical nephrectomy procedures) in 2015 (P for trend <.001). In the weighted-adjusted analysis, there were no significant differences between robotic-assisted and laparoscopic radical nephrectomy in the incidence of any (Clavien grades 1-5) postoperative complications (adjusted rates, 22.2% vs 23.4%, difference, -1.2%; 95% CI, -5.4 to 3.0%) or major (Clavien grades 3-5) complications (adjusted rates, 3.5% vs 3.8%, difference, -0.3%; 95% CI, -1.0% to 0.5%). The rate of prolonged operating time (>4 hours) for patients undergoing the robotic-assisted procedure was higher than for patients receiving the laparoscopic procedure in the adjusted analysis (46.3% vs 25.8%; risk difference, 20.5%; 95% CI, 14.2% to 26.8%). Robotic-assisted radical nephrectomy was associated with higher mean 90-day direct hospital costs ($19 530 vs $16 851; difference, $2678; 95% CI, $838 to $4519), mainly accounted for operating room ($7217 vs $5378; difference, $1839; 95% CI, $1050 to $2628) and supply costs ($4876 vs $3891; difference, $985; 95% CI, $473 to $1498).Among patients undergoing radical nephrectomy for renal mass between 2003 and 2015, the use of robotic-assisted surgery increased substantially. The use of robotic-assistance was not associated with increased risk of any or major complications but was associated with prolonged operating time and higher hospital costs compared with laparoscopic surgery.

  View details for PubMedID 29067427

• Pesticides and prostate cancer incidence and mortality: An environment-wide association study. Cancer Soerensen, S. J., Lim, D. S., Montez-Rath, M. E., Chertow, G. M., Chung, B. I., Rehkopf, D. H., Leppert, J. T. 2024

  Abstract

  Prostate cancer is the most common cancer among men in the United States, yet modifiable risk factors remain elusive. In this study, the authors investigated the potential role of agricultural pesticide exposure in prostate cancer incidence and mortality.For this environment-wide association study (EWAS), linear regression was used to analyze county-level associations between the annual use of 295 distinct pesticides (measured in kg per county) and prostate cancer incidence and mortality rates in the contiguous United States. Data were analyzed in two cohorts: 1997-2001 pesticide use with 2011-2015 outcomes (discovery) and 2002-2006 use with 2016-2020 outcomes (replication). The reported effect sizes highlight how a 1-standard-deviation increase in log-transformed pesticide use (kg per county) corresponds to changes in incidence. Analyses were adjusted for county-level demographics, agricultural data, and multiple testing.Twenty-two pesticides showed consistent, direct associations with prostate cancer incidence across both cohorts. Of these, four pesticides were also associated with prostate cancer mortality. In the replication cohort, each 1-standard-deviation increase in log-transformed pesticide use corresponded to incidence increases per 100,000 individuals (trifluralin, 6.56 [95% confidence interval (CI), 5.04-8.07]; cloransulam-methyl, 6.18 [95% CI, 4.06-8.31]; diflufenzopyr, 3.20 [95% CI, 1.09-5.31]; and thiamethoxam, 2.82 [95% CI, 1.14-4.50]). Limitations included ecological study design, potential unmeasured confounding, and lack of individual-level exposure data.The results of this study suggest a potential link between certain pesticides and increased prostate cancer incidence and mortality. These findings warrant further investigation of these specific pesticides to confirm their role in prostate cancer risk and to develop potential public health interventions.

  View details for DOI 10.1002/cncr.35572

  View details for PubMedID 39492609

• Calcium Channel Blocker Versus Renin-Angiotensin System Inhibitor in Risk of Kidney Cancer Among Patients With Hypertension: A Propensity Score-Matched Cohort Study. Cancer medicine Jung, M., Li, S., Deng, Z., Li, J., Li, M., Basran, S., Langston, M. E., Chung, B. I. 2024; 13 (22): e70429

  Abstract

  Use of antihypertensive medications could be associated with an increased risk of kidney cancer. Despite their various mechanisms of action, whether this association differs between different classes of medications remains unclear.The objective of this study is to compare the risk of kidney cancer between first-line treatment options of antihypertensive medications in a hypertensive population.In this retrospective cohort study, we used the MarketScan Databases (2007-2021). We included individuals older than 30 years of age with a diagnosis of hypertension who received first-line medications for hypertension, which included three classes: angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and dihydropyridine calcium channel blockers (dCCB). We applied a propensity score matching method and created three separate cohorts: (1) ARB versus ACEI, (2) dCCB versus ACEI, and (3) dCCB versus ACEI. For non-dCCB, we repeated the analyses. The primary outcome was kidney cancer incidence. To assess kidney cancer risk, we applied multivariable conditional Cox proportional hazards models.In the first cohort, ARB use was associated with an increased risk of kidney cancer compared to ACEI use (hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.02-1.18). In the second cohort, dCCB use was associated with an increased risk of kidney cancer compared to ACEI use (HR 1.29, 95% CI 1.18-1.40). In the third cohort, dCCB use was associated with a higher risk of kidney cancer compared to ARB use (HR 1.17, 95% CI 1.08-1.28). Null association was shown when comparing non-dCCB with ACEI or ARB use.Use of dCCB showed a higher risk of kidney cancer compared to ACEI or ARB use in patients with hypertension.

  View details for DOI 10.1002/cam4.70429

  View details for PubMedID 39548764

  View details for PubMedCentralID PMC11568363

• VI-RADS followed by Photodynamic Transurethral Resection of Non-Muscle-Invasive Bladder Cancer vs White-Light Conventional and Second-resection: the 'CUT-less' Randomised Trial Protocol. BJU international Del Giudice, F., Vestri, A., Fegatelli, D. A., Hüsch, T., Belsey, J., Nair, R., Skinner, E. C., Chung, B. I., Pecoraro, M., Sciarra, A., Franco, G., Pradere, B., Gazzaniga, P., Magloicca, F. M., Panebianco, V., De Berardinis, E. 2024

  Abstract

  A second transurethral resection of bladder tumour (Re-TURBT) is recommended by European Association of Urology (EAU) Guidelines on non-muscle-invasive bladder cancers (NMIBCs) due to the risk of understaging and/or persistent disease following the primary resection. However, in many cases this may be unnecessary, potentially harmful, and significantly expensive constituting overtreatment. The CUT-less trial aims to combine the preoperative staging accuracy of Vesical Imaging-Reporting and Data System (VI-RADS) and the intraoperative enhanced ability of photodynamic diagnosis (PDD) to overcome the primary TURBT pitfalls thus potentially re-defining criteria for Re-TURBT indications.Single-centre, non-inferiority, phase IV, open-label, randomised controlled trial with 1:1 ratio.The primary endpoint is short-term BC recurrence between the study arms to assess whether patients preoperatively categorised as VI-RADS Score 1 and/or Score 2 (i.e., very-low and low likelihood of MIBC) could safely avoid Re-TURBT by undergoing primary PDD-TURBT. Secondary endpoints include mid- and long-term BC recurrences and progression (i-ii). Also, health-related quality of life (HRQoL) outcomes (iii) and health-economic cost-benefit analysis (iv) will be performed.All patients will undergo preoperative Multiparametric Magnetic Resonance Imaging of the bladder with VI-RADS score determination. A total of 327 patients with intermediate-/high-risk NMIBCs, candidate for Re-TURBT according to EAU Guidelines, will be enrolled over a 3-year period. Participants will be randomised (1:1 ratio) to either standard of care (SoC), comprising primary white-light (WL) TURBT followed by second WL Re-TURBT; or the Experimental arm, comprising primary PDD-TURBT and omitting Re-TURBT. Both groups will receive adjuvant intravesical therapy and surveillance according to risk-adjusted schedules. Measure of the primary outcome will be the relative proportion of BC recurrences between the SoC and Experimental arms within 4.5 months (i.e., any 'early' recurrence detected at first follow-up cystoscopy). Secondary outcomes measures will be the relative proportion of late BC recurrences and/or BC progression detected after 4.5 months follow-up. Additionally, we will compute the HRQoL variation from NMIBC questionnaires modelled over a patient lifetime horizon and the health-economic analyses including a short-term cost-benefit assessment of incremental costs per Re-TURBT avoided and a longer-term cost-utility per quality-adjusted life year gained using 2-year clinical outcomes to drive a lifetime model across the two arms of treatment.ClinicalTrial.gov identifier (ID): NCT05962541; European Union Drug Regulating Authorities Clinical Trials Database (EudraCT) ID: 2023-507307-64-00.

  View details for DOI 10.1111/bju.16531

  View details for PubMedID 39397266

• Primary pyeloplasty for uretero-pelvic obstruction in the USA adult population with or without double-J indwelling ureteral stents. Insurance claims data on contemporary time to removal trends, perioperative complications, health care costs, and re-intervention rates. Minerva urology and nephrology Del Giudice, F., Hyun Han, D., Tresh, A., Li, S., Basran, S., Asero, V., Scornajenghi, C. M., Carino, D., Corvino, R., Ferro, M., Crocetto, F., Pradere, B., Gallioli, A., Krajewski, W., Nowak, Ł., Szydełko, T., Rocco, B., Sighinolfi, M. C., DE Berardinis, E., Kam, J., Nair, R., Chung, B. I. 2024; 76 (5): 606-617

  Abstract

  Using a large population-based dataset, we primarily sought to compare postoperative complications, health-care expenditures, and re-intervention rates between patients diagnosed with ureteropelvic junction obstruction (UPJO) undergoing stented vs. non-stented pyeloplasty. The secondary objective was to investigate factors that influence the timing of DJ stent removal.Patients ≥18 years old with UPJO treated with primary open or minimally-invasive pyeloplasty were identified using the Merative™ Marketscan® Databases between 2007-2021. Multivariable modeling was implemented to investigate the association between Double-J (DJ) stent placement and post-pyeloplasty complications, hospital costs, and re-intervention rates and the role of the perioperative predictors on time to DJ stent removal. Subgroup analyses stratified by ureteral stenting duration were additionally performed.Out of 4872 patients who underwent primary pyeloplasty, 4154 (85.3%) had DJ placement. Postoperative complications were rare (N.=218, 4.47%) and not associated with ureteral stenting (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.55-1.12). The median cost for in-hospital charges was $21,775, with DJ stent placement independently increasing the median aggregate amount (OR: 1.29, 95% CI: 1.09-1.53). Overall, re-interventions were performed in 21.18% of patients, with DJ stenting found to be protective (OR: 0.79, 95% CI: 0.66-0.96). Higher Charlson Comorbidity Index, longer hospital stay, and open surgical approach were independent predictors for prolonged DJ stenting time to removal.Our study suggests that patients undergoing stent-less pyeloplasty did have a higher rate of secondary procedures, but not higher complications when compared to those undergoing stented procedures. Concurrently, the non-stented approach is associated with decreased health-care expenditures, despite the increased rates of secondary procedures.

  View details for DOI 10.23736/S2724-6051.24.05834-8

  View details for PubMedID 39320251

• Corrigendum to "The Impact of Venous Thromboembolism on Upper Tract Urothelial Carcinomas Undergoing Open or Minimally Invasive Radical Nephroureterectomy in the USA: Perioperative Outcomes and Health Care Costs from Insurance Claims Data". European urology focus Tresh, A. S., Del Giudice, F., Li, S., Basran, S., Belladelli, F., De Berardinis, E., Asero, V., Ferro, M., Tataru, S., Maria Busetto, G., Falagario, U., Autorino, R., Crocetto, F., Barone, B., Pradere, B., Moschini, M., Mari, A., Krajewski, W., Nowak, Ł., Małkiewicz, B., Szydełko, T., Crivellaro, S., Rane, A., Challacombe, B., Nair, R., Chung, B. I. 2024

  View details for DOI 10.1016/j.euf.2024.09.003

  View details for PubMedID 39317526

• Hematospermia does not increase the risk of prostate cancer detection in prostate biopsy PROSTATE INTERNATIONAL Park, J., Paick, S., Choi, W., Kim, A., Kim, H., Chung, B. I., Park, H. 2024; 12 (3): 151-154

  View details for DOI 10.1016/j.prnil.2024.06.004

  View details for Web of Science ID 001334251200001

• Assessing sociodemographic and regional disparities in Oncotype DX Genomic Prostate Score uptake CANCER Mukand, N. H., Chirikova, E., Lichtensztajn, D., Negoita, S., Aboushwareb, T., Bennett, J., Brooks, J. D., Leppert, J. T., Chung, B. I., Li, C., Schwartz, S. M., Gershman, S. T., Insaf, T., Morawski, B. M., Stroup, A., Wu, X., Doherty, J. A., Petkov, V. I., Zambon, J., Gomez, S., Cheng, I. 2024

  Abstract

  The Oncotype DX Genomic Prostate Score (ODX-GPS) is a gene expression assay that predicts disease aggressiveness. The objective of this study was to identify sociodemographic and regional factors associated with ODX-GPS uptake.Data from Surveillance Epidemiology and End Results registries on men with localized prostate cancer with a Gleason score of 3 + 3 or 3 + 4, PSA ≤20 ng/mL, and stage T1c to T2c disease from 2013 through 2017 were linked with ODX-GPS data. Census-tract level neighborhood socioeconomic status (nSES) quintiles were constructed using a composite socioeconomic score. Multivariable logistic regression was used to estimate the associations of ODX-GPS uptake with age at diagnosis, race and ethnicity, nSES, geographic region, insurance type, and marital status, accounting for National Comprehensive Cancer Network risk group, year of diagnosis, and clustering by census tract.Among 111,434 eligible men, 5.5% had ODX-GPS test uptake. Of these, 78.3% were non-Hispanic White, 9.6% were Black, 6.7% were Hispanic, and 3.6% were Asian American. Black men had the lowest odds of ODX-GPS uptake (odds ratio, 0.70; 95% confidence interval [CI], 0.63-0.76). Those in the highest versus lowest quintile of nSES were 1.64 times more likely (95% CI, 1.38-2.94) to have ODX-GPS uptake. The odds of ODX-GPS uptake were statistically significantly higher among men residing in the Northeast, West, and Midwest compared to the South.Disparities in ODX-GPS uptake by race, ethnicity, nSES, and geographical region were identified. Concerted efforts should be made to ensure that this clinical test is equitably available.

  View details for DOI 10.1002/cncr.35511

  View details for Web of Science ID 001293040800001

  View details for PubMedID 39158464

• Polygenic score for body mass index in relation to mortality among patients with renal cell cancer. International journal of obesity (2005) Deng, Z., Graff, R. E., Batai, K., Chung, B. I., Langston, M. E., Kachuri, L. 2024

  Abstract

  The association between body mass index (BMI) and mortality among individuals with renal cell cancer (RCC) is debated, with some observational studies suggesting a lower mortality associated with higher BMI. However, methodological issues such as confounding and reverse causation may bias these findings. Using BMI-associated genetic variants can avoid these biases and generate more valid estimates.In this prospective cohort study, we included 1264 RCC patients (446 deaths) from the UK Biobank. We created a BMI polygenic score (PGS) based on 336 BMI-associated genetic variants. The association between the PGS and mortality (all-cause and RCC-specific) was evaluated by logistic regression (all RCC cases) and Cox regression (906 incident cases). For comparison, the associations of measured pre-diagnostic BMI and waist-to-hip ratio (WHR) with mortality were quantified by Cox regression among incident cases. We stratified these analyses by time between anthropometric measurement and RCC diagnosis to assess the influence of reverse causation.We did not observe an association between the BMI PGS and all-cause mortality among RCC patients (hazard ratio (HR) per SD increase = 0.98, 95% CI: 0.88,1.10). No association was found for pre-diagnostic BMI (HR per 5 kg/m2 increase = 0.93, 95% CI: 0.83,1.04) or WHR (HR per 0.1 increase = 0.97, 95% CI: 0.83,1.13) with mortality. In patients with anthropometrics measured within 2 years before RCC diagnosis, we observed associations of higher BMI (HR per 5 kg/m2 = 0.76, 95% CI: 0.59,0.98) and WHR (HR = 0.67 per 0.1 increase, 95% CI: 0.45,0.98) with a lower risk of death. Similar patterns were observed for RCC-specific mortality.We found no association between either genetic variants for high BMI or measured pre-diagnostic body adiposity and mortality among RCC patients, and our results suggested a role for reverse causation in the association of obesity with lower mortality. Future studies should be designed carefully to produce unbiased estimates that account for confounding and reverse causation.

  View details for DOI 10.1038/s41366-024-01609-0

  View details for PubMedID 39152336

  View details for PubMedCentralID 6221676

• Partial nephrectomy in elderly patients: a systematic review and analysis of comparative outcomes. European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology Lasorsa, F., Bignante, G., Orsini, A., Bologna, E., Licari, L. C., Bertolo, R., Del Giudice, F., Chung, B. I., Pandolfo, S. D., Marchioni, M., Fiori, C., Ditonno, P., Lucarelli, G., Autorino, R. 2024; 50 (10): 108578

  Abstract

  The management of renal masses in the elderly population is particularly challenging, as these patients are often more frail and potentially more susceptible to surgical morbidity. This review aims to provide a comprehensive analysis of the outcomes of partial nephrectomy (PN) for treating renal masses in elderly individuals.A systematic electronic literature search was conducted in May 2024 using the Medline (via PubMed) database by searching publications up to April 2024. The population, intervention, comparator, and outcome (PICO) model defined study eligibility. Studies were deemed eligible if assessing elderly patients (aged 70 years or older) (P) undergoing PN (I) with or without comparison between a different population (non-elderly) or a different treatment option (radical nephrectomy, ablation or active surveillance) (C) evaluating surgical, functional, and oncological outcomes (O).A total of 23 retrospective studies investigating the role of PN in elderly patients were finally included. PN emerged as a safe procedure also for older patients, demonstrating good outcomes. Preoperative evaluation of frailty status emerged to be paramount. Age alone was discredited as the sole reason to reject the use of PN. The main limitation is the retrospective nature of included studies and the lack of the assessment of elderly patients' frailty.The surgical treatment of renal masses in older patients is a challenging scenario. PN should be chosen over RN whenever possible since it can better preserve renal function. The use of minimally invasive techniques should be favored in this extremely fragile group of patients.

  View details for DOI 10.1016/j.ejso.2024.108578

  View details for PubMedID 39121634

• Increased risk of cardiovascular disease among kidney cancer survivors: a nationwide population-based cohort study. Frontiers in oncology Jung, M., Choo, E., Li, S., Deng, Z., Li, J., Li, M., Basran, S., Lee, S., Langston, M. E., Chung, B. I. 2024; 14: 1420333

  Abstract

  Cardiovascular disease (CVD) is a major concern of morbidity and mortality among cancer survivors. However, few evidence exists on the short- and long-term risk of CVD in kidney cancer (KCa) survivors.In this nationwide, large population-based retrospective cohort study, we used the Korean national health insurance and medical checkup survey linkage database (2007-2021), drawn from the entire Korean population. We included adults diagnosed with KCa as the first primary cancer and matched them to an individual without KCa at a 1:5 ratio. The primary outcome was CVD incidence, including myocardial infarction, stroke, atrial fibrillation, heart failure, peripheral arterial occlusion, and venous thromboembolism (VTE). We evaluated CVD risk at 6 months, 1 year, and 5 years following cancer diagnosis, using Fine-Gray competing risk models that accounted for death as a competing factor.A total of 149,232 participants were included (KCa survivors: N=20,093 and matched non-KCa individuals: N=129,139). After 6-month follow-up, KCa survivors showed an increased risk of CVD compared to the general population (subdistribution hazard ratio (HR) 2.70, 95% confidence interval (CI) 2.31-3.15). After 1 year, KCa survivors had a higher risk of CVD (HR=1.77, 95% CI: 1.56-2.00). After 5 years, this elevated CVD risk remained (HR=1.10, 95% CI: 1.03-1.18), with VTE identified as the primary contributing disease (HR=3.05, 95% CI:2.59-3.59).KCa survivors had an increased risk of CVD up to 5 years after cancer diagnosis compared to the general population. Our findings emphasize the importance of comprehensive healthcare management for both CVD and KCa throughout cancer survivorship.

  View details for DOI 10.3389/fonc.2024.1420333

  View details for PubMedID 39070148

  View details for PubMedCentralID PMC11272517

• Ambient air pollution and urological cancer risk: A systematic review and meta-analysis of epidemiological evidence. Nature communications Li, J., Deng, Z., Soerensen, S. J., Kachuri, L., Cardenas, A., Graff, R. E., Leppert, J. T., Langston, M. E., Chung, B. I. 2024; 15 (1): 5116

  Abstract

  Exposure to ambient air pollution has significant adverse health effects; however, whether air pollution is associated with urological cancer is largely unknown. We conduct a systematic review and meta-analysis with epidemiological studies, showing that a 5 μg/m3 increase in PM2.5 exposure is associated with a 6%, 7%, and 9%, increased risk of overall urological, bladder, and kidney cancer, respectively; and a 10 μg/m3 increase in NO2 is linked to a 3%, 4%, and 4% higher risk of overall urological, bladder, and prostate cancer, respectively. Were these associations to reflect causal relationships, lowering PM2.5 levels to 5.8 μg/m3 could reduce the age-standardized rate of urological cancer by 1.5 ~ 27/100,000 across the 15 countries with the highest PM2.5 level from the top 30 countries with the highest urological cancer burden. Implementing global health policies that can improve air quality could potentially reduce the risk of urologic cancer and alleviate its burden.

  View details for DOI 10.1038/s41467-024-48857-2

  View details for PubMedID 38879581

  View details for PubMedCentralID PMC11180144

• The impact of venous thromboembolism before open or minimally-invasive radical cystectomy in the USA: insurance claims data on perioperative outcomes and healthcare costs. Minerva urology and nephrology Del Giudice, F., Tresh, A., Li, S., Basran, S., Prendiville, S. G., Belladelli, F., DE Berardinis, E., Asero, V., Scornajenghi, C. M., Carino, D., Ferro, M., Rocco, B., Busetto, G. M., Falagario, U., Autorino, R., Crocetto, F., Barone, B., Pradere, B., Krajewski, W., Nowak, L., Szydelko, T., Moschini, M., Mari, A., Crivellaro, S., Porpiglia, F., Fiori, C., Amparore, D., Pichler, R., Rane, A., Challacombe, B., Nair, R., Chung, B. I. 2024; 76 (3): 320-330

  Abstract

  BACKGROUND: The relationship between venous thromboembolism (VTE) and solid malignancy has been established over the decades. With rising projected rates of bladder cancer (BCa) worldwide as well as increasing number of patients experiencing BCa and VTE, our aim is to assess the impact of a preoperative VTE diagnosis on perioperative outcomes and health-care costs in BCa cases undergoing radical cystectomy (RC).METHODS: Patients ≥18 years of age with BCa diagnosis and undergoing open or minimally invasive (MIS) RC were identified in the Merative Marketscan Research Databases between 2007 and 2021. The association of previous VTE history with 90-day complication rates, postoperative VTE events, rehospitalization, and total hospital costs (2021 USA dollars) was determined by multivariable logistic regression modeling adjusted for patient and perioperative confounders. Sensitivity analysis on VTE degree of severity (i.e., pulmonary embolism [PE] and/or peripheral deep venous thrombosis [DVT]) was also examined.RESULTS: Out of 8759 RC procedures, 743 (8.48%) had a previous positive history for any VTE including 245 (32.97%) PE, 339 (45.63%) DVT and 159 (21.40%) superficial VTE. Overall, history of VTE before RC was strongly associated with almost any worse postoperative outcomes including higher risk for any and apparatus-specific 90-days postoperative complications (odds ratio [OR]: 1.21, 95% CI, 1.02-1.44). Subsequent incidence of new VTE events (OR: 7.02, 95% CI: 5.93-8.31), rehospitalization (OR: 1.25, 95% CI: 1.06-1.48), other than home/self-care discharge status (OR: 1.53, 95% CI: 1.28-1.82), and higher health-care costs related to the RC procedure (OR: 1.43, 95% CI: 1.22-1.68) were significantly associated with a history of VTE.CONCLUSIONS: Preoperative VTE in patients undergoing RC significantly increases morbidity, post-procedure VTE events, hospital length of stay, rehospitalizations, and increased hospital costs. These findings may help during the BCa counseling on risks of surgery and hopefully improve our ability to mitigate such risks.

  View details for DOI 10.23736/S2724-6051.24.05699-4

  View details for PubMedID 38920012

• PESTICIDES AND PROSTATE CANCER INCIDENCE AND MORTALITY: AN ENVIRONMENTAL WIDE ASSOCIATION STUDY Soerensen, S., Lim, D. S., Montez-Rath, M. E., Chertow, G. M., Chung, B. I., Rehkopf, D. H., Leppert, J. T. LIPPINCOTT WILLIAMS & WILKINS. 2024: E620

  View details for Web of Science ID 001263885302097

• MUNICIPAL DRINKING WATER CONSTITUENTS AND BLADDER CANCER INCIDENCE: A WATER-WIDE ASSOCIATION STUDY (WWAS) Soerensen, S., Jackson, C., Rehkopf, D. H., Skinner, E. C., Prado, K. B., Chung, B. I., Leppert, J. T. LIPPINCOTT WILLIAMS & WILKINS. 2024: E584

  View details for Web of Science ID 001263885302029

• PHYSICIAN DENSITY AND PROSTATE CANCER MORTALITY IN THE US FROM 2011-2020 Soerensen, S., Montez-Rath, M. E., Chung, B. I., Rehkopf, D. H., Leppert, J. T. LIPPINCOTT WILLIAMS & WILKINS. 2024: E1110-E1111

  View details for Web of Science ID 001263885303468

• Air pollution mixture associated with oxidative stress exacerbation and symptoms deterioration in allergic rhinitis patients: Evidence from a panel study. The Science of the total environment Li, J., Wu, H., Xing, W., Li, X., Han, Z., Ji, R., Deng, Z., Jung, M., Sun, S., Chung, B. I., Cardenas, A., Langston, M. E. 2024: 172688

  Abstract

  With allergic rhinitis (AR) on the rise globally, there has been a growing focus on the role of environmental pollutants in the onset of AR. However, the potential mechanisms by how and which these pollutants exacerbate AR conditions remain unknown. This panel study of 49 patients diagnosed with AR over one year aimed to assess the individual and combined effects of short-term exposure to multiple ambient pollutants on oxidative stress, symptoms, and quality of life among patients with AR. All participants underwent four repeated assessments of health conditions and personal environmental exposures (PM2.5, O3, SO2, and NO2) over warm and cold seasons during 2017-2018. We evaluated two oxidative stress biomarkers (malondialdehyde [MDA], and superoxide dismutase [SOD]) via nasal lavage. We collected information on self-reported symptoms and quality of life using the Rhinitis Symptom Scale (SRS), the Visual Analog Scale (VAS), and the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) through in-person interviews. Bayesian kernel machine regression (BKMR) was used to evaluate the joint effects of pollutant mixture and identify key contributors. The results revealed a significant association of the pollutant mixture when all four pollutants were at or above their median levels, with increased oxidative stress. This was evidenced by elevated MDA and reduced SOD. We found a joint detrimental effect of the pollutant mixture on AR symptoms with a strong association with increased SRS scores, but a non-significant positive association with VAS and RQLQ scores. PM2.5, O3, and SO2 presented as the potentially primary contributors to the adverse health effects associated with the pollutant mixture in Taiyuan city. Patients with AR exposed to short-term air pollutant mixture are more likely to have greater nasal symptoms and worse quality of life from increased oxidative stress and reduced antioxidant capacity. Further research is warranted to better elucidate the underlying mechanisms.

  View details for DOI 10.1016/j.scitotenv.2024.172688

  View details for PubMedID 38663627

• Clinical and Oncological Outcomes Following Percutaneous Cryoablation vs. Partial Nephrectomy for Clinical T1 Renal Tumours: Systematic Review and Meta-Analysis. Cancers Nowak, Ł., Janczak, D., Łaszkiewicz, J., Guziński, M., Del Giudice, F., Tresh, A., Chung, B. I., Chorbińska, J., Tomczak, W., Małkiewicz, B., Szydełko, T., Krajewski, W. 2024; 16 (6)

  Abstract

  Percutaneous cryoablation (PCA) can be an alternative to partial nephrectomy (PN) in selected patients with stage T1 renal tumours. Existing meta-analyses regarding ablative techniques compared both laparoscopic and PCA with PN. That is why we decided to perform a meta-analysis that focused solely on PCA. The aim of this study was to compare the complications and functional and oncological outcomes between PCA and PN. A systematic literature search was performed in January 2024. Data for dichotomous and continuous variables were expressed as pooled odds ratios (ORs) and mean differences (MDs), both with 95% confidence intervals (CIs). Effect measures for the local recurrence-free survival (LRFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS) were expressed as pooled hazard ratios with 95% CIs. Among 6487 patients included in the 14 selected papers, 1554 (23.9%) and 4924 (76.1%) underwent PCA and PN, respectively. Compared with the PN group, patients undergoing PCA had significantly lower overall and major postoperative complication rates. There was no difference in renal function between PCA and PN groups. When analysing collective data for cT1 renal carcinoma, PCA was associated with worse LRFS compared with PN. However, subgroup analysis revealed that in the case of PCA, LRFS was not decreased in patients with cT1a tumours. Moreover, patients undergoing robotic-assisted PN had improved LRFS compared with those undergoing PCA. No significant differences were observed between PCA and PN in terms of MFS and CSS. Finally, PCA was associated with worse OS than PN in both collective and subgroup analyses. In conclusion, PCA is associated with favourable postoperative complication rates relative to PN. Regarding LRFS, PCA is not worse than PN in cT1a tumours but has a substantially relevant disadvantage in cT1b tumours. Also, RAPN might be the only surgical modality that provides better LRFS than PCA. In cT1 tumours, PCA shows MFS and CSS comparable to PN. Lastly, PCA is associated with a shorter OS than PN.

  View details for DOI 10.3390/cancers16061175

  View details for PubMedID 38539509

• The Impact of Venous Thromboembolism on Upper Tract Urothelial Carcinomas Undergoing Open or Minimally Invasive Radical Nephroureterectomy in the USA: Perioperative Outcomes and Health Care Costs from Insurance Claims Data. European urology focus Tresh, A. S., Del Giudice, F., Li, S., Basran, S., Belladelli, F., De Berardinis, E., Asero, V., Ferro, M., Tataru, S., Maria Busetto, G., Falagario, U., Autorino, R., Crocetto, F., Barone, B., Pradere, B., Moschini, M., Mari, A., Krajewski, W., Nowak, Ł., Małkiewicz, B., Szydełko, T., Crivellaro, S., Rane, A., Challacombe, B., Nair, R., Chung, B. I. 2024

  Abstract

  Venous thromboembolism (VTE) is a significant predictor of worse postoperative morbidity in cancer surgeries. No data have been available for patients with preoperative VTE and upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). Our aim was to assess the impact of a preoperative VTE diagnosis on perioperative outcomes in the RNU context.Patients aged 18 yr or older with a UTUC diagnosis undergoing RNU were identified in the Merative Marketscan Research deidentified databases between 2007 and 2021. Multivariable logistic regression adjusted by relevant perioperative confounders was used to investigate the association between a diagnosis of VTE prior to RNU and 90-d complication rates, postoperative VTE, rehospitalization, and total costs. A sensitivity analysis on VTE severity (pulmonary embolism [PE] and/or deep venous thrombosis [DVT]) was examined.Within the investigated cohort of 6922 patients, history of any VTE preceding RNU was reported in 568 (8.21%) cases, including DVT (n = 290, 51.06%), PE (n = 169, 29.75%), and superficial VTE (n = 109, 19.19%). The history of VTE before RNU was predictive of higher rates of complications, the most prevalent being respiratory complications (odds ratio [OR]: 1.78, 95% confidence interval [CI]: 1.43-2.22). Preoperative VTE was found to be associated with an increased risk of VTE following RNU (OR: 14.3, 95% CI: 11.48-17.82), higher rehospitalization rates (OR: 1.26, 95% CI 1.01-1.56) other than home discharge status (OR: 1.44, 95% CI: 1.18-1.77), and higher costs (OR 1.42, 95% CI: 1.20-1.68). Limitations include the retrospective nature and the use of an insurance database that relies on accurate coding and does not include information such as pathologic staging.The presented findings will contribute to the counseling process for patients. These patients may benefit from enhanced pre/postoperative anticoagulation. More research is needed before the following results can be used in the clinical setting.Patients aged 18 yr or older with an upper tract urothelial carcinoma (UTUC) diagnosis undergoing radical nephroureterectomy (RNU) were identified in the Merative Marketscan Research deidentified databases between 2007 and 2021. Multivariable logistic regression adjusted by relevant perioperative confounders was used to investigate the association between a diagnosis of venous thromboembolism (VTE) prior to RNU and 90-d complication rates, postoperative VTE, rehospitalization, and total costs. A sensitivity analysis on VTE severity (pulmonary embolism and/or deep venous thrombosis) was examined. The presented findings will contribute to the counseling of patients with UTUC and preoperative VTE.

  View details for DOI 10.1016/j.euf.2024.02.004

  View details for PubMedID 38433067

• Systematic review and meta-analysis of serum total testosterone and luteinizing hormone variations across hospitalized Covid-19 patients. Scientific reports Salciccia, S., Moriconi, M., Asero, V., Canale, V., Eisenberg, M. L., Glover, F., Belladelli, F., Seranio, N., Basran, S., De Berardinis, E., Di Pierro, G., Ricciuti, G. P., Chung, B. I., Sciarra, A., Del Giudice, F. 2024; 14 (1): 2786

  Abstract

  A growing body of evidence suggests the role of male hypogonadism as a possible harbinger for poor clinical outcomes across hospitalized Covid-19 patients. Accordingly, we sought to investigate the impact of dysregulated hypothalamic-pituitary-gonadal axis on the severity of the clinical manifestations for hospitalized Covid-19 patients matched with healthy controls through a systematic review and meta-analysis. Databases were searched from inception to March 2022. A standardized mean difference (SMD) meta-analysis focused on hospitalized Covid-19 patients and healthy controls was developed for studies who reported total testosterone (TT) and luteinizing hormone (LH) levels at hospital admission. Overall, n=18 series with n=1575 patients between 2020 and 2022 were reviewed. A significant decrease in SMD of TT levels in Covid-19 patients compared to paired controls was observed (-3.25nmol/L, 95%CI -0.57 and -5.93). This reduction was even more consistent when matching severe Covid-19 patients with controls (-5.04nmol/L, 95%CI -1.26 and -8.82) but similar for Covid-19 survivors and non-survivors (-3.04nmol/L, 95%CI -2.04 and -4.05). No significant variation was observed for serum LH levels across studies. Patient related comorbidities, year of the pandemic, and total lymphocyte count were associated with the observed estimates. TT levels may be a useful serum marker of poor outcomes among Covid-19 patients. These findings may support the development of ad-hoc clinical trials in the Covid-19 risk-group classification and subsequent disease monitoring. The interplay between TT and immune response should be evaluated in future researches.

  View details for DOI 10.1038/s41598-024-53392-7

  View details for PubMedID 38307934

• Exposure to particulate matter may affect semen quality via trace metals: Evidence from a retrospective cohort study on fertile males. Chemosphere Cheng, Y., Zhu, J., Tang, Q., Wang, J., Feng, J., Zhou, Y., Li, J., Pan, F., Han, X., Lu, C., Wang, X., Langston, M. E., Chung, B. I., Wu, W., Xia, Y. 2024; 346: 140582

  Abstract

  Particulate matter (PM) exposure may be associated with male semen quality. Besides, PM exposure induces up and down levels of trace metals in tissues or organs. The levels of trace metals in semen are critical for adverse male semen quality. This study aims to evaluate the concentrations of seminal-level trace metals in fertile men and assess its associations with PM exposure and to explore the mediation role of trace metals in seminal plasma plays in the relationship between PM exposure and semen quality. Total 1225 fertile men who participated in a cohort study from 2014 to 2016 were finally recruited. Multivariate linear regression was applied to explore associations between each two of PM exposure, trace metals and semen parameters. 1-year PM2.5 and PM10 exposure levels were positively associated with arsenic (As), mercury (Hg), lanthanum (La), praseodymium (Pr), neodymium (Nd) but negatively associated with vanadium (V), magnesium (Mg), strontium (Sr), barium (Ba) in semen. It was also found that most of the elements were associated with total sperm number, followed by sperm concentration. Redundancy analysis (RDA) also determined several strong positive correlations or negative correlations between 1-year PM exposure and trace metals. Mediation analysis found that trace metals had a potentially compensatory or synergetic indirect effect on the total effect of the association between 1-year PM exposure and semen quality. The retrospective cohort study provides long-term PM exposure that may cause abnormal semen quality by affecting seminal plasma element levels.

  View details for DOI 10.1016/j.chemosphere.2023.140582

  View details for PubMedID 38303402

• Patient and physician perspectives on treatments for low-risk prostate cancer: a qualitative study. BMC cancer Guan, A., Santiago-Rodriguez, E. J., Chung, B. I., Shim, J. K., Allen, L., Kuo, M., Lau, K., Loya, Z., Brooks, J. D., Cheng, I., DeRouen, M. C., Frosch, D. L., Golden, T., Leppert, J. T., Lichtensztajn, D. Y., Lu, Q., Oh, D., Sieh, W., Wadhwa, M., Cooperberg, M. R., Carroll, P. R., Gomez, S. L., Shariff-Marco, S. 2023; 23 (1): 1191

  Abstract

  BACKGROUND: Patients diagnosed with low-risk prostate cancer (PCa) are confronted with a difficult decision regarding whether to undergo definitive treatment or to pursue an active surveillance protocol. This is potentially further complicated by the possibility that patients and physicians may place different value on factors that influence this decision. We conducted a qualitative investigation to better understand patient and physician perceptions of factors influencing treatment decisions for low-risk PCa.METHODS: Semi-structured interviews were conducted among 43 racially and ethnically diverse patients diagnosed with low-risk PCa, who were identified through a population-based cancer registry, and 15 physicians who were selected to represent a variety of practice settings in the Greater San Francisco Bay Area.RESULTS: Patients and physicians both described several key individual (e.g., clinical) and interpersonal (e.g., healthcare communications) factors as important for treatment decision-making. Overall, physicians' perceptions largely mirrored patients' perceptions. First, we observed differences in treatment preferences by age and stage of life. At older ages, there was a preference for less invasive options. However, at younger ages, we found varying opinions among both patients and physicians. Second, patients and physicians both described concerns about side effects including physical functioning and non-physical considerations. Third, we observed differences in expectations and the level of difficulty for clinical conversations based on information needs and resources between patients and physicians. Finally, we discovered that patients and physicians perceived patients' prior knowledge and the support of family/friends as facilitators of clinical conversations.CONCLUSIONS: Our study suggests that the gap between patient and physician perceptions on the influence of clinical and communication factors on treatment decision-making is not large. The consensus we observed points to the importance of developing relevant clinical communication roadmaps as well as high quality and accessible patient education materials.

  View details for DOI 10.1186/s12885-023-11679-4

  View details for PubMedID 38053037

• The association of marital status with kidney cancer surgery morbidity - a retrospective cohort study. Frontiers in oncology Tang, Y., Valovska, M. T., Nolazco, J. I., Yim, K., Chung, B. I., Chang, S. L. 2023; 13: 1254181

  Abstract

  To better understand whether the marital status impacts 90-day postoperative outcomes following kidney cancer surgery.We performed a retrospective cohort study of adult patients undergoing elective partial or radical nephrectomy to manage kidney masses from 2003 to 2017 using the Premier Hospital Database, a national hospital discharge dataset. Multinomial logistic regression models controlling for a wide range of clinicodemographic, surgical, and hospital characteristics were used to assess an association between marital status and postoperative complications. The primary outcome was 90-day complications, including minor complications (Clavien grades 1-2), non-fatal major complications (Clavien grades 3-4), and mortality (Clavien grade 5). Secondary outcomes included patient disposition and readmission rates.The study cohort comprised 106,752 patients, of which 61,188 (57.32%) were married. The overall incidence of minor complications, major complications, and death was 24.04%, 6.00%, and 0.71%, respectively. Marriage was associated with a significantly lower incidence of minor (RR 0.97; 95% CI: 0.94-0.99) complications following open or radical nephrectomy and major complications (RR 0.89; 95% CI: 0.84-0.95) for all surgical types and approaches. There was no association between marital status and mortality (RR 0.94; 95% CI: 0.81-1.10).Marriage is associated with a significant reduction in major complications following kidney cancer surgery, likely because it is associated with greater social support, which is beneficial in the postoperative phase of care. Marital status and social support may play a role in the preoperative decision-making process and counseling for patients considering kidney cancer surgery.

  View details for DOI 10.3389/fonc.2023.1254181

  View details for PubMedID 37849800

  View details for PubMedCentralID PMC10577411

• Associations between antihypertensive medication use and kidney cancer incidence using the Korean nationwide insurance database Jung, M., Choo, E., Lee, S., Langston, M., Chung, B. WILEY. 2023: 260

  View details for Web of Science ID 001091511701132

• Lifetime body weight trajectories and risk of renal cell cancer: a large US prospective cohort study. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Deng, Z., Hajihosseini, M., Moore, J. X., Khan, S., Graff, R. E., Bondy, M. L., Chung, B. I., Langston, M. E. 2023

  Abstract

  Body mass index (BMI) is a known risk factor for renal cell cancer (RCC), but data are limited as to the effect of lifetime exposure to excess bodyweight.Using the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial (N=138,614, 527 incident RCCs), we identified several anthropometric measures to capture the lifetime BMI patterns: 1) BMI at specific ages; 2) adulthood BMI trajectories; 3) cumulative exposure to overweight/obesity denoted as weighted years of living overweight/obese (WYO); and 4) weight change during each age span. We conducted multivariable Cox model to quantify the association between each anthropometric metric and incident RCC.A higher BMI at ages 20 and 50 and at baseline was associated with a greater hazard of RCC. Compared to individuals who retained normal BMI throughout adulthood, we observed an increased hazard of RCC for BMI trajectory of progressing from normal BMI to overweight (HR:1.49, 95%CI:1.19,1.87), from normal BMI to obesity (HR:2.22, 95%CI:1.70,2.90), and from overweight to obesity (HR:2.78, 95%CI:1.81,4.27). Compared to individuals who were never overweight (WYO=0), elevated HRs were observed among individuals who experienced low (HR:1.31, 95%CI:0.99,1.74), medium (HR:1.57, 95%CI:1.20,2.05), and high (HR:2.10, 95%CI:1.62,2.72) WYO tertile. Weight gain of ≥10kg was associated with increased RCC incidence for each age span.Across the lifespan, being overweight/obese, weight gain, and higher cumulative exposure to excess weight were all associated with increased RCC risk.It is important to avoid weight gain and assess BMI from a life-course perspective to reduce RCC risk.

  View details for DOI 10.1158/1055-9965.EPI-23-0668

  View details for PubMedID 37624040

• Comment on: "Stage-dependent survival in patients treated with neoadjuvant chemotherapy and radical cystectomy". Minerva urology and nephrology Asero, V., Scornajenghi, C. M., Carino, D., Pandolfo, S. D., Krajewski, W., Gallioli, A., Basran, S., Tresh, A., Chung, B. I., Del Giudice, F. 2023

  View details for DOI 10.23736/S2724-6051.23.05529-5

  View details for PubMedID 37530677

• Urological complications after COVID 19 vaccine according to age, sex and manufacturer. World journal of urology Shim, S. R., Kim, K. T., Park, E., Pyun, J. H., Kim, J. H., Chung, B. I. 2023

  Abstract

  OBJECTIVES: To examine the effects of age, sex, and type of COVID-19 vaccine on urological complications after vaccination with COVID-19.MATERIALS AND METHODS: We used the Vaccine Adverse Event Reporting System (VAERS) data from December 2020 to August 2022 to analyze urological symptoms post-vaccination adverse events (AEs) associated with COVID-19 vaccines authorized for the U.S.POPULATION: We collected AEs after 1-2 dose vaccination in VAERS, but not those after an additional booster shot. Age was divided into three groups (<18years, 18-64years, and>64years), and compared incidence of AEs after vaccination with either mRNA vaccine (mRNA-1273, Moderna; and BNT162b2, Pfizer-BioNTech) or a viral vector vaccine (JNJ-78436735, Janssen/Johnson and Johnson) as reported in VAERS data.RESULTS: Cumulative incidence rates (CIRs) of LUTS, voiding symptom, storage symptom, infection, and hematuria were 0.057, 0.282, 0.223, 1.245, and 0.214, respectively. By gender, CIRs OF LUTS, storage symptom, and infection were statistically significantly higher in women, whereas CIRs of voiding symptom and hematuria were statistically significantly higher in men. CIRs of AEs per 100,000 in age groups of<18years, 18-64years, and>64years were 0.353, 1.403, and 4.067, respectively. All AE types except for voiding symptom displayed the highest CIRs in the Moderna vaccine group.CONCLUSIONS: Based on an updated analysis of available data, the prevalence of urologic complications following administration of COVID-19 vaccines is low. However, specific urologic complications such as gross hematuria are not low in incidence.

  View details for DOI 10.1007/s00345-023-04481-1

  View details for PubMedID 37400660

• Groundwater constituents and the incidence of kidney cancer. Cancer Soerensen, S. J., Montez-Rath, M. E., Cheng, I., Gomez, S. L., Oh, D. L., Jackson, C., Li, J., Rehkopf, D., Chertow, G. M., Langston, M. E., Ganesan, C., Pao, A. C., Chung, B. I., Leppert, J. T. 2023

  Abstract

  Kidney cancer incidence demonstrates significant geographic variation suggesting a role for environmental risk factors. This study sought to evaluate associations between groundwater exposures and kidney cancer incidence.The authors identified constituents from 18,506 public groundwater wells in all 58 California counties measured in 1996-2010, and obtained county-level kidney cancer incidence data from the California Cancer Registry for 2003-2017. The authors developed a water-wide association study (WWAS) platform using XWAS methodology. Three cohorts were created with 5 years of groundwater measurements and 5-year kidney cancer incidence data. The authors fit Poisson regression models in each cohort to estimate the association between county-level average constituent concentrations and kidney cancer, adjusting for known risk factors: sex, obesity, smoking prevalence, and socioeconomic status at the county level.Thirteen groundwater constituents met stringent WWAS criteria (a false discovery rate <0.10 in the first cohort, followed by p values <.05 in subsequent cohorts) and were associated with kidney cancer incidence. The seven constituents directly related to kidney cancer incidence (and corresponding standardized incidence ratios) were chlordane (1.06; 95% confidence interval [CI], 1.02-1.10), dieldrin (1.04; 95% CI, 1.01-1.07), 1,2-dichloropropane (1.04; 95% CI, 1.02-1.05), 2,4,5-TP (1.03; 95% CI, 1.01-1.05), glyphosate (1.02; 95% CI, 1.01-1.04), endothall (1.02; 95% CI, 1.01-1.03), and carbaryl (1.02; 95% CI, 1.01-1.03). Among the six constituents inversely related to kidney cancer incidence, the standardized incidence ratio furthest from the null was for bromide (0.97; 95% CI, 0.94-0.99).This study identified several groundwater constituents associated with kidney cancer. Public health efforts to reduce the burden of kidney cancer should consider groundwater constituents as environmental exposures that may be associated with the incidence of kidney cancer.

  View details for DOI 10.1002/cncr.34898

  View details for PubMedID 37287332

• Patient-level factors associated with the use of active surveillance: The talking about prostate cancer cohort. Mukand, N., Shariff-Marco, S., Brooks, J. D., Chung, B. I., Leppert, J. T., Frosh, D., Sieh, W., Guan, A., Santiago-Rodriguez, E. J., Carroll, P., Shim, J. K., Kuo, M., Allen, L., DeRouen, M., Cheng, I., Gomez, S. L., Lu, Q. LIPPINCOTT WILLIAMS & WILKINS. 2023

  View details for Web of Science ID 001053772002693

• Comment on: "Animal model assessment of a new design for a coated mitomycin-eluting biodegradable ureteral stent for intracavitary instillation as an adjuvant therapy in upper urothelial carcinoma". Minerva urology and nephrology Asero, V., Scornajenghi, C. M., Krajewski, W., Szydełko, T., Malkiewicz, B., Nowak, Ł., Gallioli, A., Basran, S., Chung, B. I., Del Giudice, F. 2023; 75 (3): 401-403

  View details for DOI 10.23736/S2724-6051.23.05354-5

  View details for PubMedID 37221829

• Biomarkers for the Detection and Surveillance of Renal Cancer. The Urologic clinics of North America Nolazco, J. I., Soerensen, S. J., Chung, B. I. 2023; 50 (2): 191-204

  Abstract

  Renal cell carcinoma (RCC) is a heterogeneous disease characterized by a broad spectrum of disorders in terms of genetics, molecular and clinical characteristics. There is an urgent need for noninvasive tools to stratify and select patients for treatment accurately. In this review, we analyze serum, urinary, and imaging biomarkers that have the potential to detect malignant tumors in patients with RCC. We discuss the characteristics of these numerous biomarkers and their ability to be used routinely in clinical practice. The development of biomarkers continues to evolve with promising prospects.

  View details for DOI 10.1016/j.ucl.2023.01.009

  View details for PubMedID 36948666

• Comment on: "Do perioperative blood transfusions impact oncological outcomes of robot-assisted radical cystectomy with intracorporeal urinary diversion? Results from a large multi-institutional registry". Minerva urology and nephrology Asero, V., Krajewski, W., Pradere, B., D'Andrea, D., Moschini, M., Soria, F., Gallioli, A., Basran, S., Chung, B. I., Del Giudice, F. 2023; 75 (2): 248-250

  View details for DOI 10.23736/S2724-6051.23.05317-X

  View details for PubMedID 36999841

• Efficacy of Different Bacillus of Calmette-Guérin (BCG) Strains on Recurrence Rates among Intermediate/High-Risk Non-Muscle Invasive Bladder Cancers (NMIBCs): Single-Arm Study Systematic Review, Cumulative and Network Meta-Analysis. Cancers Del Giudice, F., Asero, V., Bologna, E., Scornajenghi, C. M., Carino, D., Dolci, V., Viscuso, P., Salciccia, S., Sciarra, A., D'Andrea, D., Pradere, B., Moschini, M., Mari, A., Albisinni, S., Krajewski, W., Szydełko, T., Małkiewicz, B., Nowak, Ł., Laukhtina, E., Gallioli, A., Mertens, L. S., Marcq, G., Cimadamore, A., Afferi, L., Soria, F., Mori, K., Tully, K. H., Pichler, R., Ferro, M., Tataru, O. S., Autorino, R., Crivellaro, S., Crocetto, F., Busetto, G. M., Basran, S., Eisenberg, M. L., Chung, B. I., De Berardinis, E. 2023; 15 (7)

  Abstract

  In an era of Bacillus of Calmette-Guérin (BCG) shortages, the comparative efficacy from different adjuvant intravesical BCG strains in non-muscle invasive bladder cancer (NMIBC) has not been clearly elucidated. We aim to compare, through a systematic review and meta-analysis, the cumulative BC recurrence rates and the best efficacy profile of worldwide available BCG strains over the last forty years.PubMed, Scopus, Web of Science, Embase, and Cochrane databases were searched from 1982 up to 2022. A meta-analysis of pooled BC recurrence rates was stratified for studies with ≤3-y vs. >3-y recurrence-free survival (RFS) endpoints and the strain of BCG. Sensitivity analysis, sub-group analysis, and meta-regression were implemented to investigate the contribution of moderators to heterogeneity. A random-effect network meta-analysis was performed to compare BCG strains on a multi-treatment level.In total, n = 62 series with n = 15,412 patients in n = 100 study arms and n = 10 different BCG strains were reviewed. BCG Tokyo 172 exhibited the lowest pooled BC recurrence rate among studies with ≤3-y RFS (0.22 (95%CI 0.16-0.28). No clinically relevant difference was noted among strains at >3-y RFS outcomes. Sub-group and meta-regression analyses highlighted the influence of NMIBC risk-group classification and previous intravesical treated categories. Out of the n = 11 studies with n = 7 BCG strains included in the network, BCG RIVM, Tice, and Tokyo 172 presented with the best-predicted probability for efficacy, yet no single strain was significantly superior to another in preventing BC recurrence risk.We did not identify a BCG stain providing a clinically significant lower BC recurrence rate. While these findings might discourage investment in future head-to-head randomized comparison, we were, however, able to highlight some potential enhanced benefits from the genetically different BCG RIVM, Tice, and Tokyo 172. This evidence would support the use of such strains for future BCG trials in NMIBCs.

  View details for DOI 10.3390/cancers15071937

  View details for PubMedID 37046598

• Bladder Cancer and Risk Factors: Data from a Multi-Institutional Long-Term Analysis on Cardiovascular Disease and Cancer Incidence. Journal of personalized medicine Barone, B., Finati, M., Cinelli, F., Fanelli, A., Del Giudice, F., De Berardinis, E., Sciarra, A., Russo, G., Mancini, V., D'Altilia, N., Ferro, M., Porreca, A., Chung, B. I., Basran, S., Bettocchi, C., Cormio, L., Imbimbo, C., Carrieri, G., Crocetto, F., Busetto, G. M. 2023; 13 (3)

  Abstract

  Background: Bladder cancer (BCa) is a heterogeneous disease with a variable prognosis and natural history. Cardiovascular disease (CVD), although completely different, has several similarities and possible interactions with cancer. The association between them is still unknown, but common risk factors between the two suggest a shared biology. Materials and Methods: This was a retrospective study that included patients who underwent transurethral resection of bladder tumor at two high-volume institutions. Depending on the presence of a previous history of CVD or not, patients were divided into two groups. Results: A total of 2050 patients were included, and 1638 (81.3%) were diagnosed with bladder cancer. Regarding comorbidities, the most common were hypertension (59.9%), cardiovascular disease (23.4%) and diabetes (22.4%). At univariate analysis, independent risk factors for bladder cancer were age and male sex, while protective factors were cessation of smoking and presence of CVD. All these results, except for ex-smoker status, were confirmed at the multivariate analysis. Another analysis was performed for patients with high-risk bladder cancer and, in this case, the role of CVD was not statistically significant. Conclusions: Our study pointed out a positive association between CVD and BCa incidence; CVD was an independent protective factor for BCa. This effect was not confirmed for high-risk tumors. Several biological and genomics mechanisms clearly contribute to the onset of both diseases, suggesting a possible shared disease pathway and highlighting the complex interplay of cancer and CVD. CVD treatment can involve different drugs with a possible effect on cancer incidence, but, to date, findings are still inconclusive.

  View details for DOI 10.3390/jpm13030512

  View details for PubMedID 36983694

• Characteristics of recurrent acute urinary retention in BPH patients in the United States: Retrospective analysis of US-based insurance claims database. The Prostate Lee, S., Yoo, K. H., Kim, T. S., Cho, H. J., Kim, W., Oh, J. K., Li, S., Kim, S. Y., Wei, W., Huang, J., van Uem, S., Giudice, F. D., Lindars, D. P., Sathe, A. R., Chung, B. I. 2023

  Abstract

  The objective of this study is to analyze characteristics of recurrent acute urinary retention (AUR) in patients with benign prostatic hyperplasia (BPH), utilizing a population based data set. Also, we sought to report on how AUR was treated, specifically regarding the need and length of catheterization and types of procedures utilized for mitigation.A retrospective observational cohort study was performed using Optum's deidentified Clinformatics® Data Mart Database. We compared two groups, BPH patients with AUR (n = 180,737) and BPH patients without AUR (n = 1,139,760) from January 1, 2003 to December 31, 2017. Also, we analyzed the factors affecting the development of multiple episodes of AUR through age-adjusted multivariate analysis.In contrast to the 47.7% of patients who had a single AUR episode, 33.5% of AUR patients developed 3 or more subsequent episodes of retention. For age matched patients, the risks of additional episodes of retention increase significantly with older age, Caucasian race, diabetes, neurologic conditions, or low income. Overall, the rate of BPH surgery in AUR patients over the study period decreased and the most common procedure was transurethral resection of the prostate.Risk factors for multiple episodes of AUR included age (60 and older), Caucasian race, lower income socioeconomic status, diabetes, and neurological disorders. Patients with a high probability of developing recurrent episodes of AUR are recommended to receive preemptive BPH medication before such AUR occurrences. Also, more expeditious surgical treatment should be considered rather than temporary catheterization when AUR occurs.

  View details for DOI 10.1002/pros.24509

  View details for PubMedID 36891865

• Rare Presentation of Paroxysmal High B-Pee. Hypertension (Dallas, Tex. : 1979) Bradshaw, C., Abounasr, A., Brunsing, R. L., Kao, C. S., Reejhsinghani, R., Annes, J. P., Chung, B. I., Mihm, F., Bhalla, V. 2023

  View details for DOI 10.1161/HYPERTENSIONAHA.122.20790

  View details for PubMedID 36794582

• A Novel Low-Cost Uroflowmetry for Patient Telemonitoring. International journal of environmental research and public health Pandolfo, S. D., Crauso, F., Aveta, A., Cilio, S., Barone, B., Napolitano, L., Scarpato, A., Mirto, B. F., Serino, F., Del Giudice, F., Chung, B. I., Crocerossa, F., Di Zazzo, E., Trama, F., Vaglio, R., Wu, Z., Verze, P., Imbimbo, C., Crocetto, F. 2023; 20 (4)

  Abstract

  Uroflowmetry (UF) is a crucial guideline-recommended tool for men with benign prostatic obstruction (BPO). Moreover, UF is a helpful decision-making tool for the management of patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). In the last few years, telemedicine and telehealth have increased exponentially as cost-effective treatment options for both patients and physicians. Telemedicine and telehealth have been well positioned during the COVID-19 pandemic to prevent healthcare system overload and to ensure adequate management of patients through screening, diagnosis, and follow-up at home. In the present manuscript, the main characteristics and performance of a novel and low-cost device for home-based UF have been analyzed. The simple weight-transducer method has been applied to perform UF. An inexpensive load cell connected to a 24 bit analogic digital converter (ADC) sends data to a cloud server via SIM card or home Wi-Fi. Data are processed and shown in graphics with both volume and flow rate as a function of time, allowing for measurement of average flow rate, maximum flow rate, voided volume, and voiding time. A numerical algorithm allows for filtering of the dynamic effect due to the urine gravity acceleration and for removing the funnel to simplify the home measurement procedure. Through an online platform, the physician can see and compare each UF data. The device's reliability has been validated in a first laboratory setting and showed excellent performance. This approach based on domiciliary tests and an online platform can revolutionize the urologic clinic landscape by offering a constant patient cost-effective follow-up, eliminating the time wasted waiting in the office setting.

  View details for DOI 10.3390/ijerph20043287

  View details for PubMedID 36833979

• Re: Sigrid V. Carlsson, Rebecka Arnsrud Godtman, Carl-Gustav Pihl, et al. Young Age on Starting Prostate-specific Antigen Testing Is Associated with a Greater Reduction in Prostate Cancer Mortality: 24-Year Follow-up of the Göteborg Randomized Population-based Prostate Cancer Screening Trial. Eur Urol. 2023;83:103-9. European urology Kim, K. M., Kim, J. H., Chung, B. I. 2023

  View details for DOI 10.1016/j.eururo.2022.12.037

  View details for PubMedID 36774223

• Performance of Node-RADS Scoring System for a Standardized Assessment of Regional Lymph Nodes in Bladder Cancer Patients CANCERS Leonardo, C., Flammia, R., Lucciola, S., Proietti, F., Pecoraro, M., Bucca, B., Licari, L., Borrelli, A., Bologna, E., Landini, N., Del Monte, M., Chung, B. I., Catalano, C., Magliocca, F., De Berardinis, E., Del Giudice, F., Panebianco, V. 2023; 15 (3)

  Abstract

  Current cross-sectional imaging modalities exhibit heterogenous diagnostic performances for the detection of a lymph node invasion (LNI) in bladder cancer (BCa) patients. Recently, the Node-RADS score was introduced to provide a standardized comprehensive evaluation of LNI, based on a five-item Likert scale accounting for both size and configuration criteria. In the current study, we hypothesized that the Node-RADS score accurately predicts the LNI and tested its diagnostic performance.We retrospectively reviewed BCa patients treated with radical cystectomy (RC) and bilateral extended pelvic lymph node dissection, from January 2019 to June 2022. Patients receiving preoperative systemic chemotherapy were excluded. A logistic regression analysis tested the correlation between the Node-RADS score and LNI both at patient and lymph-node level. The ROC curves and the AUC depicted the overall diagnostic performance. In addition, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for different cut-off values (>1, >2, >3, >4).Overall, data from 49 patients were collected. Node-RADS assigned on CT scans images, was found to independently predict the LNI after an adjusted multivariable regression analysis, both at the patient (OR 3.36, 95%CI 1.68-9.40, p = 0.004) and lymph node (OR 5.18, 95%CI 3.39-8.64, p < 0.001) levels. Node-RADS exhibited an AUC of 0.87 and 0.91 at the patient and lymph node levels, respectively. With increasing Node-RADS cut-off values, the specificity and PPV increased from 57.1 to 97.1% and from 48.3 to 83.3%, respectively. Conversely, the sensitivity and NPV decreased from 100 to 35.7% and from 100 to 79.1%, respectively. Similar trends were recorded at the lymph node level. Potentially, Node-RADS > 2 could be considered as the best cut-off value due to balanced values at both the patient (77.1 and 78.6%, respectively) and lymph node levels (82.4 and 93.4%, respectively).The current study lays the foundation for the introduction of Node-RADS for the regional lymph-node evaluation in BCa patients. Interestingly, the Node-RADS score exhibited a moderate-to-high overall accuracy for the identification of LNI, with the possibility of setting different cut-off values according to specific clinical scenarios. However, these results need to be validated on larger cohorts before drawing definitive conclusions.

  View details for DOI 10.3390/cancers15030580

  View details for Web of Science ID 000929284600001

  View details for PubMedID 36765540

  View details for PubMedCentralID PMC9913205

• Docetaxel Enhances Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand-Mediated Apoptosis in Prostate Cancer Cells via Epigenetic Gene Regulation by Enhancer of Zeste Homolog 2. The world journal of men's health Lee, W. H., Kim, S. C., Kim, S. H., Yoon, J. H., Moon, K. H., Cheon, S. H., Kwon, T., Kim, Y. M., Park, J. W., Lee, S. H., Lee, J. M., Park, S., Chung, B. I. 2023

  Abstract

  PURPOSE: Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is a promising cancer therapeutic agent because of its tumor selectivity and its ability to induce apoptosis in cancer cells while sparing most normal cells. We evaluated whether docetaxel enhances TRAIL-mediated apoptosis in prostate cancer (PCa) cells and its mechanism.MATERIALS AND METHODS: LNCap-LN3, PC3, and DU 145 PCa cell lines were used to investigate the effects of TRAIL with docetaxel treatment (dosages, 1, 3, 5, and 10 nmol). To evaluate the mechanism, death receptor 4 (DR4), DR5, enhancer of zeste homolog 2 (EZH2) and E2F1 levels were assessed in PCa cells.RESULTS: Hormone-sensitive LNCap-LN3 showed apoptosis in proportion to the concentration of docetaxel. Castration-resistant PC3 and DU 145 showed no change irrespective of the docetaxel concentration. However, combinations of docetaxel (2 nM) and TRAIL (100 ng/mL) had a significant effect on apoptosis of DU 145 cells. In DU 145 cells, docetaxel reduced EZH2 and elevated expression of DR4. The decrease of EZH2 by docetaxel was correlated with the E2F1 level, which was considered as the promoter of EZH2. DZNep reduced EZH2 and elevated DR4 in all PCa cells. Additionally, DZNep-enhanced TRAIL mediated reduction of PCa cell viability.CONCLUSIONS: Docetaxel and the EZH2 inhibitor reduced EZH2 and elevated expression of DR4 in all PCa cell lines. Docetaxel-enhanced TRAIL mediated apoptosis in PCa via elevation of DR4 through epigenetic regulation by EZH2. To improve the efficacy of TRAIL for PCa treatment, adding docetaxel or EZH2 inhibitors to TRAIL may be promising.

  View details for DOI 10.5534/wjmh.220073

  View details for PubMedID 36593705

• How the Analysis of the Pathogenetic Variants of DDR Genes Will Change the Management of Prostate Cancer Patients. International journal of molecular sciences Sciarra, A., Frisenda, M., Bevilacqua, G., Gentilucci, A., Cattarino, S., Mariotti, G., Del Giudice, F., Di Pierro, G. B., Viscuso, P., Casale, P., Chung, B. I., Autorino, R., Crivellaro, S., Salciccia, S. 2022; 24 (1)

  Abstract

  Herein, we analyze answers achieved, open questions, and future perspectives regarding the analysis of the pathogenetic variants (PV) of DNA damage response (and repair) (DDR) genes in prostate cancer (PC) patients. The incidence of PVs in homologous recombination repair (HRR) genes among men with metastatic PC varied between 11% and 33%, which was significantly higher than that in non-metastatic PC, and BRCA2 mutations were more frequent when compared to other DDR genes. The determination of the somatic or germline PVs of BRCA2 was able to define a tailored therapy using PARP inhibitors in metastatic castration-resistant prostate cancer (mCRPC) progression after first-line therapy, with significant improvements in the radiologic progression-free survival (rPFS) and overall survival (OS) rates. We propose testing all metastatic PC patients for somatic and germline HRR mutations. Somatic determination on the primary site or on historic paraffin preparations with a temporal distance of no longer than 5 years should be preferred over metastatic site biopsies. The prognostic use of DDR PVs will also be used in selected high-risk cases with non-metastatic stages to better arrange controls and therapeutic primary options. We anticipate that the use of poly-ADP-ribose polymerase (PARP) inhibitors in hormone-sensitive prostate cancer (HSPC) and in combination with androgen receptor signaling inhibitors (ARSI) will be new strategies.

  View details for DOI 10.3390/ijms24010674

  View details for PubMedID 36614122

• Associations of Renal Cell Carcinoma Subtype with Patient Demographics, Comorbidities, and Neighborhood Socioeconomic Status in the California Population. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Lichtensztajn, D. Y., Hofer, B. M., Leppert, J. T., Brooks, J. D., Chung, B. I., Shah, S. A., DeRouen, M. C., Cheng, I. 2022

  Abstract

  Renal cell carcinoma (RCC) subtypes differ in molecular characteristics and prognosis. We investigated the associations of RCC subtype with patient demographics, comorbidity, and neighborhood socioeconomic status (nSES).Using linked California Cancer Registry and Office of Statewide Health Planning and Development data, we identified history of hypertension, diabetes, and kidney disease prior to RCC diagnosis in Asian/Pacific Islander, non-Latino Black, Latino, and non-Latino White adults diagnosed with their first pathologically-confirmed RCC from 2005 through 2015. We used multinomial multivariable logistic regression to model the association of demographics, comorbidity, and nSES with clear cell, papillary, and chromophobe RCC subtype.Of the 40,016 RCC cases included, 62.6% were clear cell, 10.9% papillary, and 5.9% chromophobe. The distribution of subtypes differed strikingly by race and ethnicity, ranging from 40.4% clear cell and 30.4% papillary in non-Latino Black adults to 70.7% clear cell and 4.5% papillary in Latino adults. In multivariable analysis, non-Latino Black individuals had a higher likelihood of presenting with papillary (odds ratio (OR) 3.99, 95% confidence interval 3.61-4.42) and chromophobe (OR 1.81, 1.54-2.13) vs clear cell subtype compared to non-Latino White individuals. Both hypertension (OR 1.19, 1.10-1.29) and kidney disease (OR 2.38, 2.04-2.77 end stage disease; OR 1.52, 1.33-1.72 non end-stage disease) were associated with papillary subtype. Diabetes was inversely associated with both papillary (OR 0.63, 0.58-0.69) and chromophobe (OR 0.61, 0.54-0.70) subtypes.RCC subtype is independently associated with patient demographics, and comorbidity.Targeted RCC treatments or RCC prevention efforts may have differential impact across population subgroups.

  View details for DOI 10.1158/1055-9965.EPI-22-0784

  View details for PubMedID 36480301

• Comparative Prospective and Longitudinal Analysis on the Platelet-to-Lymphocyte, Neutrophil-to-Lymphocyte, and Albumin-to-Globulin Ratio in Patients with Non-Metastatic and Metastatic Prostate Cancer. Current oncology (Toronto, Ont.) Salciccia, S., Frisenda, M., Bevilacqua, G., Viscuso, P., Casale, P., De Berardinis, E., Di Pierro, G. B., Cattarino, S., Giorgino, G., Rosati, D., Del Giudice, F., Carbone, A., Pastore, A., Chung, B. I., Eisenberg, M. L., Autorino, R., Crivellaro, S., Forte, F., Sciarra, A., Mariotti, G., Gentilucci, A. 2022; 29 (12): 9474-9500

  Abstract

  PURPOSE: To prospectively evaluate the albumin/globulin ratio (AGR), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) diagnostic and prognostic predictive value in a stratified population of prostate cancer (PC) cases.METHODS: Population was divided based on the clinical and histologic diagnosis in: Group A: benign prostatic hyperplasia (BPH) cases (494 cases); Group B: all PC cases (525 cases); Group B1: clinically significant PC (426 cases); Group B2: non-metastatic PC (416 cases); Group B3: metastatic PC (109 cases). NLR, PLR, and AGR were obtained at the time of the diagnosis, and only in cases with PC considered for radical prostatectomy, determinations were also repeated 90 days after surgery. For each ratio, cut-off values were determined by receiver operating characteristics curve (ROC) analysis and fixed at 2.5, 120.0, and 1.4, respectively, for NLR, PLR, and AGR.RESULTS: Accuracy in predictive value for an initial diagnosis of clinically significant PC (csPC) was higher using PLR (0.718) when compared to NLR (0.220) and AGR (0.247), but, despite high sensitivity (0.849), very low specificity (0.256) was present. The risk of csPC significantly increased only according to PLR with an OR = 1.646. The percentage of cases with metastatic PC significantly increased according to high NLR and high PLR. Accuracy was 0.916 and 0.813, respectively, for NLR and PLR cut-off, with higher specificity than sensitivity. The risk of a metastatic disease increased 3.2 times for an NLR > 2.5 and 5.2 times for a PLR > 120 and at the multivariate analysis.CONCLUSION: PLR and NLR have a significant predictive value towards the development of metastatic disease but not in relation to variations in aggressiveness or T staging inside the non-metastatic PC. Our results suggest an unlikely introduction of these analyses into clinical practice in support of validated PC risk predictors.

  View details for DOI 10.3390/curroncol29120745

  View details for PubMedID 36547159

• Outcomes of Bosniak Classification Version 2019 Class IIF Cystic Renal Masses at Imaging Surveillance. AJR. American journal of roentgenology Shen, L., Yoon, L., Chung, B. I., Kamaya, A., Tse, J. R. 2022

  Abstract

  Background: Bosniak classification system version 2019 (v2019) recommends that class IIF masses undergo follow-up imaging at 6 months, 12 months, and then annually for 5 years. The frequency and timing of upgrade on follow-up imaging are incompletely understood. Purpose: To describe the temporal evolution of Bosniak v2019 class IIF cystic renal masses, with attention to outcomes at 6-month follow-up, time to class upgrade, and malignant histologic diagnoses. Methods: This retrospective study included 219 patients (91 women, 128 men; median age, 72 years) with 246 localized class IIF masses from January 2005 to June 2022. Patients underwent both a baseline and at least one follow-up renal-mass protocol contrast-enhanced CT or MRI. Two radiologists evaluated masses at all follow-up time points to categorize masses as downgraded (class I or II), stable (localized class IIF), or upgraded (class III or IV, solid, or ≥T3a, N1, or M1 disease); a third radiologist resolved discrepancies. Incidence rate of upgrade was determined. Histopathologic outcomes were assessed for resected masses. Results: Median follow-up was 28.4 months (IQR, 13.7-59.4 months). At 6-month follow-up, 5 (2%) masses were downgraded, 241 (98%) were stable, and none were upgraded. Based on final follow-up, 14 (6%) masses were downgraded, 223 (91%) were stable, and 9 (4%) were upgraded. All upgrade events entailed a class increase to III (n=7) or IV (n=2); no mass became solid or developed T3, N1, or M1 disease. Among the nine upgraded masses, median time to upgrade was 53.5 months (IQR, 23.2-63.7 months). Incidence rate of upgrade was 3.006 per 100,000 person-days (95% CI, 1.466-5.516). Ten masses were resected; histopathology was benign in six, and malignant in four. Of the four malignant masses, one was upgraded to class III after 15 months of preoperative follow-up imaging, and three remained class IIF on preoperative follow-up imaging. No resected malignant mass developed postoperative recurrence. Conclusion: Bosniak v2019 class IIF masses are unlikely to represent aggressive malignancy; only 4% were upgraded over time, and never on initial 6-month follow-up. Clinical Impact: The currently recommended initial 6-month follow-up imaging examination for class IIF masses is of questionable clinical utility.

  View details for DOI 10.2214/AJR.22.28599

  View details for PubMedID 36416398

• Factors that influence treatment decisions: A qualitative study of racially and ethnically diverse patients with low- and very-low risk prostate cancer. Cancer medicine Guan, A., Shim, J. K., Allen, L., Kuo, M., Lau, K., Loya, Z., Brooks, J. D., Carroll, P. R., Cheng, I., Chung, B. I., DeRouen, M. C., Frosch, D. L., Golden, T., Leppert, J. T., Lichtensztajn, D. Y., Lu, Q., Oh, D. L., Sieh, W., Wadhwa, M., Gomez, S. L., Shariff-Marco, S. 2022

  Abstract

  BACKGROUND: Factors that influence prostate cancer treatment decisions are complex, multifaceted, and personal, and may vary by race/ethnicity. Although research has been published to quantify factors involved in decision-making, these studies have been limited to primarily white, and to a lesser extent, Black patients, and quantitative studies are limited for discerning the cultural and contextual processes that shape decision-making.METHODS: We conducted 43 semi-structured interviews with a racially and ethnically diverse sample of patients diagnosed with low- and very-low risk prostate cancer who had undergone treatment for their prostate cancer. Interviews were transcribed, independently coded, and analyzed to identify themes salient for decision-making, with attention to sociocultural differences.RESULTS: We found racial and ethnic differences in three areas. First, we found differences in how socialized masculinity influenced patient's feelings about different treatment options. Second, we found that for some men, religion and spirituality alleviated anxiety associated with the active surveillance protocol. Finally, for racially and ethnically minoritized patients, we found descriptions of how historic and social experiences within the healthcare system influenced decision-making.CONCLUSIONS: Our study adds to the current literature by expounding on racial and ethnic differences in the multidimensional, nuanced factors related to decision-making. Our findings suggest that factors associated with prostate cancer decision-making can manifest differently across racial and ethnic groups, and provide some guidance for future research.

  View details for DOI 10.1002/cam4.5405

  View details for PubMedID 36404625

• Robotic assisted simple prostatectomy versus other treatment modalities for large benign prostatic hyperplasia: a systematic review and meta-analysis of over 6500 cases. Prostate cancer and prostatic diseases Pandolfo, S. D., Del Giudice, F., Chung, B. I., Manfredi, C., De Sio, M., Damiano, R., Cherullo, E. E., De Nunzio, C., Cacciamani, G. E., Cindolo, L., Porpiglia, F., Mirone, V., Imbimbo, C., Autorino, R., Crocerossa, F. 2022

  Abstract

  BACKGROUND: Current guidelines recommend simple prostatectomy or endoscopic enucleation of the prostate (EEP) as treatment of choice for bladder prostatic obstruction (BPO) caused by large prostate glands. We aimed to provide a wide-ranging analysis of the currently available evidence, comparing safety and effectiveness of robot-assisted simple prostatectomy (RASP) versus open simple prostatectomy (OSP), laparoscopic simple prostatectomy (LSP), and laser EEP.METHODS: A systematic search was performed across MEDLINE, EMBASE, and Web of Science databases for retrospective and prospective studies comparing RASP to OSP or LSP or laser EEP (HoLEP/ThuLEP). Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations were followed to design the search strategies, selection criteria, and evidence report. A meta-analysis evaluated perioperative safety and effectiveness outcomes. The weighted mean difference and risk ratio were used to compare continuous and dichotomous variables, respectively. Quality was assessed using the Newcastle-Ottawa scale and the Cochrane Collaboration's tool for RCT article assessing risk of bias.RESULTS: 15 studies, including 6659 patients, were selected for meta-analysis: 13 observational studies, 1 non-randomized prospective study, and 1 randomized controlled trial. RASP was associated with statistically significant longer operative time (OT) and lower postoperative complication rate, length of stay (LOS), estimated blood loss (EBL), and transfusion rate (TR) compared to OSP. LSP showed longer LOS and lower postoperative SHIM score, with no difference in OT, EBL, and complications. Compared to laser EEP, RASP presented longer LOS and catheterization time and higher TR. ThuLEP presented shorter OT than RASP. No difference were found in functional outcomes between groups both subjectively (IPSS, QoL) and objectively (Qmax, PVR).CONCLUSION: RASP has become a size-independent treatment for the management of BPO caused by a large prostate gland. It can duplicate the functional outcomes of OSP while offering a better safety profile. When compared to LSP, the latter still stands as a valid lower-cost option, but it requires solid laparoscopic skill sets and therefore it is unlikely to spread on larger scale. When compared to laser EEP, RASP offers a shorter learning curve, but it still suffers from longer catheterization time and LOS.

  View details for DOI 10.1038/s41391-022-00616-4

  View details for PubMedID 36402815

• Characteristics of Sepsis or Acute Pyelonephritis Combined with Ureteral Stone in the United States: A Retrospective Analysis of Large National Cohort APPLIED SCIENCES-BASEL Del Giudice, F., Yoo, K., Lee, S., Oh, J., Cho, H., Kim, S., Min, G., Lee, S., Kim, W., Li, S., Wei, W., Huang, J., Brown, D. R., Spradling, K., Basran, S., Belladelli, F., Autorino, R., Pandolfo, S., Crivellaro, S., Crocetto, F., Ferro, M., Asero, V., Scornajenghi, C., Bologna, E., Sciarra, A., Salciccia, S., De Berardinis, E., Ricciuti, G., van Uem, S., Conti, S., Chung, B. 2022; 12 (21)

  View details for DOI 10.3390/app122110718

  View details for Web of Science ID 000881005000001

• Surgical checklist adherence across urology expertise levels impacts TURBT quality indicators. BJU international Del Giudice, F., D'Andrea, D., Pradere, B., Berndl, F., Pallauf, M., Flammia, R. S., Philipp, D., Moschini, M., Mari, A., Albisinni, S., Krajewski, W., Laukhtina, E., Gallioli, A., Mertens, L. S., Marcq, G., Cimadamore, A., Afferi, L., Gontero, P., Shariat, S. F., Chung, B. I., Soria, F. 2022

  Abstract

  OBJECTIVES: To address the association of perioperative surgical checklist across variable surgical expertise with transurethral resection of bladder tumor (TURBT) accuracy and oncologic outcomes in non-muscle invasive bladder cancer (NMIBC).MATERIALS AND METHODS: we relied on our prospective collaborative database of patients treated with TURBT between 2012 and 2017. Surgical experience was stratified into three groups: resident vs young vs expert consultants. The association of surgical experience with detrusor muscle (DM) presence and adherence to the standardized peri-procedural 9-items TURBT checklist was evaluated with logistic regression models. A Cox regression model was used to investigate the association of surgical experience with recurrence-free survival (RFS).RESULTS: A total of 503 patients were available for analysis. TURBT was performed by expert consultants in 265 (52.7%) patients, by young consultants in 149 patients (29.6%) and by residents in 89 patients (17.7%). Residents were more likely to have DM in the TURBT specimen than expert consultants (OR: 1.75, 95%CI 1.03-2.99, p=0.04). Conversely, no differences in DM presence were observed between young vs expert consultants (OR: 1.09, 95%CI 0.71-1.70, p=0.69). The median checklist completion rate was higher for both residents and young consultants when compared to experts counterparts (56% and 56% vs 44%, p=0.009). When focusing on patients receiving a 2nd look TURBT, the persistent disease was associated with resident status (OR: 4.24, 95%CI 1.14-17.70, p=0.037) at initial TURBT. Surgical experience was not associated with 5-years RFS.CONCLUSION: Surgeon's experience in case of adequate perioperative surgical checklist implementation was inversely associated with the presence of DM in the specimen but directly linked to higher probability of persistent disease at Re-TURBT, although no 5-yr RFS differences were noted.

  View details for DOI 10.1111/bju.15920

  View details for PubMedID 36251366

• The effect of hyperoxia on ventilation during recovery from general anesthesia: A randomized pilot study for a parallel randomized controlled trial. Journal of clinical anesthesia Doufas, A. G., Tian, L., Kutscher, S., Finnsson, E., Ágústsson, J. S., Chung, B. I., Panousis, P. 2022; 83: 110982

  Abstract

  While supplemental O2 inhalation corrects hypoxemia, its effect on post-anesthesia ventilation remains unknown. This pilot trial tested the hypothesis that hyperoxia increases the time spent with a transcutaneous PCO2 (TcPCO2) > 45 mmHg, compared with standard O2 supplementation.Single-blinded, parallel two-arm randomized pilot trial.University hospital.20 patients undergoing robotic-assisted laparoscopic nephrectomy.After institutional approval and informed consent, patients were randomized to receive O2 titrated to arterial saturation (SpO2): 90-94% (Conservative O2, N =10), or to SpO2 > 96% (Liberal O2, N = 10) for up to 90 min after anesthesia. Continuous TcPCO2, respiratory inductance plethysmography (RIP), and SpO2, were recorded. We calculated the percentage of time at TcPCO2 > 45 mmHg for each patient and compared the two groups using analysis of covariance, adjusting for sex, age, and body mass index. We also estimated the sample size required to detect the between-group difference observed in this pilot trial. RIP signals were used to calculate apnea/hypopnea index (AHI), which was then compared between two groups.The mean percentage of time with a TcPCO2 > 45 mmHg was 80.6% for the Conservative O2 (N=9) and 61.2% for the Liberal O2 (N=10) group [between-group difference of 19.4% (95% CI: -18.7% to 57.6%), P = 0.140]. With an observed effect size of 0.73, we estimated that 30 participants per group are required, to demonstrate this difference with a power of 80% at a two-sided alpha of 5%. Means SpO2 were 94.5% and 99.9% for the Conservative O2 and the Liberal O2 groups, respectively. AHI was significantly higher in the Conservative O2, compared with the Liberal O2 group (median AHI: 16 vs. 3; P = 0.0014).Hyperoxia in the post-anesthesia period reduced the time spent at TcPCO2 > 45 mmHg and significantly decreased AHI, while mean SpO2 ranged inside the a priori defined limits.ClinicalTrials.gov identifier: NCT04723433.

  View details for DOI 10.1016/j.jclinane.2022.110982

  View details for PubMedID 36265267

• Management of the incidental adrenal mass, continued surveillance versus surgical excision: analysis of US claims data on contemporary socio-demographic predictors and peri-operative outcomes. Minerva urology and nephrology Del Giudice, F., Kim, W., Li, S., DE Berardinis, E., Sciarra, A., Salciccia, S., Ferro, M., Autorino, R., Pandolfo, S. D., Crocetto, F., Galfano, A., Dell'oglio, P., Cacciamani, G. E., Pradere, B., Laukhtina, E., D'Andrea, D., Belladelli, F., Krajewski, W., Mari, A., Minervini, A., Gallioli, A., Amparore, D., Checcucci, E., Fiori, C., Porpiglia, F., Morgantini, L., Crivellaro, S., Chung, B. I. 2022

  Abstract

  BACKGROUND: Incidentally diagnosed adrenal masses represent an entity that can result in either long term follow-up, surgical excision, or both. Understanding when and which adrenal masses are ultimately excised surgically is not well understood. We sought to understand the ultimate fate of these incidentalomas using a large population-based dataset.METHODS: The primary outcome of the study was determining the trend in adoption of surveillance vs. surgical excision according to socio-demographic, economic, and pathologic indices, and also provider specialty. Secondary outcomes were the assessment of perioperative complications, operative time, surgical approach, hospital stay, and provider specialty (general surgery vs. urology) among the cohort that underwent excision.RESULTS: Out of a total of n=91,560 adrenal masses, ultimately n=3,375 (3.83%) of these underwent surgical excision. In the surgical excision cohort, the incidence of aldosteronoma, functional adenoma/Cushing's disease, and adrenocortical carcinoma was higher than in the surveillance cohort. Those patients who were older, female, and with higher Charlson Comorbidity indexes (CCI) were less likely to undergo surgical resection. Factors that predicted for an increased probability of resection included obtaining more CT/MRI scans as well as general surgeons as primary physician providers. Over the study period, the vast majority of surgeries were performed by surgeons other than urologists (12.9%) and open and laparoscopic approaches dominated, with the robotic-assisted approach accounting for a minority of the surgical cases (23.9%). The minimally invasive surgery (MIS) approach independently predicted for both lower rates of complications and shorter hospital stay.CONCLUSIONS: In the US, adrenal incidentalomas are more likely to undergo surveillance rather than surgical resection. In our study, surgery is mainly offered for functional or malignant disease and the receipt of surgery can vary by physician specialty. A MIS approach independently predicted for both lower rates of complications and shorter hospital stay.

  View details for DOI 10.23736/S2724-6051.22.05073-X

  View details for PubMedID 36197701

• A Matched-Pair Analysis after Robotic and Retropubic Radical Prostatectomy: A New Definition of Continence and the Impact of Different Surgical Techniques. Cancers d'Altilia, N., Mancini, V., Falagario, U. G., Martino, L., Di Nauta, M., Calo, B., Del Giudice, F., Basran, S., Chung, B. I., Porreca, A., Bianchi, L., Schiavina, R., Brunocilla, E., Busetto, G. M., Bettocchi, C., Annese, P., Cormio, L., Carrieri, G. 2022; 14 (18)

  Abstract

  BACKGROUND: Radical prostatectomy is considered the gold-standard treatment for patients with localized prostate cancer. The literature suggests there is no difference in oncological and functional outcomes between robotic-assisted radical prostatectomy (RARP) and open (RRP). (2) Methods: The aim of this study was to compare continence recovery rates after RARP and RRP measured with 24 h pad weights and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). After matching the population (1:1), 482 met the inclusion criteria, 241 patients per group. Continent patients with a 24 h pad test showing <20 g of urinary leakage were considered, despite severe incontinence, and categorized as having >200 g of urinary leakage. (3) Results: There was no difference between preoperative data. As for urinary continence (UC) and incontinence (UI) rates, RARP performed significantly better than RRP based on objective and subjective results at all evaluations. Univariable and multivariable Cox Regression Analysis pointed out that the only significant predictors of continence rates were the bilateral nerve sparing technique (1.25 (CI 1.02,1.54), p = 0.03) and the robotic surgical approach (1.42 (CI 1.18,1.69) p ≤ 0.001). (4) Conclusions: The literature reports different incidences of UC depending on assessment and definition of continence "without pads" or "social continence" based on number of used pads per day. In this, our first evaluation, the advantage of objective measurement through the weight of the 24 h and subjective measurement with the ICIQ-SF questionnaire best demonstrates the difference between the two surgical techniques by enhancing the use of robotic surgery over traditional surgery.

  View details for DOI 10.3390/cancers14184350

  View details for PubMedID 36139511

• Robotic-assisted laparoscopic removal of dermoid cyst mimicking an enlarged cystic mass in the seminal vesicle. IJU case reports Lascano, D., Hsieh, K., Kedia, B., Higgins, J. P., Chung, B. I. 2022; 5 (5): 346-349

  Abstract

  Introduction: Isolated seminal vesicle cysts not associated with Zinner syndrome is a rare disorder that can present initially with urinary obstructive symptoms or nonspecific groin pain.Case description: We present the uncommon case of a dermoid cyst mimicking a seminal vesicle cyst treated with robotic-assisted laparoscopic seminal vesiculectomy.Conclusion: For dermoid cysts, surgical excision is the gold standard of treatment with a high cure rate and little risk of regrowth if spillage is avoided and full resection is completed. Robotic-assisted laparoscopic surgery is a viable management option with good visualization of the anatomy.

  View details for DOI 10.1002/iju5.12477

  View details for PubMedID 36090941

• Quality of Web-Based Patient Information on Robotic Radical Cystectomy Remains Poor: A Standardized Assessment. Urology practice Pandolfo, S. D., Aveta, A., Loizzo, D., Crocerossa, F., La Rocca, R., Del Giudice, F., Chung, B. I., Wu, Z., Lucarelli, G., Mirone, V., Imbimbo, C., Autorino, R. 2022; 9 (5): 498-503

  Abstract

  Patients frequently use the Web to obtain health information. This trend increased during the COVID19 pandemic. We aimed to assess the quality of Web-based information on robot-assisted radical cystectomy.A Web search was conducted in November 2021 using the 3 most common engines (Google/Bing/Yahoo). Search terms were "robotic cystectomy," "robot-assisted cystectomy," and "robotic radical cystectomy." The top 25 results generated for each term by each search engine were included. Duplicate pages, pages advertised, and pages with paywall access were excluded. Selected websites were classified as academic, physician, commercial, and unspecified. The quality of site contents was evaluated using the DISCERN and Journal of the American Medical Association (JAMA) assessment instruments, and HONcode (Health on the Net Foundation) seal and reference presence. Flesch Reading Ease Score was used for readability assessment.Of the 225 sites examined only 34 were eligible for analysis, including 35.3% classified as "academic," 44.1% "physician," 11.8% "commercial," and 8.8% "unspecified." Average±SD DISCERN and JAMA scores were 45.5±15.7 and 1.9±1.1, respectively. Commercial websites had the highest DISCERN and JAMA scores with a mean±SD of 64.7±8.7 and 3.6±0.5, respectively. Physician websites had a significantly lower JAMA mean score than commercial ones (p <0.001). Six websites had HONcode seals and 10 reported references. Readability was difficult as it was at the level of college graduate.As the role of robot-assisted radical cystectomy continues to grow worldwide, the overall quality of Web-based information related to this procedure remains poor. An effort should be made by health care providers to assure patients can have better access to reliable and readable informational material.

  View details for DOI 10.1097/UPJ.0000000000000335

  View details for PubMedID 37145731

• Quality of Web-Based Patient Information on Robotic Radical Cystectomy Remains Poor: A Standardized Assessment UROLOGY PRACTICE Pandolfo, S., Aveta, A., Loizzo, D., Crocerossa, F., La Rocca, R., Del Giudice, F., Chung, B., Wu, Z., Lucarelli, G., Mirone, V., Imbimbo, C., Autorino, R. 2022; 9 (5): 498-503

  View details for DOI 10.1097/UPJ.0000000000000335

  View details for Web of Science ID 000963165400052

• Recent Trends in the Diagnostic and Surgical Management of Benign Prostatic Hyperplasia in the US from 2004 to 2017: Annual Changes in the Selection of Treatment Options and Medical Costs APPLIED SCIENCES-BASEL Del Giudice, F., Oh, J., Basran, S., Nicaise, E., Song, P., Kim, W., Kim, S., Min, G., Yoo, K., Cho, H., Lee, S., Sciarra, A., Salciccia, S., De Berardinis, E., Asero, V., Scornajenghi, C., Pradere, B., Krajewski, W., Gallioli, A., Ferro, M., Crocetto, F., Pandolfo, S., Autorino, R., Belladelli, F., Mari, A., Busetto, G., Li, S., Crivellaro, S., Chung, B. 2022; 12 (17)

  View details for DOI 10.3390/app12178697

  View details for Web of Science ID 000852826800001

• Accuracy of the CUETO, EORTC 2016 and EAU 2021 scoring models and risk stratification tables to predict outcomes in high-grade non-muscle-invasive urothelial bladder cancer. Urologic oncology Krajewski, W., Aumatell, J., Subiela, J. D., Nowak, L., Tukiendorf, A., Moschini, M., Basile, G., Poletajew, S., Malkiewicz, B., Giudice, F. D., Maggi, M., Chung, B. I., Cimadamore, A., Galosi, A. B., Fave, R. F., D'Andrea, D., Shariat, S. F., Hornak, J., Babjuk, M., Chorbinska, J., Teoh, J. Y., Muilwijk, T., Joniau, S., Tafuri, A., Antonelli, A., Panunzio, A., Alvarez-Maestro, M., Simone, G., Mastroianni, R., Laszkiewicz, J., Lonati, C., Zamboni, S., Simeone, C., Niedziela, L., Candela, L., Macek, P., Contieri, R., Hidalgo, B. G., Rivas, J. G., Sosnowski, R., Mori, K., Mir, C., Soria, F., Gonzalez-Padilla, D. A., Faba, O. R., Palou, J., Ploussard, G., Rajwa, P., Halon, A., Laukhtina, E., Pradere, B., Tully, K., Burgos, F. J., Cidre, M. A., Szydelko, T., European Association of Urology- Young Academic Urologists (EAU-YAU): Urothelial carcinoma working group 2022

  Abstract

  PURPOSE: Non-muscle-invasive bladder cancers (NMIBC) constitute 3-quarters of all primary diagnosed bladder tumors. For risk-adapted management of patients with NMIBC, different risk group systems and predictive models have been developed. This study aimed to externally validate EORTC2016, CUETO and novel EAU2021 risk scoring models in a multi-institutional retrospective cohort of patients with high-grade NMIBC who were treated with an adequate BCG immunotherapy.METHODS: The Kaplan-Meier estimates for recurrence-free survival and progression-free survival were performed, predictive abilities were assessed using the concordance index (C-index) and area under the curve (AUC).RESULTS: A total of 1690 patients were included and the median follow-up was 51 months. For the overall cohort, the estimates recurrence-free survival and progression-free survival rates at 5-years were 57.1% and 82.3%, respectively. The CUETO scoring model had poor discrimination for disease recurrence (C-index/AUC for G2 and G3 grade tumors: 0.570/0.493 and 0.559/0.492) and both CUETO (C-index/AUC for G2 and G3 grade tumors: 0.634/0.521 and 0.622/0.525) EAU2021 (c-index/AUC: 0.644/0.522) had poor discrimination for disease progression.CONCLUSION: Both the CUETO and EAU2021 scoring systems were able to successfully stratify risks in our population, but presented poor discriminative value in predicting clinical events. Due to the lack of data, model validation was not possible for EORTC2016. The CUETO and EAU2021 systems overestimated the risk, especially in highest-risk patients. The risk of progression according to EORTC2016 was slightly lower when compared with our population analysis.

  View details for DOI 10.1016/j.urolonc.2022.06.008

  View details for PubMedID 35851185

• Contemporary trends in the surgical management of urinary incontinence after radical prostatectomy in the United States. Prostate cancer and prostatic diseases Del Giudice, F., Huang, J., Li, S., Sorensen, S., Enemchukwu, E., Maggi, M., Salciccia, S., Ferro, M., Crocetto, F., Pandolfo, S. D., Autorino, R., Krajewski, W., Crivellaro, S., Cacciamani, G. E., Bologna, E., Asero, V., Scornajenghi, C., Moschini, M., D'Andrea, D., Brown, D. R., Chung, B. I. 2022

  Abstract

  PURPOSE: To identify trends, costs, and predictors in the use of different surgical procedures for post-radical prostatectomy incontinence (PPI).MATERIALS AND METHODS: We identified 21,589 men who were diagnosed with localized prostate cancer (PCa) and treated with radical prostatectomy (RP) from 2003 to 2017. The primary outcome was the incontinence procedure performances. Optum's de-identified Clinformatics Data Mart Database was queried to define the cohort of interest. The average costs of the different incontinence procedures were obtained and compared. Also, demographic, and clinical predictors of incontinence surgery were evaluated by multivariable regression analysis.RESULTS: Of the 21,589 men with localized PCa treated with RP, 740 (3.43%) underwent at least one incontinence procedure during a median of 5 years of follow-up. In total, there were 844 unique incontinence procedures. Male slings were the most common procedure (47.5%), had an intermediate cost compared to the other treatment options, and was the first-choice treatment for the majority of patients (50%). The use of an artificial urinary sphincter (AUS) was the second most common (35.3%), but also was the most expensive treatment and was first-choice-treatment for 32.3% of patients. On multivariable analysis, metabolic syndrome related disorders, adjuvant/salvage radiation therapy as well as a history of neurological comorbidities were independently associated with an increased likelihood of incontinence surgery.CONCLUSIONS: The receipt of male slings increased and then subsequently decreased, while AUS utilization was stable, and the use of urethral bulking agents was uncommon. From a cost standpoint, AUS was the most expensive option. Finally, patient's comorbidity history and RP related factors were found to influence the choice for primary or subsequent PPI interventions.

  View details for DOI 10.1038/s41391-022-00558-x

  View details for PubMedID 35729329

• The Impact of Venous Thromboembolism on Mortality and Morbidity During Nephrectomy for Renal Mass. Urology Patel, H. V., Sterling, J. A., Srivastava, A., Ghodoussipour, S. B., Jang, T. L., Grandhi, M. S., August, D. A., Rahimi, S. A., Chung, B. I., Chang, S. L., Singer, E. A. 2022

  Abstract

  OBJECTIVES: To determine the morbidity, mortality, and costs associated with having concurrent venous thromboembolism (VTE) at the time of surgical resection of a renal mass.PATIENTS AND METHODS: We identified 108,430 patients undergoing elective partial or radical nephrectomy for a renal mass from 2013 to 2017 using the Premier Healthcare database. The association of VTE with 90-day complication rates, mortality, ICU admission, readmission, and direct hospital costs (2019 US dollars) was determined with multivariable logistic regression and quantile regression models, respectively.RESULTS: Of the 108,430 patients who underwent elective partial or radical nephrectomy, 1.2% (n=1,301) of patients were diagnosed with a preoperative VTE. Patients with preoperative VTE have higher rates of minor (OR 1.47, 95% CI 1.34-1.62, p<0.0001) and major complications (OR 2.53, 95% CI 2.23-2.86, p<0.0001), mortality (OR 2.03, 95% CI 1.6-2.57, p<0.0001), and readmissions (OR 1.73, 95% CI 1.57-1.90, p<0.0001) compared to patients without preoperative VTE at the time of nephrectomy. Notably, the predicted probability for a major complication was significantly higher among patients with preoperative VTE who underwent either partial or radical nephrectomy, irrespective of the surgical approach utilized. Furthermore, rates of all types of complications except endocrine and soft tissue were significantly increased in patients undergoing nephrectomy with preoperative VTE compared to those without VTE.CONCLUSIONS: VTE at the time of nephrectomy is associated with significantly higher rates of major complications, increased mortality, and higher overall costs. Taken together, these findings have important implications for the counseling and management of renal masses in presence of VTE.

  View details for DOI 10.1016/j.urology.2022.05.033

  View details for PubMedID 35691439

• Correlation of 68Ga-RM2 PET with Post-Surgery Histopathology Findings in Patients with Newly Diagnosed Intermediate- or High-Risk Prostate Cancer. Journal of nuclear medicine : official publication, Society of Nuclear Medicine Duan, H., Baratto, L., Fan, R. E., Soerensen, S. J., Liang, T., Chung, B. I., Thong, A. E., Gill, H., Kunder, C., Stoyanova, T., Rusu, M., Loening, A. M., Ghanouni, P., Davidzon, G. A., Moradi, F., Sonn, G. A., Iagaru, A. 2022

  Abstract

  Rationale: 68Ga-RM2 targets gastrin-releasing peptide receptors (GRPR), which are overexpressed in prostate cancer (PC). Here, we compared pre-operative 68Ga-RM2 PET to post-surgery histopathology in patients with newly diagnosed intermediate- or high-risk PC. Methods: Forty-one men, 64.0+/-6.7-year-old, were prospectively enrolled. PET images were acquired 42 - 72 (median+/-SD 52.5+/-6.5) minutes after injection of 118.4 - 247.9 (median+/-SD 138.0+/-22.2)MBq of 68Ga-RM2. PET findings were compared to pre-operative mpMRI (n = 36) and 68Ga-PSMA11 PET (n = 17) and correlated to post-prostatectomy whole-mount histopathology (n = 32) and time to biochemical recurrence. Nine participants decided to undergo radiation therapy after study enrollment. Results: All participants had intermediate (n = 17) or high-risk (n = 24) PC and were scheduled for prostatectomy. Prostate specific antigen (PSA) was 8.8+/-77.4 (range 2.5 - 504) ng/mL, and 7.6+/-5.3 (range 2.5 - 28.0) ng/mL when excluding participants who ultimately underwent radiation treatment. Pre-operative 68Ga-RM2 PET identified 70 intraprostatic foci of uptake in 40/41 patients. Post-prostatectomy histopathology was available in 32 patients in which 68Ga-RM2 PET identified 50/54 intraprostatic lesions (detection rate = 93%). 68Ga-RM2 uptake was recorded in 19 non-enlarged pelvic lymph nodes in 6 patients. Pathology confirmed lymph node metastases in 16 lesions, and follow-up imaging confirmed nodal metastases in 2 lesions. 68Ga-PSMA11 and 68Ga-RM2 PET identified 27 and 26 intraprostatic lesions, respectively, and 5 pelvic lymph nodes each in 17 patients. Concordance between 68Ga-RM2 and 68Ga-PSMA11 PET was found in 18 prostatic lesions in 11 patients, and 4 lymph nodes in 2 patients. Non-congruent findings were observed in 6 patients (intraprostatic lesions in 4 patients and nodal lesions in 2 patients). Both 68Ga-RM2 and 68Ga-PSMA11 had higher sensitivity and accuracy rates with 98%, 89%, and 95%, 89%, respectively, compared to mpMRI at 77% and 77%. Specificity was highest for mpMRI with 75% followed by 68Ga-PSMA11 (67%), and 68Ga-RM2 (65%). Conclusion: 68Ga-RM2 PET accurately detects intermediate- and high-risk primary PC with a detection rate of 93%. In addition, it showed significantly higher specificity and accuracy compared to mpMRI and similar performance to 68Ga-PSMA11 PET. These findings need to be confirmed in larger studies to identify which patients will benefit from one or the other or both radiopharmaceuticals.

  View details for DOI 10.2967/jnumed.122.263971

  View details for PubMedID 35552245

• 68Ga-PSMA-11 PET/MRI in patients with newly diagnosed intermediate or high-risk prostate adenocarcinoma: PET findings correlate with outcomes after definitive treatment. Journal of nuclear medicine : official publication, Society of Nuclear Medicine Moradi, F., Duan, H., Song, H., Davidzon, G. A., Chung, B. I., Thong, A. E., Loening, A. M., Ghanouni, P., Sonn, G., Iagaru, A. 2022

  Abstract

  Prostate-specific membrane antigen (PSMA) PET offers superior accuracy to other imaging modalities in initial staging of prostate cancer and is more likely to affect management. We examined the prognostic value of 68Ga-PSMA-11 uptake in primary lesion and presence of metastatic disease on PET in newly diagnosed prostate cancer patients prior to initial therapy. Methods: In a prospective study from April 2016 to December 2020, 68Ga-PSMA-11 PET/MRI was done in men with new diagnosis of intermediate or high-grade prostate cancer who were candidates for prostatectomy. Patients were followed up after initial therapy for up to 5 years. We examined the Kendall correlation between PET (intense uptake in primary lesion and presence of metastatic disease) and clinical and pathologic findings (grade group, extraprostatic extension, nodal involvement) relevant for risk stratification, and examined the relationship between PET findings and outcome using Kaplan-Meier analysis. Results: Seventy-three men, 64.0±6.3 years of age were imaged. Seventy-two had focal uptake in prostate and in 20 (27%), PSMA-avid metastatic disease was identified. Uptake correlated with grade group and prostate-specific antigen (PSA). Presence of PSMA metastasis correlated with grade group and pathologic nodal stage. PSMA PET had higher per-patients positivity than nodal dissection in patients with only 5-15 nodes removed (8/41 vs. 3/41) but lower positivity if more than 15 nodes were removed (13/21 vs. 10/21). High uptake in primary (SUVmax>12.5, P = .008) and presence of PSMA metastasis (P = .013) were associated with biochemical failure, and corresponding hazard ratios for recurrence within 2-years (4.93 and 3.95, respectively) were similar or higher than other clinicopathologic prognostic factors. Conclusions: 68Ga-PSMA-11 PET can risk stratify patients with intermediate or high-grade prostate cancer prior to prostatectomy based on degree of uptake in prostate and presence of metastatic disease.

  View details for DOI 10.2967/jnumed.122.263897

  View details for PubMedID 35512996

• THE ACCURACY OF VESICAL IMAGING-REPORTING AND DATA SYSTEM (VI-RADS): AN UPDATED COMPREHENSIVE MULTI-INSTITUTIONAL, MULTI-READERS SYSTEMATIC REVIEW AND META-ANALYSIS FROM DIAGNOSTIC EVIDENCE INTO FUTURE CLINICAL RECOMMENDATIONS Del Giudice, F., Flammia, R., Pecoraro, M., Moschini, M., D'Andrea, D., Chung, B. I., Pisciotti, L., Sciarra, A., De Berardinis, E., Panebianco, V. LIPPINCOTT WILLIAMS & WILKINS. 2022: E697

  View details for Web of Science ID 000836935506067

• Ureteroscopy and tailored treatment of upper tract urothelial cancer: Recent advances and unmet needs. BJU international Loizzo, D., Pandolfo, S. D., Del Giudice, F., Cerrato, C., Chung, B. I., Wu, Z., Imbimbo, C., Ditonno, P., Derweesh, I., Autorino, R. 2022

  View details for DOI 10.1111/bju.15746

  View details for PubMedID 35412680

• The accuracy of Vesical Imaging-Reporting and Data System (VI-RADS): an updated comprehensive multi-institutional, multi-readers systematic review and meta-analysis from diagnostic evidence into future clinical recommendations WORLD JOURNAL OF UROLOGY Del Giudice, F., Flammia, R., Pecoraro, M., Moschini, M., D'Andrea, D., Messina, E., Pisciotti, L., De Berardinis, E., Sciarra, A., Panebianco, V. 2022; 40 (7): 1617-1628

  Abstract

  To determine through a comprehensive systematic review and meta-analysis the cumulative diagnostic performance of vesical imaging-reporting and data system (VIRADS) to predict preoperative muscle-invasiveness among different institutions, readers, and optimal scoring accuracy thresholds.PubMed, Cochrane and Embase were searched from inception up to May 2021. Sensitivity (Sn), Specificity (Sp) were first estimated and subsequently pooled using hierarchical summary receiver operating characteristics (HSROC) modeling for both cut-off ≥ 3 and ≥ 4 to predict muscle-invasive bladder cancer (MIBC). Further sensitivity analysis, subgroup analysis and meta-regression were conducted to investigate contribution of moderators to heterogeneity.In total, n = 20 studies from 2019 to 2021 with n = 2477 patients by n = 53 genitourinary radiologists met the inclusion criteria. Pooled weighted Sn and Sp were 0.87 (95% CI 0.82-0.91) and 0.86 (95% CI 0.80-0.90) for cut-off ≥ 3 while 0.78 (95% CI 0.74-0.81) and 0.94 (95% CI 0.91-0.96) for cut-off ≥ 4. The area under the HSROC curve was 0.93 (95% CI 0.90-0.95) and 0.91 (95% CI 0.88-0.93) for cut-off ≥ 3 and ≥ 4, respectively. Meta-regression analyses showed no influence of clinical characteristics nor cumulative reader's experience while study design and radiological characteristics were found to influence the estimated outcome.We demonstrated excellent worldwide diagnostic performance of VI-RADS to determine pre-trans urethral resection of bladder tumor (TURBT) staging. Our findings corroborate wide reliability of VI-RADS accuracy also between different centers with varying experience underling the importance that standardization and reproducibility of VI-RADS may confer to multiparametric magnetic resonance imaging (mpMRI) for preoperative BCa discrimination.

  View details for DOI 10.1007/s00345-022-03969-6

  View details for Web of Science ID 000769849600001

  View details for PubMedID 35294583

  View details for PubMedCentralID PMC9237003

• Compared Efficacy of Adjuvant Intravesical BCG-TICE vs. BCG-RIVM for High-Risk Non-Muscle Invasive Bladder Cancer (NMIBC): A Propensity Score Matched Analysis. Cancers Del Giudice, F., Flammia, R. S., Chung, B. I., Moschini, M., Pradere, B., Mari, A., Soria, F., Albisinni, S., Krajewski, W., Szydelko, T., Laukhtina, E., D'Andrea, D., Gallioli, A., Mertens, L. S., Maggi, M., Sciarra, A., Salciccia, S., Ferro, M., Scornajenghi, C. M., Asero, V., Cattarino, S., De Angelis, M., Cacciamani, G. E., Autorino, R., Pandolfo, S. D., Falagario, U. G., D'Altilia, N., Mancini, V., Chirico, M., Cinelli, F., Bettocchi, C., Cormio, L., Carrieri, G., De Berardinis, E., Busetto, G. M., On Behalf Of European Association Of Urology Eau-Young Academic Urologists Yau Urothelial Cancer Working Party 2022; 14 (4)

  Abstract

  BACKGROUND: Intravesical immunotherapy with bacillus Calmette-Guerin (BCG) is the standard therapy for high-risk non-muscle invasive bladder cancer (NMIBC). The superiority of any BCG strain over another could not be demonstrated yet.METHODS: Patients with NMIBCs underwent adjuvant induction ± maintenance schedule of intravesical immunotherapy with either BCG TICE or RIVM at two high-volume tertiary institutions. Only BCG-naive patients and those treated with the same strain over the course of follow-up were included. One-to-one (1:1) propensity score matching (PSM) between the two cohorts was utilized to adjust for baseline demographic and tumor characteristics imbalances. Kaplan-Meier estimates and multivariable Cox regression models according to high-risk NMIBC prognostic factors were implemented to address survival differences between the strains. Sub-group analysis modeling of the influence of routine secondary resection (re-TUR) in the setting of the sole maintenance adjuvant schedule for the two strains was further performed.RESULTS: 852 Ta-T1 NMIBCs (n = 719, 84.4% on TICE; n = 133, 15.6% on RIVM) with a median of 53 (24-77) months of follow-up were reviewed. After PSM, no differences at 5-years RFS, PFS, and CSS at both Kaplan-Meier and Cox regression analyses were detected for the whole cohort. In the sub-group setting of full adherence to European/American Urology Guidelines (EAU/NCCN), BCG TICE demonstrated longer 5-years RFS compared to RIVM (68% vs. 43%, p = 0.008; HR: 0.45 95% CI 0.25-0.81).CONCLUSION: When routinely performing re-TUR followed by a maintenance BCG schedule, TICE was superior to RIVM for RFS outcomes. However, no significant differences were detected for PFS and CSS, respectively.

  View details for DOI 10.3390/cancers14040887

  View details for PubMedID 35205635

• Comment on: Postoperative outcomes of Fast-Track-enhanced recovery protocol in open radical cystectomy: comparison with standard management in a high-volume center and Trifecta proposal. Minerva urology and nephrology Del Giudice, F., Chung, B. I., Moschini, M., Mari, A., D'Andrea, D., Soria, F., Krajewski, W., Gallioli, A., DE Berardinis, E., Maggi, M., EAU-YAU Urothelial Cancer Working Party 2022; 74 (1): 119-121

  View details for DOI 10.23736/S2724-6051.22.04872-8

  View details for PubMedID 35272453

• Crosstalk of necroptosis and pyroptosis defines tumor microenvironment characterization and predicts prognosis in clear cell renal carcinoma. Frontiers in immunology Fu, L., Bao, J., Li, J., Li, Q., Lin, H., Zhou, Y., Li, J., Yan, Y., Langston, M. E., Sun, T., Guo, S., Zhou, X., Chen, Y., Liu, Y., Zhao, Y., Lu, J., Huang, Y., Chen, W., Chung, B. I., Luo, J. 2022; 13: 1021935

  Abstract

  Pyroptosis and necroptosis are two recently identified forms of immunogenic cell death in the tumor microenvironment (TME), indicating a crucial involvement in tumor metastasis. However, the characteristics of necroptosis and pyroptosis that define tumor microenvironment and prognosis in ccRCC patients remain unknown. We systematically investigated the transcriptional variation and expression patterns of Necroptosis and Pyroptosis related genes (NPRGs). After screening the necroptosis-pyroptosis clusters, the potential functional annotation for clusters was explored by GSVA enrichment analysis. The Necroptosis-Pyroptosis Genes (NPG) scores were used for the prognosis model construction and validation. Then, the correlations of NPG score with clinical features, cancer stem cell (CSC) index, tumor mutation burden (TMB), TME, and Immune Checkpoint Genes (ICGs) were also individually explored to evaluate the prognosis predictive values in ccRCC. Microarray screenings identified 27 upregulated and 1 downregulated NPRGs. Ten overall survival associated NPRGs were filtered to construct the NPG prognostic model indicating a better prognostic signature for ccRCC patients with lower NPG scores (P< 0.001), which was verified using the external cohort. Univariate and multivariate analyses along with Kaplan-Meier survival analysis demonstrated that NPG score prognostic model could be applied as an independent prognostic factor, and AUC values of nomogram from 1- to 5- year overall survival with good agreement in calibration plots suggested that the proposed prognostic signature possessed good predictive capabilities in ccRCC. A high-/sNPG score is proven to be connected with tumor growth and immune-related biological processes, according to enriched GO, KEGG, and GSEA analyses. Comparing patients with a high-NPG score to those with a low-NPG score revealed significant differences in clinical characteristics, growth and recurrence of malignancies (CSC index), TME cell infiltration, and immunotherapeutic response (P< 0.005), potentially making the NPG score multifunctional in the clinical therapeutic setting. Furthermore, AIM2, CASP4, GSDMB, NOD2, and RBCK1 were also found to be highly expressed in ccRCC cell lines and tumor tissues, and GASP4 and GSDMB promote ccRCC cells' proliferation, migration, and invasion. This study firstly suggests that targeting the NPG score feature for TME characterization may lend novel insights into its clinical applications in the prognostic prediction of ccRCC.

  View details for DOI 10.3389/fimmu.2022.1021935

  View details for PubMedID 36248876

• Growth Kinetics and Progression Rate of Bosniak Classification, Version 2019 III and IV Cystic Renal Masses on Imaging Surveillance. AJR. American journal of roentgenology Tse, J. R., Shen, L., Shen, J., Yoon, L., Chung, B. I., Kamaya, A. 2022

  Abstract

  Background: Active surveillance is increasingly used as first-line management for localized renal masses. Triggers for intervention primarily reflect growth kinetics, which are poorly investigated for cystic masses defined by Bosniak classification version 2019 (v2019). Objective: To determine growth kinetics and incidence rates of progression of class III and IV cystic renal masses, as defined by Bosniak classification v2019. Methods: This retrospective study included 105 patients (68 men, 37 women; median age, 67 years) with 112 Bosniak v2019 class III or IV cystic renal masses on baseline renal-mass protocol CT or MRI examinations from January 2005 to September 2021. Mass dimensions were measured. Progression was defined as any of: linear growth rate (LGR) ≥5 mm per year (representing clinical guideline threshold for intervention), volume doubling time <1 year, T category increase, or N1 or M1 disease. Class III and IV masses were compared. Time-to-progression was estimated using Kaplan-Meier curve analysis. Results: At baseline, 58 masses were class III and 54 were class IV. Median follow-up was 406 days. Median LGR was for class III masses 0.0 mm per year [interquartile range (IQR) -1.3 to 1.8] and for class IV masses 2.3 mm per year (IQR 0.0¬¬-5.7) (p<.001). LGR exceeded 5 mm per year in 4 (7%) class 3 masses and 15 (28%) class IV masses (p=.005). Two patients, both with class IV masses, developed distant metastases. Incidence rate of progression was for class III masses 11.0 (95% CI 4.5-22.8) and for class IV masses 73.6 (95% CI 47.8-108.7) per 100,000 person-days of follow-up. Median time-to-progression was undefined for class III mases given small number of progression events and 710 days for class IV masses. Hazard ratio of progression for class IV relative to class III masses was 5.1 (95% CI 2.5-10.8) (p<.001). Conclusion: During active surveillance of cystic masses evaluated using Bosniak classification v2019, class IV masses grew faster and were more likely to progress than class III masses. Clinical Impact: In comparison with current active surveillance guidelines that treat class III and IV masses similarly, future iterations may incorporate relatively more intensive surveillance for class IV masses.

  View details for DOI 10.2214/AJR.22.27400

  View details for PubMedID 35293234

• Re: Preoperative Detection of Vesical Imaging-Reporting and Data System (VI-RADS) Score 5 Reliably Identifies Extravesical Extension of Urothelial Carcinoma of the Urinary Bladder and Predicts Significant Delayed Time to Cystectomy: Time to Reconsider the Need for Primary Deep Transurethral Resection of Bladder Tumour in Cases of Locally Advanced Disease? JOURNAL OF UROLOGY Del Giudice, F., Leonardo, C., Simone, G., Pecoraro, M., De Berardinis, E., Cipollari, S., Flammia, S., Bicchetti, M., Busetto, G., Chung, B., Gallucci, M., Catalano, C., Panebianco, V. 2022; 207 (1): 229

  View details for Web of Science ID 000729599700103

• Contemporary Trends of Systemic Neoadjuvant and Adjuvant Intravesical Chemotherapy in Patients With Upper Tract Urothelial Carcinomas Undergoing Minimally Invasive or Open Radical Nephroureterectomy: Analysis of US Claims on Perioperative Outcomes and Health Care Costs. Clinical genitourinary cancer Del Giudice, F., van Uem, S., Li, S., Vilson, F. L., Sciarra, A., Salciccia, S., Busetto, G. M., Maggi, M., Tiberia, L., Viscuso, P., Canale, V., Panebianco, V., Pecoraro, M., Ferro, M., Moschini, M., Krajewski, W., D'Andrea, D., Cacciamani, G. E., Mari, A., Soria, F., Porpiglia, F., Fiori, C., Amparore, D., Checcucci, E., Autorino, R., De Berardinis, E., Chung, B. I. 1800

  Abstract

  INTRODUCTION: New evidence indicates that minimally invasive surgery (MIS) (laparoscopic or robotic-assisted [LNU, RANU]) reaches oncologic equivalence compared with Open Radical Nephroureterectomy (ORNU) for high-risk upper-tract urothelial carcinoma (UTUC). Recently, European Association of Urology (EAU) Guidelines suggested implementing neoadjuvant chemotherapy (NAC) to standard treatment to improve oncologic outcomes of high-risk UTUC. We aimed (1) To explore contemporary trends of MIS for RNU in the United States and to compare perioperative outcomes and costs with that of ORNU. (2) To determine the trends of NAC and postoperative intravesical chemotherapy (PIC) administration for high-risk UTUC and to assess their contribution to perioperative outcomes and costs.PATIENTS AND METHODS: The Optum Clinformatics Data Mart de-identified database was queried from 2003 to 2018 to retrospectively examine patients who had undergone LNU/RANU or ORNU with or without NAC and PIC. We evaluated temporal adoption trends, complications, and health care cost analyses. We obtained descriptive statistics and utilized multivariable regression modeling to assess outcomes.RESULTS: A total of n=492 ORNU and n=1618 LNU/RANU procedures were reviewed. The MIS approach was associated with a statistically significant lower risk of intraoperative complications (adjusted Odds Ratio [aOR], 0.48, 95% CI:0.24-0.96), risk of hospitalization costs (aOR: 0.62, 95% CI:0.49-0.78), and shorter hospital stay (aOR: 0.20, 95% CI:0.15-0.26) when compared to ORNU. Overall, adoption of NAC and PIC accounted for only n=81 and n < 37 cases respectively. The implementation of NAC and higher number of cycles were associated with an increased probability of any complication rate (aOR: 2.06, 95% CI:1.26-3.36) and hospital costs (aOR: 2.12, 95% CI:1.33-3.38).CONCLUSION: MIS has become the approach of choice for RNU in the US. Although recommended by guidelines, neither NAC nor postoperative bladder instillation of chemotherapy has been routinely incorporated into the clinical practice of patients with UTUC.

  View details for DOI 10.1016/j.clgc.2021.11.016

  View details for PubMedID 35031226

• Association of statin use and oncological outcomes in patients with first diagnosis of T-1 high grade non-muscle invasive urothelial bladder cancer: results from a multicenter study MINERVA UROLOGY AND NEPHROLOGY Ferro, M., Marchioni, M., Lucarelli, G., Vartolomei, M. D., Soria, F., Terracciano, D., Mistretta, F. A., Luzzago, S., Buonerba, C., Cantiello, F., Mari, A., Minervini, A., Veccia, A., Antonelli, A., Musi, G., Hurle, R., Busetto, G. M., Del Giudice, F., Chung, B., Berardinelli, F., Perdona, S., Del Prete, P., Mirone, V., Borghesi, M., Porreca, A., Bove, P., Autorino, R., Crisan, N., Abu Farhan, A. R., Battaglia, M., Ditonno, P., Russo, G., Muto, M., Damiano, R., Manfredi, M., Porpiglia, F., De Cobelli, O., Schips, L. 2021; 73 (6): 796-802

  View details for DOI 10.23736/S2724-6051.20.04076-X

  View details for Web of Science ID 000754885200013

• Robotic-assisted radical cystectomy is associated with lower perioperative mortality in octogenarians. Urologic oncology Yu, A., Wang, Y., Mossanen, M., Preston, M., Carvalho, F. L., Chung, B. I., Chang, S. L. 2021

  Abstract

  OBJECTIVES: To compare perioperative outcomes between robotic and open radical cystectomy in octogenarians using real-world data SUBJECTS AND METHODS: Using the Premier Healthcare Database, we found 13,127 patients who underwent robotic-assisted radical cystectomy (RARC) between 2008 and 2017, of which 15.1% were ≥80 years old. Perioperative mortality was the primary outcome of interest. Secondary outcomes include complications, hospital length of stay, readmission rates, and disposition after discharge. Multivariable regression analysis was used to adjust for patient and hospital characteristics.RESULTS: In octogenarians, mortality at the index admission was 2.2% in those who underwent RARC, compared to 4.6% in those who underwent open surgery (P = 0.027). On multivariable analysis, robotic surgery was associated with lower in-hospital mortality in octogenarians (OR 0.46, 95% CI 0.22-0.99, P = 0.047) even after controlling for patient, and hospital characteristics.CONCLUSION: RARC is safe and feasible in octogenarians. Elderly patients may derive more benefit from minimally invasive radical cystectomy compared to a younger cohort.

  View details for DOI 10.1016/j.urolonc.2021.08.027

  View details for PubMedID 34602361

• EFFICACY OF THREE BCG STRAINS (CONNAUGHT, TICE AND RIVM) WITH OR WITHOUT SECONDARY RESECTION (RE-TUR) FOR INTERMEDIATE/HIGH-RISK NON-MUSCLE-INVASIVE BLADDER CANCERS: RESULTS FROM A RETROSPECTIVE SINGLE-INSTITUTION COHORT ANALYSIS Del Giudice, F., Busetto, G., Maggi, M., Sciarra, A., Salciccia, S., Falagario, U., Ferro, M., van Uem, S., Chung, B. I., Skinner, E. C., De Berardinis, E. LIPPINCOTT WILLIAMS & WILKINS. 2021: E119

  View details for Web of Science ID 000693688000230

• Deep Learning Improves Speed and Accuracy of Prostate Gland Segmentations on Magnetic Resonance Imaging for Targeted Biopsy JOURNAL OF UROLOGY Soerensen, S., Fan, R. E., Seetharaman, A., Chen, L., Shao, W., Bhattacharya, I., Kim, Y., Sood, R., Borre, M., Chung, B., To'o, K. J., Rusu, M., Sonn, G. A. 2021; 206 (3): 605-612

  View details for Web of Science ID 000711819100035

• Impact of inflammatory bowel disease on radical prostatectomy outcomes and costs of care PROSTATE INTERNATIONAL Goldberg, I. P., Chang, S. L., Kundu, S. D., Chung, B., Singer, E. A. 2021; 9 (2): 66-71

  View details for DOI 10.1016/j.prnil.2020.08.001

  View details for Web of Science ID 000663381000002

• Impact of inflammatory bowel disease on radical prostatectomy outcomes and costs of care. Prostate international Goldberg, I. P., Chang, S. L., Kundu, S. D., Chung, B. I., Singer, E. A. 2021; 9 (2): 66-71

  Abstract

  Recent studies suggest an association between prostate cancer and inflammatory bowel disease (IBD). Our objectives were to investigate clinical and financial impacts of IBD on radical prostatectomy (RP) and to determine the impact of surgical approach on our findings.The Premier Hospital Database was queried for patients who underwent RP from 2003 to 2017. Multivariable logistic regression models were used to determine the independent impact of IBD on complications and readmission rates. We determined 90-day readmissions and examined 90-day hospital costs adjusted to 2019 US dollars with multivariable quantile regression models.Our study population included 262,189 men with prostate cancer, including 3,408 (1.3%) with IBD. There were higher odds for any complication for IBD patients compared with non-IBD controls for RP (15.64% vs. 10.66%). Patients with IBD had overall complication rates of 14.1% (P < 0.05) for open surgery and 17.2% for minimally invasive surgery (MIS) (P < 0.01). Between 2013 and 2017, the IBD cohort had significantly more complications (odds ratios (ORs): 2; 95% confidence interval (CI): 1.5 to 2.67; P < 0.0001), was more likely to have surgical costs in the top quartile (OR: 1.6; 95% CI: 1.23 to 2.1; P < 0.01), and had higher readmission rates (OR: 1.51; 95% CI: 1.1 to 2.06; P = 0.01).The IBD cohort who underwent MIS had the highest complication rates. Hospital readmissions and surgical costs were significantly higher for the IBD cohort who underwent RP between 2013 and 2017, when a minimally invasive approach was more prevalent than an open approach. These findings may be important when deciding which surgical approach to take when performing RP on men with IBD.

  View details for DOI 10.1016/j.prnil.2020.08.001

  View details for PubMedID 34386447

  View details for PubMedCentralID PMC8322805

• Deep Learning Improves Speed and Accuracy of Prostate Gland Segmentations on MRI for Targeted Biopsy. The Journal of urology Soerensen, S. J., Fan, R. E., Seetharaman, A., Chen, L., Shao, W., Bhattacharya, I., Kim, Y., Sood, R., Borre, M., Chung, B. I., To'o, K. J., Rusu, M., Sonn, G. A. 2021: 101097JU0000000000001783

  Abstract

  PURPOSE: Targeted biopsy improves prostate cancer diagnosis. Accurate prostate segmentation on MRI is critical for accurate biopsy. Manual gland segmentation is tedious and time-consuming. We sought to develop a deep learning model to rapidly and accurately segment the prostate on MRI and to implement it as part of routine MR-US fusion biopsy in the clinic.MATERIALS AND METHODS: 905 subjects underwent multiparametric MRI at 29 institutions, followed by MR-US fusion biopsy at one institution. A urologic oncology expert segmented the prostate on axial T2-weighted MRI scans. We trained a deep learning model, ProGNet, on 805 cases. We retrospectively tested ProGNet on 100 independent internal and 56 external cases. We prospectively implemented ProGNet as part of the fusion biopsy procedure for 11 patients. We compared ProGNet performance to two deep learning networks (U-Net and HED) and radiology technicians. The Dice similarity coefficient (DSC) was used to measure overlap with expert segmentations. DSCs were compared using paired t-tests.RESULTS: ProGNet (DSC=0.92) outperformed U-Net (DSC=0.85, p <0.0001), HED (DSC=0.80, p< 0.0001), and radiology technicians (DSC=0.89, p <0.0001) in the retrospective internal test set. In the prospective cohort, ProGNet (DSC=0.93) outperformed radiology technicians (DSC=0.90, p <0.0001). ProGNet took just 35 seconds per case (vs. 10 minutes for radiology technicians) to yield a clinically utilizable segmentation file.CONCLUSIONS: This is the first study to employ a deep learning model for prostate gland segmentation for targeted biopsy in routine urologic clinical practice, while reporting results and releasing the code online. Prospective and retrospective evaluations revealed increased speed and accuracy.

  View details for DOI 10.1097/JU.0000000000001783

  View details for PubMedID 33878887

• A Biofeedback guided program or pelvic floor muscle electric stimulation can improve early recovery of urinary continence after radical prostatectomy: a meta-analysis and systematic review. International journal of clinical practice Sciarra, A., Viscuso, P., Arditi, A., Mariotti, G., De Berardinis, E., Di Pierro, G. B., Canale, V., Gentilucci, A., Busetto, G. M., Maggi, M., Eisenberg, M. L., Vilson, F., Chung, B. I., Ferro, M., Salciccia, S., Del Giudice, F. 2021: e14208

  Abstract

  PURPOSE: Urinary incontinence (UI) after radical prostatectomy (RP) is an early side effect after catheter removal. This systematic review and meta-analysis was conducted to compare different forms of non-invasive treatments for post-RP UI and to analyze whether the addition of biofeedback (BF) and/or pelvic floor muscle electric stimulation (PFES) to PF muscle exercise (PFME) alone can improve results in terms of continence recovery rate.MATERIALS AND METHODS: A literature search was performed following the PRISMA guidelines. We performed a cumulative meta-analysis to explore the trend in the effect sizes across subgroups during a 12-mo follow-up.RESULTS: 26 articles were selected. At baseline after RP and catheter removal, mean pad weight varied extremely. At 1- and 3-mo intervals, mean difference in pad weight recovery from baseline was significantly higher using guided programs (BF, PFES or both) than using PFME alone (3-mo: PFME 111.09 g (95%CI 77.59-144.59), BF 213.81 g (95%CI -80.51-508-13), PFES 306.88 g (95%CI 158.11-455.66), BF+PFES 266.31 g (95%CI 22.69-302.93); p<0.01), while at 6- and 12-mo differences were similar (p>0.04). At 1- and 3-mo intervals, event rate (ER) of continence recovery was significantly higher using guided programs than using PFME alone (3-mo: PFME 0.40 (95%CI 0.30-0.49), BF 0.49 (95%CI 0.31-0.67), PFES 0.57 (95%CI 0.46-0.69), BF+PFES 0.75 (95%CI 0.60-0.91); p<0.01), while at 6- and 12-mo ERs were similar.CONCLUSIONS: Regarding non-invasive treatment of UI secondary to RP, the addition of guided programs using BF or/and PFES demonstrated to improve continence recovery rate, particularly in the first 3-mo interval, when compared to the use of PFME alone.

  View details for DOI 10.1111/ijcp.14208

  View details for PubMedID 33811418

• Prevalence of Postprostatectomy Incontinence Requiring Anti-incontinence Surgery After Radical Prostatectomy for Prostate Cancer: A Retrospective Population-Based Analysis. International neurourology journal Kim, J. H., Jeong, I. G., Khandwala, Y. S., Hernandez-Boussard, T., Brooks, J. D., Chung, B. I. 2021

  Abstract

  Purpose: The aim of this study was to examine the prevalence of surgery for post-prostatectomy incontinence (PI) following minimally invasive surgery compared to conventional open surgery for prostate cancer.Methods: This retrospective cohort study used the Florida State Ambulatory Surgery and State Inpatient Databases, 2008 to 2010, RP patients were identified using ICD-9/10 procedure codes and among this cohort PI was identified also using ICD-9/10 codes. Surgical approaches included Minimally invasive (robotic or laparoscopic) vs. open (retropubic or perineal) RP. The primary outcome was the overall prevalence of surgery for PI. The secondary outcome was the association of PI requiring anti-incontinence surgery with the surgical approach for RP.Results: Among the 13535 patients initially included in the study (mean age, 63.3 years), 6932 (51.2%) underwent open RP and 6603 (49.8%) underwent minimally invasive RP. The overall prevalence of surgical procedures for PI during the observation period among the all patients who had received RP was 3.3%. The rate of PI surgery for patients receiving minimally invasive surgery was higher than that for patients receiving open surgery (4.8% vs. 3.0%; risk difference, 1.8%; 95% CI, 0.3% to 3.4%). The adjusted prevalence of PI surgery for patients who had undergone laparoscopic RP was higher than that for those with retropubic RP (8.6% vs. 3.7%).Conclusions: Among patients undergoing RP for prostate cancer, the prevalence of PI surgery is not negligible. Patients undergoing minimally invasive RP had higher adjusted rates for PI surgery compared to open approaches, which was attributed to high rate of PI surgery following laparoscopic approach and low rate of PI surgery following perineal approach. More studies are needed to establish strategies to reduce the rate of PI surgery after RP.

  View details for DOI 10.5213/inj.2040296.148

  View details for PubMedID 33705635

• Efficacy of three BCG strains (Connaught, TICE and RIVM) with or without secondary resection (re-TUR) for intermediate/high-risk non-muscle-invasive bladder cancers: results from a retrospective single-institution cohort analysis. Journal of cancer research and clinical oncology Del Giudice, F., Busetto, G. M., Gross, M. S., Maggi, M., Sciarra, A., Salciccia, S., Ferro, M., Sperduti, I., Flammia, S., Canale, V., Chung, B. I., Conti, S. L., Eisenberg, M. L., Skinner, E. C., De Berardinis, E. 2021

  Abstract

  PURPOSE: (I) To evaluate the clinical efficacy of three different BCG strains in patients with intermediate-/high-risk non-muscle-invasive bladder cancer (NMIBC). (II) To determine the importance of performing routine secondary resection (re-TUR) in the setting of BCG maintenance protocol for the three strains.METHODS: NMIBCs who received an adjuvant induction followed by a maintenance schedule of intravesical immunotherapy with BCG Connaught, TICE and RIVM. Only BCG-naive and those treated with the same strain over the course of follow-up were included. Cox proportional hazards model was developed according to prognostic factors by the Spanish Urological Oncology Group (CUETO) as well as by adjusting for the implementation of re-TUR.RESULTS: n=422 Ta-T1 patients (Connaught, n=146; TICE, n=112 and RIVM, n=164) with a median (IQR) follow-up of 72 (60-85) were reviewed. Re-TUR was associated with improved recurrence and progression outcomes (HRRFS: 0.63; 95% CI 0.46-0.86; HRPFS: 0.55; 95% CI 0.31-0.86). Adjusting for CUETO risk factors and re-TUR, BGC TICE and RIVM provided longer RFS compared to Connaught (HRTICE: 0.58, 95% CI 0.39-0.86; HRRIVM: 0.61, 95% CI 0.42-0.87) while no differences were identified between strains for PFS and CSS. Sub-analysis of only re-TUR cases (n=190, 45%) showed TICE the sole to achieve longer RFS compared to both Connaught and RIVM.CONCLUSION: Re-TUR was confirmed to ensure longer RFS and PFS in intermediate-/high-risk NMIBCs but did not influence the relative single BCG strain efficacy. When routinely performing re-TUR followed by a maintenance BCG schedule, TICE was superior to the other strains for RFS outcomes.

  View details for DOI 10.1007/s00432-021-03571-0

  View details for PubMedID 33675400

• Comparison of the clinical usefulness of different urinary tests for the initial detection of bladder cancer: a systematic review. Current urology Sciarra, A., Di Lascio, G., Del Giudice, F., Leoncini, P. P., Salciccia, S., Gentilucci, A., Porreca, A., Chung, B. I., Di Pierro, G., Busetto, G. M., De Berardinis, E., Maggi, M. 2021; 15 (1): 22-32

  Abstract

  Objectives: The standard initial approach in patients with hematuria or other symptoms suggestive of bladder cancer (BC) is a combination of cystoscopy and urine cytology (UC); however, UC has low sensitivity particularly in low-grade tumors. The aim of the present review was to critically analyze and compare results in the literature of promising molecular urinary tests for the initial diagnosis of BC.Methods: We searched in the Medline and Cochrane Library databases for literature from January 2009 to January 2019, following the PRISMAguidelines.Results: In terms of sensitivity, ImmunoCyt showed the highest mean and median value, higher than UC. All tests analyses showed higher mean and median sensitivity when compared with UC. In terms of specificity, only UroVysion and Microsatellite analyses showed mean and median values similar to those of UC, whereas for all other tests, the specificity was lower than UC. It is evident that the sensitivity of UC is particularly low in low grade BC. Urinary tests mainly had improved sensitivity when compared to UC, and ImmunoCyt and UroVysion had the highest improvement in low grade tumors.Conclusions: Most of the proposed molecular markers were able to improve the sensitivity with similar or lower specificity when compared to UC. However, variability of results among the different studies was strong. Thus, as of now, none of these markers presented evidences so as to be accepted by international guidelines for diagnosis of BC.

  View details for DOI 10.1097/CU9.0000000000000012

  View details for PubMedID 34084118

• Impact of inflammatory bowel disease on radical prostatectomy outcomes and costs of care. Goldberg, I., Chang, S., Kundu, S., Chung, B. I., Singer, E. A. LIPPINCOTT WILLIAMS & WILKINS. 2021

  View details for DOI 10.1200/JCO.2021.39.6_suppl.230

  View details for Web of Science ID 000636801500253

• Association of statin use and oncological outcomes in patients with first diagnosis of T1 high grade non-muscle invasive urothelial bladder cancer: results from a multicentre study. Minerva urologica e nefrologica = The Italian journal of urology and nephrology Ferro, M., Marchioni, M., Lucarelli, G., Dorin, V. M., Soria, F., Terracciano, D., Mistretta, F. A., Luzzago, S., Buonerba, C., Cantiello, F., Mari, A., Minervini, A., Veccia, A., Antonelli, A., Musi, G., Hurle, R., Busetto, G. M., Del Giudice, F., Chung, B. I., Berardinelli, F., Perdona, S., Del Prete, P., Mirone, V., Borghesi, M., Porreca, A., Bove, P., Autorino, R., Crisan, N., Abu Farhan, A. R., Battaglia, M., Ditonno, P., Russo, G. I., Muto, M., Damiano, R., Manfredi, M., Porpiglia, F., De Cobelli, O., Schips, L. 2021

  Abstract

  INTRODUCTION: We aimed to test the hypothesis that the immune-modulatory effect of statins may improve survival outcomes in patients with non-muscle invasive bladder cancer (NMIBC). We focused on a cohort of patients diagnosed with high risk NMIBC, that were treated with intravesical BCG immunotherapy.PATIENTS AND METHODS: We included patients at first diagnosis of T1 high grade NMIBC after transurethral resection of bladder (TURB). All procedures were performed at 18 different tertiary institutions between January 2002 and December 2012. Univariable and multivariable models were used to test differences in terms of residual tumour, disease recurrence, disease progression and overall mortality (OM) rates.RESULTS: Overall, 1510 patients with T1 high grade NMIBC at TURB were included in our analyses. Of these, 402 (26.6%) were statin users. At multivariable analysis, statin use was associated with a higher rates of high grade BC at re-TURB (OR: 1.37, 95%CI: 1.04-1.78; p=0.022), while at follow-up it was not independently associated with OM (HR: 0.71, 95%CI: 0.50-1.03; p=0.068) and disease progression rates (HR: 0.97, 95%CI: 0.79-1.19; p=0.753). Conversely, statin use has been shown to be independently associated with a lower risk of recurrence (HR:0.80, 95%CI: 0.67-0.95; p=0.009). The median recurrence-free survival was 47 (95%CI 40-49) months for those classified as non-statin users vs. 53 (95%CI 48-68) months in those classified as statin users.CONCLUSIONS: Statin daily intake do not compromise oncological outcomes in high risk NMIBC patients treated with BCG. Moreover, statin may have a beneficial effect on recurrence rates in this cohort of patients.

  View details for DOI 10.23736/S0393-2249.20.04076-X

  View details for PubMedID 33439571

• Impact of uni- or multifocal perineural invasion in prostate cancer at radical prostatectomy. Translational andrology and urology Sciarra, A., Maggi, M., Del Proposto, A., Magliocca, F. M., Ciardi, A., Panebianco, V., De Berardinis, E., Salciccia, S., Di Pierro, G. B., Gentilucci, A., Kasman, A. M., Chung, B. I., Ferro, M., de Cobelli, O., Del Giudice, F., Busetto, G. M., Gallucci, M., Frisenda, M. 2021; 10 (1): 66–76

  Abstract

  Background: Aim of this study was to correlate perineural invasion (PNI) with other clinical-pathological parameters in terms of prognostic indicators in prostate cancer (PC) cases at the time of radical prostatectomy (RP).Methods: Prospective study of 288 consecutive PC cases undergoing RP. PNI determination was performed either in biopsy or in RP specimens classifying as uni- and multifocal PNI. The median follow-up time was 22 (range, 6-36) months.Results: At biopsy PNI was found in 34 (11.8%) cases and in 202 (70.1%) cases at the time of surgery. Among those identified at RP 133 (46.1%) and 69 (23.9%) cases had uni- and multi-PNI, respectively. Presence of PNI was significantly (P<0.05) correlated with unfavorable pathological parameters such higher stage and grade. The percentage of extracapsular extension in PNI negative RP specimens was 18.6% vs. 60.4% of PNI positive specimens. However, the distribution of pathological staging and International Society of Urological Pathology (ISUP) grading did not vary according to whether PNI was uni- or multifocal. The risk of biochemical progression increased 2.3 times in PNI positive cases was significantly associated with the risk of biochemical progression (r=0.136; P=0.04). However, at multivariate analysis PNI was not significantly associated with biochemical progression [hazard ratio (HR): 1.87, 95% confidence interval (CI): 0.68-3.12; P=0.089]. Within patients with intermediate risk disease, multifocal PNI was able to predict cases with lower mean time to biochemical and progression free survival (chi-square 5.95; P=0.04).Conclusions: PNI at biopsy is not a good predictor of the PNI incidence at the time of RP. PNI detection in surgical specimens may help stratify intermediate risk cases for the risk of biochemical progression.

  View details for DOI 10.21037/tau-20-850

  View details for PubMedID 33532297

• ProGNet: Prostate Gland Segmentation on MRI with Deep Learning Soerensen, S., Fan, R., Seetharaman, A., Chen, L., Shao, W., Bhattacharya, I., Borre, M., Chung, B., To'o, K., Sonn, G., Rusu, M., Isgum, Landman, B. A. SPIE-INT SOC OPTICAL ENGINEERING. 2021

  View details for DOI 10.1117/12.2580448

  View details for Web of Science ID 000672800200091

• Prevalence of benign pathology after partial nephrectomy for suspected renal tumor: A systematic review and meta-analysis. International journal of surgery (London, England) Kim, J. H., Shim, S. R., Lee, H. Y., Park, J. J., Khandwala, Y., Jeong, I. G., Chung, B. I. 2020

  Abstract

  OBJECTIVE: To investigate the overall prevalence of benign pathology after partial nephrectomy (PN) and identify predictive factors for benign pathology after PN.METHODS: A systematic review was performed following the PRISMA guidelines. PubMed/Medline, Embase, and the Cochrane Library were searched up to January 2019PRISMA guidelines. The data for the meta-analysis and network meta-analysis were pooled using a random-effects model.RESULTS: There were 144 studies included in the final analysis, which was comprised of 79 observational studies (n = 37,300) and 65 comparative studies (n = 18,552). The overall prevalence rate of benign pathology after PN was 0.19 (95% CI: 0.18 - 0.21). According to the procedure types, the prevalence rate of benign pathology was 0.17 (95% CI: 0.15 - 0.19), 0.24 (95% CI: 0.22 - 0.27), and 0.16 (95% CI: 0.15 - 0.18) in open partial nephrectomy, laparoscopic partial nephrectomy, and robot-assisted laparoscopic partial nephrectomy, respectively. The significant moderating factors were gender, publication year, the origin of the study, and procedure types. The three most common benign pathology types were oncocytomas, angiomyolipomas, and renal cysts (44.50%, 30.20%, and 10.99%, respectively).CONCLUSIONS: The overall prevalence of benign pathology after PN was not low and it was affected by female gender, studies published before 2010, studies originating from Western areas, and laparoscopic procedure types.

  View details for DOI 10.1016/j.ijsu.2020.11.009

  View details for PubMedID 33220454

• Safety and Feasibility of Outpatient Surgery in Benign Prostatic Hyperplasia: a Systematic Review and Meta-analysis. Journal of endourology Salciccia, S., Del Giudice, F., Maggi, M., Eisenberg, M., Chung, B. I., Conti, S. L., Kasman, A., Vilson, F. L., Ferro, M., Lucarelli, G., Viscuso, P., Di Pierro, G., Busetto, G. M., Luzi, M., Sperduti, I., Ricciuti, G. P., De Berardinis, E., Sciarra, A. 2020

  Abstract

  PURPOSE: Most of endourological procedures along the urinary tract have been widely practiced as outpatient operations, including surgery for BPH. This systematic review and meta-analysis was conducted to assess safety and feasibility of outpatient surgery for patients suffering from symptomatic BPH candidate for endoscopic disobstruction.MATERIALS AND METHODS: PubMed, Web of Science, Cochrane, and Embase were searched up until March 30, 2020. MINORS tool was utilized to assess the quality of included studies and a pooled measure of failure or event rate (FR, ER) estimate was calculated. Further sensitivity analysis, subgroup analysis, and meta-regression were conducted to investigate contribution of moderators to heterogeneity.RESULTS: Twenty studies with a total of 1626 patients treated according to outpatient criteria for endoscopic BPH surgery were included. In total, 18 studies reporting data on immediate hospital readmission and/or inability to discharge after endoscopic procedure presented FR estimates ranging from 1.7% to 51.1%. Pooled FR estimate was 7.8% (95% confidence interval [CI]: 5.2%-10.3%); Heterogeneity: Q=76.85; d.f.=17, p<.001; I2= 75.12%. Subgroup analysis according to surgical technique revealed difference among the three approaches with pooled FR of 3% (95%CI: 1%-4.9%), 7.1% (95%CI: 3.9-10.4) and 11.8% (95%CI: 7-16.7%) for TURP, Green-light and HoLEP respectively (p<.001). At meta-regression analysis, none of the retrieved covariates were able to significantly influence the cumulative outcomes reported. ER for postoperative complications and early outpatient visit showed a pooled estimate of 18.6% (95%CI: 13.2%-23.9%) and 7.7% (95%CI: 4.3%-11%) respectively.CONCLUSIONS: Our analysis revealed how transurethral procedures for BPH on an outpatient setting are overall reliable and safe. Of note, there were significant outcome differences between groups with regard of type of surgical procedure, perioperative prostate volume and discharge protocol suggesting the need for further prospective analysis to better elucidate the best strategy in such outpatient conduct.

  View details for DOI 10.1089/end.2020.0538

  View details for PubMedID 33081521

• Systematic Review and Meta-Analysis of Vesical Imaging-Reporting and Data System (VI-RADS) Inter-Observer Reliability: An Added Value for Muscle Invasive Bladder Cancer Detection. Cancers Del Giudice, F., Pecoraro, M., Vargas, H. A., Cipollari, S., De Berardinis, E., Bicchetti, M., Chung, B. I., Catalano, C., Narumi, Y., Catto, J. W., Panebianco, V. 2020; 12 (10)

  Abstract

  The Vesical Imaging-Reporting and Data System (VI-RADS) has been introduced to provide preoperative bladder cancer staging and has proved to be reliable in assessing the presence of muscle invasion in the pre-TURBT (trans-urethral resection of bladder tumor). We aimed to assess through a systematic review and meta-analysis the inter-reader variability of VI-RADS criteria for discriminating non-muscle vs. muscle invasive bladder cancer (NMIBC, MIBC). PubMed, Web of Science, Cochrane, and Embase were searched up until 30 July 2020. The Quality Appraisal of Diagnostic Reliability (QAREL) checklist was utilized to assess the quality of included studies and a pooled measure of inter-rater reliability (Cohen's Kappa [kappa] and/or Intraclass correlation coefficients (ICCs)) was calculated. Further sensitivity analysis, subgroup analysis, and meta-regression were conducted to investigate the contribution of moderators to heterogeneity. In total, eight studies between 2018 and 2020, which evaluated a total of 1016 patients via 21 interpreting genitourinary (GU) radiologists, met inclusion criteria and were critically examined. No study was considered to be significantly flawed with publication bias. The pooled weighted mean kappa estimate was 0.83 (95%CI: 0.78-0.88). Heterogeneity was present among the studies (Q = 185.92, d.f. = 7, p < 0.001; I2 = 92.7%). Meta-regression analyses showed that the relative % of MIBC diagnosis and cumulative reader's experience to influence the estimated outcome (Coeff: 0.019, SE: 0.007; p= 0.003 and 0.036, SE: 0.009; p = 0.001). In the present study, we confirm excellent pooled inter-reader agreement of VI-RADS to discriminate NMIBC from MIBC underlying the importance that standardization and reproducibility of VI-RADS may confer to multiparametric magnetic resonance (mpMRI) for preoperative BCa staging.

  View details for DOI 10.3390/cancers12102994

  View details for PubMedID 33076505

• Patient factors predict complicationsafter partial nephrectomy: Validation and calibration of the PREP (Preoperative Risk Evaluation for Partial Nephrectomy) score. BJU international Huynh, M. J., Wang, Y., Joshi, M., Krasnow, R., Yu, A. X., Mossanen, M., Chung, B. I., Chang, S. L. 2020

  Abstract

  OBJECTIVES: To develop and validate the PREP (Preoperative Risk Evaluation for Partial Nephrectomy) score to predict the probability of major postoperative complications following partial nephrectomy (PN) based on patient comorbidities.PATIENTS AND METHODS: The Premier Healthcare Database was used to identify patients who had undergone elective PN. Through review of ICD-9 codes, we identified patient comorbidities and major surgical complications (Clavien grade 3-5). Multivariable logistic regression was used to identify predictors of major complications. We used half of the set as the training cohort to develop our risk score and the other half as a validation cohort.RESULTS: From 2003-2015, 25,451 PN were performed. The overall rate of major complications was 4.9%. The final risk score consisted of 10 predictors: age, sex, CHF, CAD, COPD, CKD, diabetes, hypertension, obesity, smoking. In the training cohort, the area under the receiver-operator characteristic curve (AUC) was 0.75 (95% CI 0.73-0.78), while the AUC for the validation cohort was 0.73 (95% CI 0.70-0.75). The predicted probabilities of major complication in the low risk (≤10 points), intermediate risk (11-20 points), high risk (21-30 points), and very high risk (>30 points) categories were 3% (95% CI 2.6-3.2), 8% (95% CI 7.2-9.2), 24% (95% CI 20.5-27.8), and 41% (95% CI 34.5-47.8) respectively.CONCLUSIONS: We developed and validated the PREP score to predict the risk of complications following PN based on patient characteristics. Calculation of the PREP score can help providers select treatment options for patients with a cT1a renal mass and enhance the informed consent process for patients planning to undergo PN.

  View details for DOI 10.1111/bju.15240

  View details for PubMedID 32920933

• An Examination of the Relationship between Mental Distress, Functional and Psychosocial Quality of Life Indicators in a Population Based Sample of Prostate Cancer Survivors Who Received Curative Treatment Comment UROLOGY PRACTICE Chung, B. 2020; 7 (5): 390

  View details for DOI 10.1097/UPJ.0000000000000104.02

  View details for Web of Science ID 000569064700018

• Editorial Commentary. Urology practice Chung, B. 2020; 7 (5): 390

  View details for DOI 10.1097/UPJ.0000000000000104.02

  View details for PubMedID 37296564

• Preoperative detection of VI-RADS (Vesical Imaging-Reporting and Data System) score 5 reliably identifies extravesical extension of urothelial carcinoma of the urinary bladder and predicts significant delayed time-to-cystectomy: time to reconsider the need for primary deep trans-urethral resection of bladder tumor in case of locally advanced disease? BJU international Del Giudice, F., Leonardo, C., Simone, G., Pecoraro, M., De Berardinis, E., Cipollari, S., Flammia, S., Bicchetti, M., Busetto, G. M., Chung, B. I., Gallucci, M., Catalano, C., Valeria, P. 2020

  Abstract

  OBJECTIVES: (I) To determine VI-RADS score 5 accuracy in predicting locally advanced bladder cancer (BCa) as to potentially identify those patients who could avoid the morbidity of deep TURBT in favor of histologic sampling-TUR prior to radical cystectomy (RC). (II) To explore the predictive value of VI-RADS score 5 on time-to-cystectomy (TTC) outcomes.PATIENTS AND METHODS: We retrospectively reviewed patients ineligible or refusing cisplatin-based combination neoadjuvant chemotherapy (NAC) who underwent multiparametric magnetic resonance imaging (mpMRI) of the bladder prior to staging TURBT followed by RC for muscle invasive BCa (MIBC). Sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated for VI-RADS category 5 vs. category 2-4 cases to assess the accuracy of mpMRI for extravesical BCa detection (≥pT3). VI-RADS score performance was assessed by receiver operating characteristics (ROC) curve analysis. A Ƙ statistic was calculated to estimate mpMRI and pathologic diagnostic agreement. The risk of delayed TTC (i.e. time from initial BCa diagnosis >3 months) was assessed using an adjusted multivariable logistic regression model.RESULTS: A total of 149 T2-T4a, cN0-M0 patients (VI-RADS score 5, n=39 vs. VI-RADS score 2-4, n=110) were examined. VI-RADS score 5 demonstrated sensitivity, specificity, PPV, and NPV, in detecting extravesical disease of 90.2% (95% confidence interval [CI]: 84-94.3), 98.1% (95% CI: 94-99.6), 94.9% (95%CI:89.6-97.6) and 96.4% (95% CI:91.6-98.6), respectively. The area under the curve (AUC) was 94.2% (95%CI: 88.7-99.7) and inter-reader agreement was excellent (Ƙinter:0.89). Mean TTC was 4.2 ± 2.3 and 2.8 ± 1.1 and months for score 5 vs. 2-4 respectively (p<.0001). VI-RADS score 5 was found to independently increase risk for delayed TTC (OR: 2.81, 95%CI: 1.20-6.62).CONCLUSION: VI-RADS is valid and reliable in differentiating patients with extravesical disease from those with muscle-confined, BCa before TURBT. Detection of VI-RADS score 5 was found to predict significant delay in TTC independently form other clinic-pathological features. In the future, higher VI-RADS scores could potentially avoid the morbidity of extensive primary resections in favor of sampling-TUR for histology. Further prospective, larger, and multi-institutional trials are required to validate clinical applicability of our findings.

  View details for DOI 10.1111/bju.15188

  View details for PubMedID 32783347

• Prospective assessment of two-gene urinary test with multiparametric magnetic resonance imaging of the prostate for men undergoing primary prostate biopsy. World journal of urology Busetto, G. M., Del Giudice, F., Maggi, M., De Marco, F., Porreca, A., Sperduti, I., Magliocca, F. M., Salciccia, S., Chung, B. I., De Berardinis, E., Sciarra, A. 2020

  Abstract

  PURPOSE: To evaluate the diagnostic accuracy of SelectMDx and its association with multiparametric magnetic resonance (mpMRI) in predicting prostate cancer (PCa) and clinically significant PCa (csPCa) on prostate biopsies among men scheduled for initial prostate biopsy.METHODS: In this single-center prospective study, 52 men scheduled for initial prostate biopsy, based on elevated total PSA level (>3ng/ml) or abnormal digital rectal examination, were consecutively included. All subjects underwent SelectMDx, PSA determination and mpMRI.RESULTS: SelectMDx score was positive in 94.1 and 100% of PCa and csPCa, respectively, and in only 8.6% of negative cases at biopsy. The probability for a csPCa at the SelectMDx score was significantly (p=0.002) higher in csPCa (median value 52.0%) than in all PCa (median value 30.0%). SelectMDx showed slightly lower sensitivity (94.1 versus 100.0%) but higher specificity (91.4%) than total PSA (17.1%), and the same sensitivity but higher specificity than mpMRI (80.0%) in predicting PCa at biopsy. The association of SelectMDx plus mpMRI rather than PSA density (PSAD) plus mpMRI showed higher specificity (both 91.4%) compared to the association of PSA plus mpMRI (85.7%). In terms of csPCa predictive value, SelectMDx showed higher specificity (73.3%) than PSA (13.3%) and mpMRI (64.4%); as for the association of SelectMDx plus mpMRI (75.6%) versus PSA plus mpMRI (68.9%), the association of PSAD plus mpMRI showed the highest specificity (80.0%).CONCLUSION: Our results of SelectMDx can be confirmed as significant but their impact on clinical practice together with a cost-effectiveness evaluation should be investigated in a larger prospective multicenter analysis.

  View details for DOI 10.1007/s00345-020-03359-w

  View details for PubMedID 32681273

• The cost of obesity in radical cystectomy. Urologic oncology Huynh, M. J., Wang, Y., Chang, S. L., Tully, K. H., Chung, B. I., Wright, J. L., Mossanen, M. 2020

  Abstract

  INTRODUCTION: The prevalence of obesity is on the rise in the Unites States, and obesity has been associated with increased complications and costs in a variety of complex surgeries. However, the contribution of obesity to the overall costs of radical cystectomy has not been studied in detail using contemporary data. Our objective is to assess the variation in healthcare costs due to obesity on the index hospitalization for radical cystectomy in the United States between 2003 and 2015.MATERIALS AND METHODS: This was a retrospective cohort study, using the Premier Healthcare Database, of 1,242 patients who underwent radical cystectomy and were either overweight (25  ≤  body mass index [BMI] < 30), obese (30  ≤  BMI < 40), or morbidly obese (BMI ≥ 40). The primary outcome costs of the index hospitalization for each BMI category. Multivariable median regression was used to identify drivers of increased costs.RESULTS: The cost of the index hospitalization for cystectomy was $24,596 (95% confidence interval [CI], $22,599-$26,592) for overweight patients. The costs for obese and morbidly obese patients were $2,158 (95% CI, -$80 to $4,395, P = 0.059) and $5,308 (95% CI, $2,652-$7,964, P < 0.001) higher compared to overweight patients, respectively. After adjustment for operative time or length of stay in the multivariable models, there were no longer any differences in cost. Operative time was prolonged as BMI increased (median operative time for overweight, obese, and morbidly obese: 346, 391, and 420 minutes, respectively P = 0.0001). Median length of stay was 1 day shorter for overweight vs. morbidly obese patients (P = 0.0030), with each additional day costing $1,738 (95% CI, $1,654 to $1,821, P < 0.0001) on multivariable analysis.CONCLUSIONS: The cost of radical cystectomy is greater for obese and morbidly obese patients compared to overweight patients. The increased financial cost is driven by increased operative times and longer length of stay.

  View details for DOI 10.1016/j.urolonc.2020.05.014

  View details for PubMedID 32620482

• Aggressive Paraganglioma of the Urinary Bladder with Local Recurrence and Pelvic Metastasis. Pathology oncology research : POR Yoo, K. H., Choi, T., Lee, H., Song, M. J., Chung, B. I. 2020

  Abstract

  Many pheochromocytoma and extra-adrenal paraganglioma are benign, but some are malignant. Pheochromocytoma of the Adrenal gland Scaled Score analyzed the histological characteristics of the tumor. Tumors with a Pheochromocytoma of the Adrenal gland Scaled Score of 4 or higher have a higher risk of recurrence. This pattern is thought to be applicable to paraganglioma as well, and to future patient follow-up efforts. We report a recurrent and metastatic paraganglioma of the urinary bladder.

  View details for DOI 10.1007/s12253-020-00841-z

  View details for PubMedID 32548698

• AUTHOR REPLY. Urology Huang, J. T., Cole, A. P., Mossanen, M., Preston, M. A., Wang, Y., Kibel, A. S., Chung, B. I., Huang, W. J., Chang, S. L. 2020; 140: 121

  View details for DOI 10.1016/j.urology.2020.01.051

  View details for PubMedID 32456860

• Testicular cancer in Hispanics: Incidence of subtypes over time according to neighborhood sociodemographic factors in California DeRouen, M. C., McKinley, M., Shah, S. A., Borno, H. T., Aoki, R., Lichtensztajn, D. Y., Leppert, J. T., Brooks, J. D., Chung, B., Gomez, S. L., Cheng, I. AMER ASSOC CANCER RESEARCH. 2020

  View details for DOI 10.1158/1538-7755.DISP19-C053

  View details for Web of Science ID 000580647800288

• Association of renal cell carcinoma subtypes with race/ethnicity and comorbid medical conditions Lichtensztajn, D. Y., Hofer, B. M., Leppert, J. T., Brooks, J. D., Chung, B., Shah, S. A., DeRouen, M. C., Gomez, S. L., Cheng, I. AMER ASSOC CANCER RESEARCH. 2020

  View details for DOI 10.1158/1538-7755.DISP19-PR16

  View details for Web of Science ID 000580647800537

• Testicular cancer in Hispanics: incidence of subtypes over time according to neighborhood sociodemographic factors in California. Cancer causes & control : CCC DeRouen, M. C., McKinley, M., Shah, S. A., Borno, H. T., Aoki, R., Lichtensztajn, D. Y., Leppert, J. T., Brooks, J. D., Chung, B. I., Gomez, S. L., Cheng, I. 2020

  Abstract

  PURPOSE: Hispanic men in the USA experience the second-highest incidence rate of testicular germ cell tumors (TGCTs), behind non-Hispanic (NH) White men, and have experienced steep increases in TGCT in recent decades. It is unknown whether increases in incidence differ according to neighborhood sociodemographic factors.METHODS: We conducted a population-based study of n=3759 Hispanic and n=8469 NH White men (n=12,228 total) diagnosed with TGCT in California during the three most recent pericensal periods. We calculated incidence rates according to neighborhood socioeconomic status (nSES) and among Hispanics, according to ethnic enclave. We calculated incidence rate ratios to compare rates across nSES and ethnic enclave and to examine changes in rates over pericensal time periods according to these neighborhood factors for major histologic types (i.e., seminoma and nonseminoma).RESULTS: Hispanic men residing in high SES, compared to low SES, neighborhoods had greater incidence of seminoma and nonseminoma testicular cancer across pericensal periods, as did Hispanic men in low enclave (less ethnic), compared to high enclave, neighborhoods. Between the periods 1998-2002 and 2008-2012, Hispanic men residing in low SES neighborhoods experienced a 39% increased incidence of seminoma, while those residing in low and middle SES neighborhoods experienced 87% and 48% increased incidence of nonseminoma, respectively.CONCLUSION: While TGCT incidence has increased among all Hispanic men, incidence increases appear to be driven disproportionately by those residing in lower SES and lower enclave neighborhoods, particularly for nonseminoma.

  View details for DOI 10.1007/s10552-020-01311-2

  View details for PubMedID 32440828

• Identification of Quality Improvement Projects from AUA White Papers UROLOGY PRACTICE Gretzer, M., Greene, K., Chung, B., Kobashi, K. 2020; 7 (2): 103–7

  View details for DOI 10.1097/UPJ.0000000000000098

  View details for Web of Science ID 000525456700005

• Reply by Authors. Urology practice Gretzer, M., Greene, K., Chung, B., Kobashi, K. 2020; 7 (2): 108

  View details for DOI 10.1097/UPJ.0000000000000098.02

  View details for PubMedID 37317425

• Identification of Quality Improvement Projects from AUA White Papers. Urology practice Gretzer, M., Greene, K., Chung, B., Kobashi, K. 2020; 7 (2): 103-108

  Abstract

  Health care professionals often lack training in quality improvement methods, which makes it challenging to participate in improvement efforts.Following a review of the recently published AUA (American Urological Association) white papers on "Optimizing Outcomes in Urologic Surgery" a detailed list of potential quality improvement projects was created as our AUA Leadership Program project.In this article we familiarize the reader with basic tools used in quality improvement project development and the components of quality initiative planning required for implementation of a sample of the identified projects in clinical practice. The projects identified are derived from the areas highlighted in the AUA white papers addressing preoperative, intraoperative and postoperative considerations for quality and safety.We anticipate that this information will be useful for students, residents and practicing urologists to expand their involvement in quality improvement and build multidisciplinary projects based on the work the AUA has already done in this area.

  View details for DOI 10.1097/UPJ.0000000000000098

  View details for PubMedID 37317440

• Cost-effectiveness of dual-energy CT versus multiphasic single-energy CT and MRI for characterization of incidental indeterminate renal lesions. Abdominal radiology (New York) Patel, B. N., Boltyenkov, A. T., Martinez, M. G., Mastrodicasa, D., Marin, D., Jeffrey, R. B., Chung, B., Pandharipande, P., Kambadakone, A. 2020

  Abstract

  PURPOSE: To evaluate the cost-effectiveness of DECT versus multiphasic CT and MRI for characterizing small incidentally detected indeterminate renal lesions using a Markov Monte Carlo decision-analytic model.BACKGROUND: Incidental renal lesions are commonly encountered due to the increasing utilization of medical imaging and the increasing prevalence of renal lesions with age. Currently recommended imaging modalities to further characterize incidental indeterminate renal lesions have some inherent drawbacks. Single-phase DECT may overcome these limitations, but its cost-effectiveness remains uncertain.MATERIALS AND METHODS: A decision-analytic (Markov) model was constructed to estimate life expectancy and lifetime costs for otherwise healthy 64-year-old patients with small (≤4cm) incidentally detected, indeterminate renal lesions on routine imaging (e.g., ultrasound or single-phase CT). Three strategies for evaluating renal lesions for enhancement were compared: multiphase SECT (e.g., true unenhanced and nephrographic phase), multiphasic MRI, and single-phase DECT (nephrographic phase in dual-energy mode). The model incorporated modality-specific diagnostic test performance, incidence, and prevalence of incidental renal cell carcinomas (RCCs), effectiveness, costs, and health outcomes. An incremental cost-effectiveness analysis was performed to identify strategy preference at willingness-to-pay (WTP) thresholds of $50,000 and $100,000 per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analysis were performed.RESULTS: In the base case analysis, expected mean costs per patient undergoing characterization of incidental renal lesions were $2567 for single-phase DECT, $3290 for multiphasic CT, and $3751 for multiphasic MRI. Associated quality-adjusted life-years were the highest for single-phase DECT at 0.962, for multiphasic MRI it was 0.940, and was the lowest for multiphasic CT at 0.925. Because of lower associated costs and higher effectiveness, the single-phase DECT strategy dominated the other two strategies.CONCLUSIONS: Single-phase DECT is potentially more cost-effective than multiphasic SECT and MRI for evaluating small incidentally detected indeterminate renal lesions.

  View details for DOI 10.1007/s00261-019-02380-x

  View details for PubMedID 31894384

• Contemporary trends in percutaneous renal mass biopsy utilization in the United States. Urologic oncology Ozambela, M. n., Wang, Y. n., Leow, J. J., Silverman, S. G., Chung, B. I., Chang, S. L. 2020

  Abstract

  Patients with a renal mass traditionally proceed directly to surgery without a preoperative tissue diagnosis confirming malignancy. Many surgically treated renal masses represent benign tumors or indolent malignancies on final pathology. This has led to a growing body of literature supporting an expanded role for percutaneous renal mass biopsy (RMB). This study aims to characterize national trends in RMB utilization.Patients undergoing renal biopsy during a 12-year period (2006-2017) in the Premier Hospital Database were captured using International Classification of Diseases, Ninth Revision and Tenth Revision codes. We restricted our analysis to patients with a concurrent diagnosis of a renal mass. We determined utilization rate, subsequent interventions within 90 days of biopsy, predictors of RMB, and 30-day RMB complication rates. We applied sampling weights and adjusted for hospital clustering to achieve a nationally representative analysis.Among 115,511 patients who met the inclusion criteria, the annual number of RMB rose from 7,196 in 2006 to 11,528 in 2017; during this period, more than 3 times as many patients proceeded directly to surgery without a prior RMB. After RMB, 85,848 (74.32%) patients were not treated within 90 days. Of those treated, thermal ablation was more common than surgery (17,269 vs. 12,394). Trend analysis showed that patients with metastatic disease represented a decreasing proportion of patients receiving RMB (27.0%-21.8%; P < 0.001). Compared to patients who proceeded directly to surgery, RMB was more commonly performed in patients in the highest age group (80 years and older, 15.9% vs. 9.2%), unmarried (50% vs. 45.9%), with more medical comorbidities (Charlson comorbidity index ≥4, 30.9% vs. 17.4%), or with metastatic disease (24.5% vs. 10.4%). Multivariable regression analysis determined the primary predictor of RMB was the presence of metastatic disease. Hematuria was the most common complication present in 5.18% of patients followed by pneumothorax in 1.75%. All other complications were rare (<0.4%).Although there has been progressive adoption of RMB for the management of renal masses in the United States, utilization remains relatively limited and differentially employed across the population based on both clinical and nonclinical patient factors. More research is needed to understand which factors are considered when determining whether to utilize RMB in the evaluation of a renal mass.

  View details for DOI 10.1016/j.urolonc.2020.07.022

  View details for PubMedID 32912815

• Delayed blood transfusion is associated with mortality following radical cystectomy. Scandinavian journal of urology Tan, W. S., Wang, Y. n., Trinh, Q. D., Preston, M. A., Kelly, J. D., Hrouda, D. n., Kibel, A. S., Krasnow, R. E., Liu, J. J., Chung, B. I., Chang, S. L., Mossanen, M. n. 2020: 1–7

  Abstract

  Objectives: To examine the temporal association between blood transfusion and 90-day mortality in patients with bladder cancer treated with radical cystectomy.Methods: This represents a retrospective cohort study of patients treated with radical cystectomy within the Premier Hospital network between 2003 and 2015. Patients outcomes were stratified those who received early blood transfusion (day of surgery) vs delayed blood transfusion (postoperative day ≥1) during the index admission. Primary end point was 90-day mortality following surgery.Results: The median age of 12,056 patients identified was 70 years. A total of 7,201 (59.7%) patients received blood transfusion. Within 90 days following surgery, 57 (2.2%), 162 (5.9%) and 123 (6.7%) patients in the early, delayed and both early and delayed transfused patients died respectively. Following multivariate logistic regression to account for patient (age and Charlson Comorbidity Index [CCI]) and hospital (surgeon volume, surgical approach and academic status) factors, delayed blood transfusion was independently associated with 90-day mortality (Odds ratio [OR], 2.64; 95% Confidence Interval [CI], 1.98-3.53; p < 0.001). A sensitivity analysis defining early blood transfusion as <2 days postoperatively, increased 90-day mortality persisted in patients receiving delayed transfusion (OR, 2.20; 95% CI, 1.63-3.00; p < 0.001). Older patients (≥77 years) with the highest CCI (≥2) had a 7% absolute increase in the predicted probability of 90-day mortality if they were transfused late compared to patients transfused early.Conclusion: Patient undergoing cystectomy may benefit from expedited transfusion to prevent subsequent clinical deterioration which may lead to patient mortality. Future work is needed to elucidate the optimal timing of blood transfusion.

  View details for DOI 10.1080/21681805.2020.1777195

  View details for PubMedID 32538224

• Alvimopan is Associated with a Reduction in Length of Stay and Hospital Costs for Patients Undergoing Radical Cystectomy. Urology Huang, J. T., Cole, A. P., Mossanen, M. n., Preston, M. A., Wang, Y. n., Kibel, A. S., Chung, B. I., Huang, W. J., Chang, S. L. 2020

  Abstract

  To evaluate the impact of alvimopan in patient undergoing radical cystectomy (RC) for bladder cancer. We hypothesize that alvimopan can decrease cost for RC by reducing length of stay (LOS).We identified patients who underwent elective RC for bladder cancer from 2009 to 2015 in the Premier Healthcare Database, a nationwide, all-payer hospital-based database, and compared patients who received and did not receive alvimopan in the perioperative period. Hospitals that had no record of administering alvimopan for patients undergoing RC were excluded. The primary outcomes were LOS and the direct hospital costs. The secondary outcomes were 90-day readmission for ileus and major complications.After applying the inclusion criteria, the study cohort consisted of 1087 patients with 511 patients receiving perioperative alvimopan. Alvimopan was associated with a reduction in hospital costs by -$2,709 (95%CI: -$4,507 to -$912, p=0.003), decreased median LOS (7 vs 8 days, p<0.001), and lower likelihood of readmission for ileus (adjusted OR: 0.63, p=0.041). While alvimopan use led to higher pharmacy costs, this was outweighed by lower room and board costs due to the reduced LOS. There was no significant difference between two groups regarding major complications. These results were robust across multiple adjusted regression models.Our data show that alvimopan is associated with a substantial cost-saving in patients undergoing radical cystectomy, and suggest that routine use of alvimopan may be a potential cost-effective strategy to reduce the overall financial burden of bladder cancer.

  View details for DOI 10.1016/j.urology.2020.01.049

  View details for PubMedID 32268172

• Circulating preoperative testosterone level predicts unfavourable disease at radical prostatectomy in men with International Society of Urological Pathology Grade Group 1 prostate cancer diagnosed with systematic biopsies. World journal of urology Ferro, M. n., Lucarelli, G. n., de Cobelli, O. n., Vartolomei, M. D., Damiano, R. n., Cantiello, F. n., Crocerossa, F. n., Perdonà, S. n., Del Prete, P. n., Cordima, G. n., Musi, G. n., Del Giudice, F. n., Busetto, G. M., Chung, B. I., Porreca, A. n., Ditonno, P. n., Battaglia, M. n., Terracciano, D. n. 2020

  Abstract

  The association between circulating total testosterone (T) levels and clinically significant PCa is still a matter of debate. In this study, we evaluated whether serum testosterone levels may have a role in predicting unfavorable disease (UD) and biochemical recurrence (BCR) in patients with clinically localized (≤ cT2c) ISUP grade group 1 PCa at biopsy.408 patients with ISUP grade group 1 prostate cancer, undergone to radical prostatectomy and T measurement were included. The outcome of interest was the presence of unfavourable disease (UD) defined as ISUP grade group [Formula: see text] 3 and/or pT [Formula: see text] 3a.Statistically significant differences resulted between serum testosterone values and ISUP grade groups (P < 0.0001). Significant correlation was found analyzing testosterone values versus age (P < 0.0001), and versus PSA (P = 0.008). BCR-free survival was significantly decreased in patients with low levels of testosterone (P = 0.005). These findings were confirmed also in the ISUP 1-2 subgroups (P = 0.01). ROC curve analysis showed that T outperformed PSA in predicting UD (AUC 0.718 vs AUC 0.525; P < 0.001) and was and independent risk factor for BCR.Our findings suggested that circulating total T was a significant predictor of UD at RP in patients with preoperative low- to intermediate-risk diseases, confirming the potential role of circulating androgens in preoperative risk assessment of PCa patients.

  View details for DOI 10.1007/s00345-020-03368-9

  View details for PubMedID 32683462

• Urinary Stone Disease in Pregnancy: Current Management Practices in a Large National Cohort. Urology Spradling, K. n., Sohlberg, E. M., Li, S. n., Zhang, C. A., Brubaker, W. D., Dallas, K. n., Pao, A. C., Liao, J. n., Leppert, J. T., Elliott, C. S., Chung, B. I., Min, G. E., Conti, S. L. 2020

  Abstract

  To define current national practice patterns of imaging modalities and urologic procedures in pregnant women with urinary stone disease.Using the IBM® MarketScan® national insurance claims database, we identified pregnant women with urinary stone disease and their corresponding gestational age between 2011-2016 using administrative claims data. We then assessed each encounter for urinary stone disease or stone-related urologic procedure during their pregnancy. We abstracted demographic information as well as codes for stone procedures and imaging.We identified 14,298 pregnant women with urinary stone disease during the study period. Of the 12,315 undergoing abdominal imaging (86.1%), magnetic resonance imaging (MRI) in 2.8%, x-ray in 9%, and ultrasound in 74.3%. Computed tomography was not used as a diagnostic modality during pregnancy. Procedural intervention was performed in 749 women (5.2%): 476 (3.3%) ureteral stent placement without definitive stone treatment, 93 (0.6%) percutaneous nephrostomy placement, and 180 (1.3%) ureteroscopy (URS) for definitive stone treatment. URS was most commonly performed before 34 weeks gestation with only 27 cases (15%) performed after.This large national cohort reveals the current imaging and procedural practice patterns for urinary stone disease during pregnancy and provides a critical baseline as these practice patterns evolve in the future.

  View details for DOI 10.1016/j.urology.2020.03.050

  View details for PubMedID 32311447

• Postoperative vacuum therapy following AMS (TM) LGX 700 (R) inflatable penile prosthesis placement: penile dimension outcomes and overall satisfaction INTERNATIONAL JOURNAL OF IMPOTENCE RESEARCH Antonini, G., De Berardinis, E., Busetto, G., Del Giudice, F., Chung, B., Conti, S. L., Ferro, M., Musi, G., Fragas, R., De Cobelli, O., Sperduti, I., Gross, M. S., Perito, P. E. 2020; 32 (1): 133–39

  View details for DOI 10.1038/s41443-019-0125-z

  View details for Web of Science ID 000509912200020

• Practice Pattern of Redo Varicocelectomy for Recurrent Varicocele according to Type of Initial Treatment: Retrospective Analysis of a United States-Based Insurance Claims Database. The world journal of men's health Park, H. K., Min, G. E., Chung, K. J., Li, S. n., Choi, W. S., Chung, B. I. 2020

  Abstract

  The objective of this study was to investigate the type of redo varicocelectomy according to the initial surgery type using a large population of USA insurance data.This is a retrospective observational cohort study. Administrative claims data were extracted from the IBM® MarketScan Research Database. We included all newly diagnosed patients with varicocele from January 2007 to December 2014 using International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes. The treatment methods were identified by Current Procedural Terminology (CPT) code.A total of 261,785 subjects were diagnosed with varicocele. Of these, a total of 19,800 (7.6%) patients underwent varicocele surgery. Inguinal, abdominal, laparoscopic, microsurgery, and embolization surgery were performed in 66%, 19%, 10%, 3%, and 2%, respectively, as initial treatment. A total of 340 patients (1.7%) underwent redo varicocele surgery. Inguinal, microscopic, embolization, abdominal, and laparoscopic surgery were used as the redo method in 43%, 25%, 16%, 8%, and 7%, respectively. The redo inguinal approach was the preferred method in patients who first underwent inguinal, abdominal, and laparoscopic surgery, but not in patients who underwent microscopic or embolization procedures. Most patients who initially underwent microscopic varicocelectomy or embolization underwent redo varicocelectomy using the same method.Compared to the type of initial varicocelectomy, there were changes in the proportion of each type of surgical approach in redo operation procedures. While inguinal varicocelectomy is the most common method in redo operations, the number of microscopic varicocelectomy or embolization procedures is significantly increased in redo surgery.

  View details for DOI 10.5534/wjmh.190170

  View details for PubMedID 32648378

• Body mass index and age correlate with antioxidant supplementation effects on sperm quality: Post hoc analyses from a double-blind placebo-controlled trial. Andrologia Busetto, G. M., Del Giudice, F. n., Virmani, A. n., Sciarra, A. n., Maggi, M. n., Ferro, M. n., Porreca, A. n., Chung, B. I., Agarwal, A. n., De Berardinis, E. n. 2020: e13523

  Abstract

  Spermatozoa are vulnerable to lack of energy and oxidative stress as a result of elevated levels of reactive oxygen species. Therefore, it is essential that appropriate nutrients are available during maturation. This randomised, double-blind, placebo-controlled trial investigated the effect of 6-month supplementation with carnitines and other micronutrients on sperm quality in 104 subjects with oligo- and/or astheno- and/or teratozoospermia with or without varicocele. Semen analyses were done at the beginning and end of the treatment. In addition to main analyses, post hoc analyses for age and body mass index (BMI) were carried out. Results were interpreted by dividing the population into two age and BMI classes. In 94 patients who completed the study, all sperm parameters increased in supplemented patients compared to the placebo group. A significant (p = .0272) difference in supplementation efficacy was observed for total motility on patients with varicocele and BMI < 25. In the same group, also the progressive motility was significantly superior (p = .0159). For Responder analysis, total motility results were confirmed in both the cited group (p = .0066) and in the varicocele group with BMI < 25 and age < 35 (p = .0078). This study suggests that supplementation is more effective in subjects with varicocele younger than 35 years with BMI < 25.

  View details for DOI 10.1111/and.13523

  View details for PubMedID 32017167

• Racial disparities in analgesic use amongst patients presenting to the emergency department for kidney stones in the United States. The American journal of emergency medicine Berger, A. J., Wang, Y. n., Rowe, C. n., Chung, B. n., Chang, S. n., Haleblian, G. n. 2020

  Abstract

  We sought quantify racial disparities in use of analgesia amongst patients seen in Emergency Departments for renal colic.We identified all individuals presenting to the Emergency Department with urolithiasis from 2003 to 2015 in the nationally representative Premier Hospital Database. We included patients discharged in ≤1 day and excluded those with chronic pain or renal insufficiency. We assessed the relationship between race/ethnicity and opioid dosage in morphine milligram equivalents (MME), and ketorolac, through multivariable regression models adjusting for patient and hospital characteristics.The cohort was 266,210 patients, comprised of White (84%), Black (6%) and Hispanic (10%) individuals. Median opioid dosage was 20 MME and 55.5% received ketorolac. Our adjusted model showed Whites had highest median MME (20 mg) with Blacks (-3.3 mg [95% CI: -4.6 mg to -2.1 mg]) and Hispanics (-6.0 mg [95% CI: -6.9 mg to -5.1 mg]) receiving less. Blacks were less likely to receive ketorolac (OR: 0.72, 95% CI: 0.62-0.84) while there was no difference between Whites and Hispanics.Black and Hispanic patients in American Emergency Departments with acute renal colic receive less opioid medication than White patients; Black patients are also less likely to receive ketorolac.

  View details for DOI 10.1016/j.ajem.2020.01.017

  View details for PubMedID 31987745

• Extracting Patient-Centered Outcomes from Clinical Notes in Electronic Health Records: Assessment of Urinary Incontinence After Radical Prostatectomy. EGEMS (Washington, DC) Gori, D., Banerjee, I., Chung, B. I., Ferrari, M., Rucci, P., Blayney, D. W., Brooks, J. D., Hernandez-Boussard, T. 2019; 7 (1): 43

  Abstract

  Objective: To assess documentation of urinary incontinence (UI) in prostatectomy patients using unstructured clinical notes from Electronic Health Records (EHRs).Methods: We developed a weakly-supervised natural language processing tool to extract assessments, as recorded in unstructured text notes, of UI before and after radical prostatectomy in a single academic practice across multiple clinicians. Validation was carried out using a subset of patients who completed EPIC-26 surveys before and after surgery. The prevalence of UI as assessed by EHR and EPIC-26 was compared using repeated-measures ANOVA. The agreement of reported UI between EHR and EPIC-26 was evaluated using Cohen's Kappa coefficient.Results: A total of 4870 patients and 716 surveys were included. Preoperative prevalence of UI was 12.7 percent. Postoperative prevalence was 71.8 percent at 3 months, 50.2 percent at 6 months and 34.4 and 41.8 at 12 and 24 months, respectively. Similar rates were recorded by physicians in the EHR, particularly for early follow-up. For all time points, the agreement between EPIC-26 and the EHR was moderate (all p < 0.001) and ranged from 86.7 percent agreement at baseline (Kappa = 0.48) to 76.4 percent agreement at 24 months postoperative (Kappa = 0.047).Conclusions: We have developed a tool to assess documentation of UI after prostatectomy using EHR clinical notes. Our results suggest such a tool can facilitate unbiased measurement of important PCOs using real-word data, which are routinely recorded in EHR unstructured clinician notes. Integrating PCO information into clinical decision support can help guide shared treatment decisions and promote patient-valued care.

  View details for DOI 10.5334/egems.297

  View details for PubMedID 31497615

• Examining the relationship between complications and perioperative mortality following radical cystectomy: a population-based analysis BJU INTERNATIONAL Mossanen, M., Krasnow, R. E., Zlatev, D. V., Tan, W., Preston, M. A., Trinh, Q., Kibel, A. S., Sonpavde, G., Schrag, D., Chung, B. I., Chang, S. L. 2019; 124 (1): 40–46

  View details for DOI 10.1111/bju.14636

  View details for Web of Science ID 000471830900010

• Letter to the Editor RE: Srougi et al., Septic Shock Following Surgical Decompression of Obstructing Ureteral Stones: A Prospective Analysis (From: Srougi V, Moscardi PR, Marchini GS, et al. J Endourol 2017;32:446-450; DOI: 10.1089/end.2017.0896) JOURNAL OF ENDOUROLOGY Yoo, K., Min, G., Lee, H., Chung, B. 2019

  View details for DOI 10.1089/end.2019.0128

  View details for Web of Science ID 000475257300001

• Hospital Charges for Urologic Surgery Episodes of Care Are Rising Despite Declining Costs MAYO CLINIC PROCEEDINGS McClintock, T. R., Wang, Y., Shah, M. A., Mossanen, M., Chung, B. I., Chang, S. L. 2019; 94 (6): 995–1002

  View details for DOI 10.1016/j.mayocp.2019.02.008

  View details for Web of Science ID 000470060400015

• Re: Timu J. Murtola, Hemo Syvala, Teemu Tolonen, et al. Atorvastatin Versus Placebo for Prostate Cancer Before Radical Prostatectomy-A Randomized, Double-blind, Placebo-controlled Clinical Trial. Eur Urol 2018;74:697-701 EUROPEAN UROLOGY Kim, J., Chung, B. I. 2019; 75 (6): E164–E165

  View details for DOI 10.1016/j.eururo.2019.01.042

  View details for Web of Science ID 000467916500006

• Change of Trends in the Treatment Modality for Pediatric Nephrolithiasis: Retrospective Analysis of a US-Based Insurance Claims Database JOURNAL OF ENDOUROLOGY Park, H., Kim, J., Min, G., Choi, W., Li, S., Chung, K., Chung, B. I. 2019: 1–5

  View details for DOI 10.1089/end.2019.0154

  View details for Web of Science ID 000469289300001

• Point Shear Wave Elastography Using Machine Learning to Differentiate Renal Cell Carcinoma and Angiomyolipoma. Ultrasound in medicine & biology Sagreiya, H., Akhbardeh, A., Li, D., Sigrist, R., Chung, B. I., Sonn, G. A., Tian, L., Rubin, D. L., Willmann, J. K. 2019

  Abstract

  The question of whether ultrasound point shear wave elastography can differentiate renal cell carcinoma (RCC) from angiomyolipoma (AML) is controversial. This study prospectively enrolled 51 patients with 52 renal tumors (42 RCCs, 10 AMLs). We obtained 10 measurements of shear wave velocity (SWV) in the renal tumor, cortex and medulla. Median SWV was first used to classify RCC versus AML. Next, the prediction accuracy of 4 machine learning algorithms-logistic regression, naive Bayes, quadratic discriminant analysis and support vector machines (SVMs)-was evaluated, using statistical inputs from the tumor, cortex and combined statistical inputs from tumor, cortex and medulla. After leave-one-out cross validation, models were evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). Tumor median SWV performed poorly (AUC = 0.62; p = 0.23). Except logistic regression, all machine learning algorithms reached statistical significance using combined statistical inputs (AUC = 0.78-0.98; p < 7.1 * 10-3). SVMs demonstrated 94% accuracy (AUC = 0.98; p = 3.13 * 10-6) and clearly outperformed median SWV in differentiating RCC from AML (p = 2.8 * 10-4).

  View details for DOI 10.1016/j.ultrasmedbio.2019.04.009

  View details for PubMedID 31133445

• Bisphosphonate use and risk of renal cell carcinoma: A population-based case-control study BASIC & CLINICAL PHARMACOLOGY & TOXICOLOGY Chung, B. I., Hellfritzsch, M., Ulrichsen, S. P., Sorensen, H. T., Ehrenstein, V. 2019; 124 (5): 642–46

  View details for DOI 10.1111/bcpt.13180

  View details for Web of Science ID 000465187300015

• Changing Trends in the Treatment of Nephrolithiasis in the Real World JOURNAL OF ENDOUROLOGY Chung, K., Kim, J., Min, G., Park, H., Li, S., Del Giudice, F., Han, D., Chung, B. I. 2019; 33 (3): 248–53

  View details for DOI 10.1089/end.2018.0667

  View details for Web of Science ID 000462452100011

• How Have Hospital Pricing Practices for Surgical Episodes of Care Responded to Affordable Care Act-Related Medicaid Expansion? UROLOGY McClintock, T. R., Wang, Y., Shah, M. A., Chung, B. I., Chang, S. L. 2019; 125: 79-85

  View details for DOI 10.1016/j.urology.2018.10.034

  View details for Web of Science ID 000459863100018

• National trends of preoperative imaging modalities before partial nephrectomy for renal masses in the U.S from 2007-2015 CUAJ-CANADIAN UROLOGICAL ASSOCIATION JOURNAL Kim, J., Li, S., Khandwala, Y., Del Giudice, F., Chung, K., Park, H., Chung, B. I. 2019; 13 (3): E89–E94

  View details for DOI 10.5489/cuaj.5414

  View details for Web of Science ID 000459702400006

• Association of Prevalence of Benign Pathologic Findings After Partial Nephrectomy With Preoperative Imaging Patterns in the United States From 2007 to 2014 JAMA SURGERY Kim, J., Li, S., Khandwala, Y., Chung, K., Park, H., Chung, B. I. 2019; 154 (3): 225–31

  View details for DOI 10.1001/jamasurg.2018.4602

  View details for Web of Science ID 000461900900011

• How Have Hospital Pricing Practices for Surgical Episodes of Care Responded to Affordable CareAct-Related Medicaid Expansion? Urology McClintock, T. R., Wang, Y., Shah, M. A., Chung, B. I., Chang, S. L. 2019; 125: 79–85

  Abstract

  OBJECTIVE: To determine how Medicaid expansion under the Affordable Care Act of 2010 (ACA) has affected hospital pricing practices for surgical episodes of care.METHODS: Given that safety net hospitals would be more vulnerable to decreasing reimbursement due to an increase in proportion of Medicaid patients, we utilized the Premier Healthcare Database to compare institutional charge-to-cost ratio (CCR) in safety net hospitals vs nonsafety net hospitals for 8 index urologic surgery procedures during the period from 2012 to 2015. The effect of Medicaid expansion on CCR was assessed through difference-in-differences analysis.RESULTS: CCR among safety net hospitals increased from 4.06 to 4.30 following ACA-related Medicaid expansion. This did not significantly differ from the change among nonsafety net hospitals, which was from 4.00 to 4.38 (P = .086). The census division with the highest degree of Medicaid expansion experienced a smaller increase in CCR among safety net hospitals relative to nonsafety net (P < .0001). CCR increased by a greater degree in safety net hospitals compared to nonsafety net in the census division where Medicaid expansion was the least prevalent (P < .0001).CONCLUSION: Safety net hospitals have not preferentially increased CCR in response to ACA-related Medicaid expansion. Census divisions where safety net hospitals did increase CCR more than their nonsafety net counterparts do not correspond to those where Medicaid expansion was most prevalent. This could indicate that, despite being more vulnerable to an increased proportion of more poorly reimbursing Medicaid patients, safety net hospitals have not reacted by increasing charges to private payers.

  View details for PubMedID 30803723

• Postoperative vacuum therapy following AMS LGX 700 inflatable penile prosthesis placement: penile dimension outcomes and overall satisfaction. International journal of impotence research Antonini, G., De Berardinis, E., Busetto, G. M., Del Giudice, F., Chung, B. I., Conti, S. L., Ferro, M., Musi, G., Fragas, R., De Cobelli, O., Sperduti, I., Gross, M. S., Perito, P. E. 2019

  Abstract

  Penile shortening after inflatable penile prosthesis for erectile dysfunction is a common postoperative patient complaint and can reduce overall satisfaction with the procedure. In this prospective study we report our results regarding penile dimensions and patient satisfaction outcomes after 1 year of follow-up from AMSLGX700 penile prosthesis implant with 6 months of vacuum erectile device therapy. Seventy-four selected patients with medically refractory erectile dysfunction underwent AMS LGX 700 IPP placement. Postoperatively, patients were assigned vacuum device therapy for 5min twice daily. Follow-up continued for 1 year after surgery. Dimensional and functional results were assessed. Baseline median preoperative stretched penile length and girth were 14cm (range 10-17) and 9cm (range 7-12), respectively. At the end of the study penile median dimensional outcomes were 17cm (range 13-23) for length and 11cm (range 10-13) for girth while a median number of 24 pumps (range 18-29) to fully inflate the device was seen. Baseline median International Index of Erectile Function (IIEF-5) score was 9 (range 5-11), at 6 months 20 (range 18-26) and at 1 year was 25 (range 20-27) (p<0.0001). Median Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) score at the end of the follow-up was 74 (range 66-78). Our postoperative rehabilitation program is feasible and should be recommended after prothesis surgery in order to increase overall satisfaction with the procedure. Penile postoperative dimensional outcomes were statistically significant improved and complications were negligible.

  View details for PubMedID 30745567

• Re: Timu J. Murtola, Hemo Syvala, Teemu Tolonen, et al. Atorvastatin Versus Placebo for Prostate Cancer Before Radical Prostatectomy-A Randomized, Double-blind, Placebo-controlled Clinical Trial. Eur Urol 2018;74:697-701. European urology Kim, J. H., Chung, B. I. 2019

  View details for PubMedID 30738708

• Changing trends in the treatment of nephrolithiasis in the real world. Journal of endourology Chung, K. J., Kim, J. H., Min, G. E., Park, H. K., Li, S., Del Giudice, F., Han, D. H., Chung, B. I. 2019

  Abstract

  INTRODUCTION: Changes in the surgical treatment of nephrolithiasis, owing to recent technical advances and innovations, have made treatments more effective and less invasive. In this retrospective observational cohort study, we identified the changing trends in the treatment of nephrolithiasis.METHODS: We included patients with newly diagnosed nephrolithiasis who received any treatment in the United States, including extracorporeal shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and open surgery, from January 2007 to December 2014. Demographic factors, such as age, sex, region, surgical treatment type, and cost data, were analyzed.RESULTS: The median age of the patients at treatment was 52 years, and the ratio of men and women was similar. There were definite changes in the trends of all treatment modalities (p<0.01). Both the number and percentage tended to increase for RIRS, whereas for SWL, the number increased but the percentage showed a steady decrease. In PCNL, both number and percentage increased to a minor degree. The overall cost of nephrolithiasis treatments during the study period nearly doubled (from $30,998,726 to $57,310,956). The number of treatments and average cost per treatment increased annually for each treatment modality. RIRS was the least expensive; the other procedures in the decreasing order of their mean costs were as follows: SWL, PCNL, and open surgery.CONCLUSIONS: There was a gradual but constant change in treatment trends of nephrolithiasis, with an increasing trend for RIRS and a decreasing trend for SWL. Although PCNL has relatively invasive characteristics, it is still in steady demand.

  View details for PubMedID 30628473

• Risk of Depression after 5 Alpha Reductase Inhibitor Medication: Meta-Analysis. The world journal of men's health Kim, J. H., Shim, S. R., Khandwala, Y. n., Del Giudice, F. n., Sorensen, S. n., Chung, B. I. 2019

  Abstract

  Although five-alpha reductase inhibitor (5-ARI) is one of standard treatment for benign prostatic hyperplasia (BPH) or alopecia, potential complications after 5-ARI have been issues recently. This study aimed to investigate the risk of depression after taking 5-ARI and to quantify the risk using meta-analysis.A total of 209,940 patients including 207,798 in 5-ARI treatment groups and 110,118 in control groups from five studies were included for final analysis. Inclusion criteria for finial analysis incudes clinical outcomes regarding depression risk in BPH or alopecia patients. Overall hazard ratio (HR) and odds ratio (OR) for depression were analyzed. Moderator analysis and sensitivity analysis were performed to determine whether HR or OR could be affected by any variables, including number of patients, age, study type, and control type.The pooled overall HRs for the 5-ARI medication was 1.23 (95% confidence interval [CI], 0.99-1.54) in a random effects model. The pooled overall ORs for the 5-ARI medication was 1.19 (95% CI, 0.95-1.49) in random effects model. The sub-group analysis showed that non-cohort studies had higher values of HR and OR than cohort studies. Moderator analysis using meta-regression showed that there were no variables that affect the significant difference in HR and OR outcomes. However, in sensitivity analysis, HR was significantly increased by age (p=0.040).Overall risk of depression after 5-ARI was significantly not high, however its clinical importance needs validation by further studies. These quantitative results could provide useful information for both clinicians and patients.

  View details for DOI 10.5534/wjmh.190046

  View details for PubMedID 31190484

• Re: Srougi, et al., Septic Shock Following Surgical Decompression of Obstructing Ureteral Stones: A Prospective Analysis. Journal of endourology Yoo, K. H., Min, G. E., Lee, H. L., Chung, B. I. 2019

  Abstract

  N/A.

  View details for PubMedID 31094235

• Crowdsourced Assessment of Ureteroscopy with Laser Lithotripsy Video Feed Does Not Correlate with Trainee Experience JOURNAL OF ENDOUROLOGY Conti, S. L., Brubaker, W., Chung, B. I., Sofer, M., Hsi, R. S., Shinghal, R., Elliott, C. S., Caruso, T., Leppert, J. T. 2019; 33 (1): 42–49

  View details for DOI 10.1089/end.2018.0534

  View details for Web of Science ID 000459441800008

• Efficacy and safety of Finasteride (5 alpha-reductase inhibitor) monotherapy in patients with benign prostatic hyperplasia: A critical review of the literature ARCHIVIO ITALIANO DI UROLOGIA E ANDROLOGIA Busetto, G., Del Giudice, F., D'Agostino, D., Romagnoli, D., Minervini, A., Rocco, B., Antonelli, A., Celia, A., Schiavina, R., Cindolo, L., Chung, B., Kim, J., Maggi, M., Sciarra, A., De Berardinis, E., Porreca, A. 2019; 91 (4): 205–11

  Abstract

  Combination therapy with 5 alpha-reductase inhibitor (5-ARI) and alpha-blocker can be considered as a gold standard intervention for medical management of lower urinary tract symptoms related to benign prostatic hyperplasia (LUTS/BPH). On the other hand, 5-ARI monotherapy and in particular Finasteride alone is currently getting focus of attention especially due to lack of systematic reviews investigating efficacy outcomes and/or adverse events associated.Aim of the present critical review was to analyze current knowledge of clinical efficacy and incidence of adverse events associated with 5-ARI treatment for LUTS/BPH.A systematic review of clinical trials of the literature of the past 20 years was performed using database from PubMed, Cochrane Collaboration and Embase. A total of 8821 patients were included in this study and inclusion criteria for studies selection were: data from randomized clinical trials (RCTs) focusing their attention on the clinical role of Finasteride monotherapy for symptomatic BPH. Parameters of research included prostate specific antigen (PSA), prostate volume (PV), International Prostate Symptom Score (IPPS), postvoid residual urine (PVR), voiding symptoms of IPSS (voiding IPSS), maximum urinary flow rate (Qmax), and adverse events (AEs).Overall 12 original articles were included and critically evaluated. Sample sizes of patient actively treated with finasteride varied from 13 to 1524 cases analyzed in a single study. Follow-up after treatments ranged from 3 to 54 months. The effect of finasteride in reducing prostate volume (PV) was moderate (standardized mean difference (SMD) effect between 0.5 to 0.8 for all trials evaluable) while the effect on IPSS score and Qmax was considered significant (SMD in the 0.2 to 0.5 variation range). No severe AEs and/or psychiatric disorders were retrieved among the studies. Sexual health dysfunctions were significantly influenced by finasteride therapy when compared with placebo treated patients.Although significant clinical benefits of finasteride monotherapy were demonstrated, the effective size of the available reports included in the analysis is limited. Additional head-to-head studies would be needed to re-evaluate clinical efficacy and safety of 5-ARI in combination or not with alpha blockers.

  View details for DOI 10.4081/aiua.2019.4.205

  View details for Web of Science ID 000518888000001

  View details for PubMedID 31937082

• Change of trends in the treatment modality for pediatric nephrolithiasis: Retrospective analysis of a US-based insurance claims database. Journal of endourology Park, H. K., Kim, J. H., Min, G. E., Choi, W. S., Li, S. n., Chung, K. J., Chung, B. I. 2019

  Abstract

  The objective of this study was to show the prevalence and investigate treatment trends of pediatric nephrolithiasis based on a large population of US insurance individual's data.This research involved a retrospective observational cohort study. Administrative claims data were extracted from the IBM® MarketScan Research Database. We included all newly diagnosed patients with nephrolithiasis, aged less than 18 years old at the time of diagnosis from January 1, 2007 to December 31, 2014. The patient cohort with nephrolithiasis was selected using the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) code for nephrolithiasis. Each treatment method was searched by Current Procedural Terminology (CPT) code.A total of 28,014 patients were diagnosed with nephrolithiasis in our cohort. Of nephrolithiasis patients, 701 (2.5%) patients were treated by surgical methods. The mean age of patients at the time of treatment was 13 years old. Shockwave lithotripsy (SWL) was the most used treatment modality during the period. SWL was performed in 66% of patients. The case number of SWL did not tend to change according to year, while Retrograde intrarenal surgery (RIRS) tended to increase from 15% to 31%. Percutaneous nephrolithotripsy (PCNL) decreased from 13% to fewer than 10 cases. The number of open surgeries was very small and did not show any tendency.During the study period, SWL is stable. RIRS has become more popular in treating renal stones while PCNL has decreased. These results suggest that the RIRS has become more popular than PCNL in treating large renal stones.

  View details for PubMedID 31016995

• Hospital Charges for Urologic Surgery Episodes of Care Are Rising Despite Declining Costs. Mayo Clinic proceedings McClintock, T. R., Wang, Y. n., Shah, M. A., Mossanen, M. n., Chung, B. I., Chang, S. L. 2019

  Abstract

  To investigate the temporal relationship of hospital charges relative to recorded costs for surgical episodes of care.This retrospective cohort study selected individuals who underwent any of 8 index urologic surgical procedures at 392 unique institutions from January 1, 2005, through December 31, 2015. For each surgical encounter, cost and charge data reported by hospitals were extracted and adjusted to 2016 US dollars. Trend analysis and multivariable logistic regression modeling were used to assess outcomes. The primary outcome was trend in median charge and cost. Secondary outcomes consisted of hospital characteristics associated with membership in the highest quartile of institutional charge-to-cost ratio.Cohort-level median cost per encounter trended down from $6824 in 2005 to $5586 in 2015 (P for trend<.001), and charges increased from $20,210 to $25,773 during the same period (P for trend<.001). Hospitals in the highest quartile of institutional charge-to-cost ratio were more likely to be safety net, nonteaching, urban, lower surgical volume, smaller, and located outside the Midwest (P<.001 for each characteristic).The pricing trends shown herein could indicate some success in cost-containment for surgical episodes of care, although higher hospital charges may be increasingly used to bolster reimbursement from third-party payers and to compensate for escalating costs in other areas.

  View details for PubMedID 31079963

• Association of Prevalence of Benign Pathologic Findings After Partial Nephrectomy With Preoperative Imaging Patterns in the United States From 2007 to 2014. JAMA surgery Kim, J. H., Li, S., Khandwala, Y., Chung, K. J., Park, H. K., Chung, B. I. 2018

  Abstract

  Importance: Although the intent of nephron-sparing surgery is to eradicate malignant tumors found on preoperative imaging, benign masses often cannot be differentiated from malignant tumors. However, in the past there have been discrepancies in the reported percentages of benign masses removed by partial nephrectomy (PNx).Objective: To investigate the annual trend of prevalence of benign pathologic findings after PNx and to investigate what potential factors are associated with this prevalence.Design, Setting, and Participants: A total of 18 060 patients who underwent PNx between 2007 and 2014 were selected from Truven Health MarketScan Research Databases. We selected those patients who underwent PNx as an inpatient from 2007 and set the surgery date as the index date. Overall, a total of 21 445 patients with International Classification of Diseases, Ninth Revision, Clinical Modification code of 55.4 were identified from 2007 to 2015.Main Outcomes and Measures: The annual trend of benign pathologic findings was described as an actual number and as a proportion. Univariate and multiple analyses were performed to investigate factors predictive of a benign final pathologic diagnosis, including type of preoperative imaging modality or performance of a renal mass biopsy.Results: Among the 18 060 patients, mean (SD) age was 57 (12) years, and there were 10637 (58.9%) men and 7423 (41.1%) women. The overall prevalence of benign pathologic findings was 30.9% and the annual trends demonstrated a prevalence of over 30% for nearly every year of the study period. On univariate analysis, the performance of magnetic resonance imaging (MRI) and renal mass biopsy was associated with benign pathologic findings (P=.02 and P<.001, respectively). On multivariable analysis, female sex (odds ratio [OR], 0.62; 95% CI, 0.58-0.66; P<.001), older age (>65 years) (OR, 0.99; 95% CI, 0.99-0.99; P<.001), and computed tomography (CT) only preoperative imaging (OR, 1.16; 95% CI, 1.05-1.28; P=.004) were associated with benign pathologic findings after PNx.Conclusions and Relevance: We found that the overall prevalence of benign pathologic findings after PNx was higher than the literature suggests, with consistent year-over-year rates exceeding 30%. Female sex, older age (>65 years), and CT only preoperative imaging were predictive of a benign tumor. Further elucidation concerning covariates associated with a benign diagnosis should be the focus of future investigations to identify a cohort of patients who could potentially avoid unnecessary surgical intervention.

  View details for PubMedID 30516801

• Costs variations for percutaneous nephrolithotomy in the US from 2003-2015: A contemporary analysis of an all-payer discharge database CUAJ-CANADIAN UROLOGICAL ASSOCIATION JOURNAL Leow, J. J., Valiquette, A., Chung, B. I., Chang, S. L., Quoc-Dien Trinh, Korets, R., Bhojani, N. 2018; 12 (12): 407–14

  Abstract

  We sought to evaluate population-based costs variations and predictors of outlier costs for percutaneous nephrolithotomy (PCNL) in the U.S.Using the Premier Healthcare Database, we identified all patients diagnosed with kidney/ureter calculus who underwent PCNL from 2003-2015. We evaluated 90-day direct hospital costs, defining high- and low-cost surgery as those >90th and <10th percentile, respectively. We constructed a multilevel, hierarchical regression model and calculated the pseudo-R2 of each variable, which translates to the percentage variability contributed by that variable on 90-day direct hospital costs.A total of 114 581 patients underwent PCNL during the 12-year study period. Mean cost in the low-cost group was $5787 (95% confidence interval [CI] 5716-5856) vs. $38 590(95% CI 37 357-39 923) in the high-cost group. Cost variations were substantially impacted by patient (63.7%) and surgical (18.5%) characteristics and less so by hospital characteristics (3.9%). Significant predictors of high costs included more comorbidities (≥2 vs. 0: odds ratio [OR] 1.81; p=0.01) and hospital region (Northeast vs. Midwest: OR 2.04; p=0.03). Predictors of low cost were hospital bed size of 300-499 beds (OR 1.35; p<0.01) and urban hospitals (OR 2.77; p=0.01). Factors less likely to be associated with low-cost PCNL were more comorbidities (Charlson Comorbidity Index [CCI] ≥2: OR 0.69; p<0.0001), larger hospitals (OR 0.61; p=0.01), and teaching hospitals (OR 0.33; p<0.0001).Our contemporary analysis demonstrates that patient and surgical characteristics had a significant effect on costs associated with PCNL. Poor comorbidity status contributed to high costs, highlighting the importance of patient selection.

  View details for PubMedID 29940133

  View details for PubMedCentralID PMC6261720

• Examining the relationship between complications and perioperative mortality following radical cystectomy: A population-based analysis. BJU international Mossanen, M., Krasnow, R. E., Zlatev, D. V., Tan, W. S., Preston, M. A., Trinh, Q., Kibel, A. S., Sonpavde, G., Schrag, D., Chung, B. I., Chang, S. L. 2018

  Abstract

  OBJECTIVE: To examine the incidence of perioperative complications after RC and assess their impact on 90-day postoperative mortality during the index stay and upon readmission.MATERIAL AND METHODS: A total of 57,553 bladder cancer patients (unweighted cohort: 9,137 patients) treated with RC at 360 hospitals in the United States between 2005 to 2013 within the Premier Healthcare Database were used for analysis. Ninety-day perioperative mortality was the primary outcomes. Multivariable regression was used to predict the probability of mortality; models were adjusted for patient, hospital, and surgical characteristics.RESULTS: An increase in the number of complications resulted in an increasing predicted probability of mortality with a precipitous increase if patients had ≥4 complications compared to one complication during hospitalization following RC (index stay) (1.0% to 9.7%, p<0.001) and during readmission (2.0% to 13.1%, p<0.001). A readmission complication nearly doubled the predicted probability of postoperative mortality as compared to an initial complication (3.9% vs. 7.4%, p <0.001). During the initial hospitalization cardiac (OR=3.1, 95% CI 1.9-5.1), pulmonary (OR=4.8, 95% CI 2.8-8.4), and renal (OR=3.6, 95% CI 2-6.7) related complications had the most significant impact on the odds of mortality across categories examined.CONCLUSIONS: The number and nature of complications have a distinct impact on mortality after RC. As complications increase, there is an associated increase in perioperative mortality. This article is protected by copyright. All rights reserved.

  View details for PubMedID 30499636

• Bisphosphonate use and risk of renal cell carcinoma: a population-based case-control study. Basic & clinical pharmacology & toxicology Chung, B. I., Hellfritzsch, M., Ulrichsen, S. P., Sorensen, H. T., Ehrenstein, V. 2018

  Abstract

  The purpose of this study was to evaluate the association between the use of bisphosphonates and the risk of developing renal cell carcinoma (RCC). We conducted a case-control study in Denmark, using data linked from population-based health and administrative registries. We identified all cases of RCC from 1996 to 2013 and sampled population controls in a 10:1 ratio from the underlying population free of RCC, while matching on sex, birth year and calendar time. Bisphosphonate use before RCC diagnosis, excluding the year leading up to the diagnosis, was measured using outpatient prescription dispensations. We used conditional logistic regression to compute crude and adjusted odds ratios (ORs) comparing ever vs. never bisphosphonate use in doses indicated for treatment of osteoporosis, overall and stratified by sex, with the OR estimating the incidence rate ratio. We also examined the effects by cumulative dose and specific agent. There were 2748 RCC cases and 27,480 controls. The adjusted ORs for ever vs. never bisphosphonate use were 1.07 (95% confidence interval: 0.94-1.22) overall; 1.15 (1.00-1.32) for women; and 0.78 (0.54-1.12) for men. Smoking could not be directly controlled for in the analysis. We found a weak association between use of oral bisphosphonates and risk of renal cell carcinoma in females. The observed association could be due to confounding by cigarette smoking, and future studies are required to assess this association further. This article is protected by copyright. All rights reserved.

  View details for PubMedID 30472809

• Performance of multiparametric MRI appears better when measured in patients who undergo radical prostatectomy. Research and reports in urology Wang, N. N., Fan, R. E., Leppert, J. T., Ghanouni, P., Kunder, C. A., Brooks, J. D., Chung, B. I., Sonn, G. A. 2018; 10: 233-235

  Abstract

  Utilization of pre-biopsy multiparametric MRI (mpMRI) is increasing. To optimize the usefulness of mpMRI, physicians should accurately quote patients a numerical risk of cancer based on their MRI. The Prostate Imaging Reporting and Data System (PIRADS) standardizes interpretation of mpMRI; however, reported rates of clinically significant prostate cancer (CSC) stratified by PIRADS score vary widely. While some publications use radical prostatectomy (RP) specimens as gold standard, others use biopsy. We hypothesized that much of the variation in CSC stems from differences in cancer prevalence in RP cohorts (100% prevalence) vs biopsy cohorts. To quantify the impact of this selection bias on cancer yield according to PIRADS score, we analyzed data from 614 men with 854 lesions who underwent targeted biopsy from 2014 to 2018. Of these, 125 men underwent RP. We compared the PIRADS detection rates of CSC (Gleason ≥7) on targeted biopsy between the biopsy-only and RP cohorts. For all PIRADS scores, CSC yield was much greater in patients who underwent RP. For example, CSC was found in 30% of PIRADS 3 lesions in men who underwent RP vs 7.6% in men who underwent biopsy. Our results show that mpMRI performance appears to be better in men who undergo RP compared with those who only receive biopsy. Physicians should understand the effect of this selection bias and its magnitude when discussing mpMRI results with patients considering biopsy, and take great caution in quoting CSC yields from publications using RP as gold standard.

  View details for DOI 10.2147/RRU.S178064

  View details for PubMedID 30538970

  View details for PubMedCentralID PMC6254536

• Crowd Sourced Assessment of Ureteroscopy with Laser Lithotripsy video feed does not correlate with Trainee Experience. Journal of endourology Conti, S. L., Brubaker, W., Chung, B. I., Sofer, M., Hsi, R. S., Shinghal, R., Elliott, C. S., Caruso, T., Leppert, J. T. 2018

  Abstract

  OBJECTIVES: We sought to validate the use of crowd sourced surgical video evaluation in the evaluation of flexible ureteroscopic laser lithotripsy videos using a modified global assessment scale previously validated for ureteroscopic skills.METHODS: We collected video feeds from 30 intra-renal ureteroscopic laser lithotripsy cases where residents post graduate year(PGY) 2 through 6 handled the ureteroscope. The video feeds were annotated to represent the overall performance and to contain the parts of the procedure being scored. The videos were submitted to a commercially available surgical video evaluation platform. We used a validated ureteroscopic laser lithotripsy global assessment tool that was modified to account for the fact that this scoring system looked at the video feed only. Videos were evaluated by crowd workers recruited using Amazon's Mechanical Turk as well as 5 Endourology trained experts. Mean scores were calculated and intraclass correlation coefficients(ICCs) were computed for the expert domain and total scores. The ICCs were estimated using a linear mixed-effects model. Spearman rank correlation coefficients were calculated as a measure of the strength of the relationships between the crowd mean and the expert average scores.RESULTS: 30 videos were reviewed 2,488 times by 487 crowd workers and five expert endourologists. ICCs between expert raters were all below accepted levels of correlation(0.30) with the overall score having an ICC of .000. Overall the crowd scores did not correlate with expert scores except for the stone retrieval domain (0.60 p = 0.015). Crowd sourced scores had a negative correlation with PGY level(-0.44 p=0.019).CONCLUSIONS: Given the poor agreement between experts and poor correlation between expert and crowd scores when evaluating video feeds of ureteroscopic laser lithotripsy, assessment of skills using intraoperative video feeds may not be reliable. This is further supported by the inverse correlation between crowd scores and PGY level.

  View details for PubMedID 30450963

• Contemporary trends in the utilisation of radical prostatectomy BJU INTERNATIONAL McClintock, T. R., Wang, Y., Cole, A. P., Chung, B. I., Kibel, A. S., Chang, S. L., Quoc-Dien Trinh 2018; 122 (5): 726–28

  View details for PubMedID 29797448

• Undertreatment of High-Risk Localized Prostate Cancer in the California Latino Population JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Lichtensztajn, D. Y., Leppert, J. T., Brooks, J. D., Shah, S. A., Sieh, W., Chung, B., Gomez, S. L., Cheng, I. 2018; 16 (11): 1353-1360

  View details for DOI 10.6004/jnccn.2018.7060

  View details for Web of Science ID 000450238000006

• Undertreatment of High-Risk Localized Prostate Cancer in the California Latino Population. Journal of the National Comprehensive Cancer Network : JNCCN Lichtensztajn, D. Y., Leppert, J. T., Brooks, J. D., Shah, S. A., Sieh, W., Chung, B. I., Gomez, S. L., Cheng, I. 2018; 16 (11): 1353–60

  Abstract

  Background: The NCCN Clinical Practice Guidelines in Oncology recommend definitive therapy for all men with high-risk localized prostate cancer (PCa) who have a life expectancy >5 years or who are symptomatic. However, the application of these guidelines may vary among ethnic groups. We compared receipt of guideline-concordant treatment between Latino and non-Latino white men in California. Methods: California Cancer Registry data were used to identify 2,421 Latino and 8,636 non-Latino white men diagnosed with high-risk localized PCa from 2010 through 2014. The association of clinical and sociodemographic factors with definitive treatment was examined using logistic regression, overall and by ethnicity. Results: Latinos were less likely than non-Latino whites to receive definitive treatment before (odds ratio [OR], 0.79; 95% CI, 0.71-0.88) and after adjusting for age and tumor characteristics (OR, 0.84; 95% CI, 0.75-0.95). Additional adjustment for sociodemographic factors eliminated the disparity. However, the association with treatment differed by ethnicity for several factors. Latino men with no health insurance were considerably less likely to receive definitive treatment relative to insured Latino men (OR, 0.34; 95% CI, 0.23-0.49), an association that was more pronounced than among non-Latino whites (OR, 0.63; 95% CI, 0.47-0.83). Intermediate-versus high-grade disease was associated with lower odds of definitive treatment in Latinos (OR, 0.75; 95% CI, 0.59-0.97) but not non-Latino whites. Younger age and care at NCI-designated Cancer Centers were significantly associated with receipt of definitive treatment in non-Latino whites but not in Latinos. Conclusions: California Latino men diagnosed with localized high-risk PCa are at increased risk for undertreatment. The observed treatment disparity is largely explained by sociodemographic factors, suggesting it may be ameliorated through targeted outreach, such as that aimed at younger and underinsured Latino men.

  View details for PubMedID 30442735

• Efficacy and safety of 5 alpha-reductase inhibitor monotherapy in patients with benign prostatic hyperplasia: A meta-analysis PLOS ONE Kim, J., Baek, M., Sun, H., Lee, B., Li, S., Khandwala, Y., Del Giudice, F., Chung, B. 2018; 13 (10)

  View details for DOI 10.1371/journal.pone.0203479

  View details for Web of Science ID 000446342400022

• Trends in penile prosthesis implantation and analysis of predictive factors for removal. World journal of urology Li, K., Brandes, E. R., Chang, S. L., Leow, J. J., Chung, B. I., Wang, Y., Eswara, J. R. 2018

  Abstract

  PURPOSE: This study aims to analyze patient demographics, hospital characteristics, and clinical risk factors which predict penile prosthesis removal. We also examine costs of penile prosthesis removal and trends in inflatable versus non-inflatable penile prostheses implantation in the USA from 2003 to 2015.METHODS: Cross-sectional analysis from Premier Perspective Database was completed using data from 2003 to 2015. We compared the relative proportion of inflatable versus non-inflatable penile prostheses implanted. We separated the prosthesis removal group based on indication for removal-Group 1 (infection), Group 2 (mechanical complication), and Group 3 (all explants). All groups were compared to a control group of patients with penile implants who were never subsequently explanted. Multivariate analysis was performed to analyze patient and hospital factors which predicted removal. Cost comparison was performed between the explant groups.RESULTS: There were 5085 penile prostheses implanted with a stable relative proportion of inflatable versus non-inflatable prosthesis over the 13-year study period. There were 3317 explantations. Patient factors associated with prosthesis removal were non-black race, Charlson Comorbidity Index, diabetes, and HIV status. Hospital factors associated with removal included non-teaching status, hospital region, year of removal, and annual surgeon volume. Median hospitalization costs of all explantations were $10,878. Explantations due to infection cost $11,252 versus $8602 for mechanical complications.CONCLUSIONS: This large population-based study demonstrates a stable trend in inflatable versus non-inflatable prosthesis implantation. We also identify patient and hospital factors that predict penile prosthesis removal which has clinical utility for patient risk stratification and counseling.

  View details for DOI 10.1007/s00345-018-2491-4

  View details for PubMedID 30251052

• Inflatable Penile Prosthesis Placement, Scratch Technique and Postoperative Vacuum Therapy as a Combined Approach to Definitive Treatment of Peyronie's Disease JOURNAL OF UROLOGY Antonini, G., De Berardinis, E., Del Giudice, F., Busetto, G., Lauretti, S., Fragas, R., Chung, B. I., Conti, S. L., Giannarelli, D., Sperduti, I., Gross, M. S., Perito, P. E. 2018; 200 (3): 642–47

  Abstract

  Peyronie's disease is a devastating condition resulting in penile malformation, erectile dysfunction, pain and emotional distress. In this prospective, 2 institution study we evaluated a multimodal surgical and mechanical combined approach to the definitive treatment of Peyronie's disease and concomitant erectile dysfunction.A total of 145 select patients underwent endocavernous disruption of Peyronie's disease plaques via the scratch technique, followed by inflatable penile prosthesis insertion. Postoperatively patients were assigned to vacuum device therapy for 3 minutes twice daily to continue penile curvature correction. Followup continued for 1 year after surgery. Anatomical and functional results were assessed.Patients with plaques in the proximal third, middle third and subcoronal areas of the penis had a mean ± SD postoperative residual curvature of 21.5 ± 4.5, 17.3 ± 4.8 and 14.1 ± 3.1 degrees, respectively. After 24 weeks of vacuum therapy the mean penile curvature deviation decreased to 8.7 ± 2.5, 9.1 ± 2.9 and 7.7 ± 0.9 degrees, respectively. The mean IIEF-5 (International Index of Erectile Function) score was 9.8 ± 2.3 preoperatively, 18.9 ± 3.1 at 6 months (p <0.001) and 24.1 ± 3.6 at 1 year (p <0.001). The mean EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction) score at the end of followup was 64.6 ± 11.8. Operative and postoperative complications were minimal.Our novel combination of intraoperative and postoperative therapies in the treatment of patients with Peyronie's disease and an inflatable penile prosthesis was safe and efficacious with excellent functional outcomes. Penile curvature corrections were statistically significant and complications were negligible.

  View details for PubMedID 29678456

• Comparative Effectiveness of Transurethral Resection Techniques in the Inpatient Setting for Benign Prostatic Hyperplasia. Urology practice Meyer, C. P., Friedlander, D. F., Wang, Y., Hollis, M., Lipsitz, S. R., Eswara, J., Kathrins, M., Bhojani, N., Chughtai, B., Sun, M., Chung, B. I., Chang, S. L., Trinh, Q. D. 2018; 5 (5): 377-382

  Abstract

  Monopolar transurethral resection is the conventional surgical standard of care for bladder outlet obstruction due to benign prostatic enlargement. Bipolar resection and GreenLight™ photovaporization have emerged as options with favorable safety profiles. The literature comparing these modalities is limited by sample size and absence of cost data. We compared costs and short-term safety of monopolar, bipolar and laser vaporization techniques in an all-payer inpatient discharge database.A total of 20,323 men 40 to 80 years old with a diagnosis of benign prostatic hyperplasia who underwent an outlet procedure between 2003 and 2013 were identified in the Premier Research Database. Using propensity weighted logistic regression we assessed treatment trends and perioperative safety outcomes.Monopolar resection remained the most commonly performed procedure between 2003 and 2013. However, its use decreased by 20% (p <0.001). Whereas there were no differences between bipolar and monopolar resection with regard to operative time (p >0.99), length of stay (p=0.82) and 90-day complication rates (p=0.34), GreenLight photovaporization was associated with prolonged operative time (+12 minutes, 95% CI 10.25 to 13.75, p <0.001) and shorter length of stay (OR 0.51, 95% CI 0.37 to 0.7, p <0.001) compared to monopolar resection. Bipolar resection ($982, 95% CI 509-1,456; p <0.001) and GreenLight photovaporization ($1,536; 95% CI 1,296-1,775; p <0.001) were associated with greater 90-day direct hospital costs than monopolar resection. GreenLight photovaporization was associated with decreased odds of dilutional hyponatremia, stricture formation and prostatitis relative to monopolar resection.We found a modest perioperative safety benefit with bipolar resection and GreenLight photovaporization relative to monopolar resection. However, both procedures were associated with higher costs.

  View details for DOI 10.1016/j.urpr.2017.08.006

  View details for PubMedID 37312317

• Charge-to-Cost Ratio Varies among Common Urological Surgery Procedures. Urology practice McClintock, T. R., Mossanen, M., Shah, M. A., Wang, Y., Chung, B. I., Chang, S. L. 2018; 5 (5): 349-350

  View details for DOI 10.1016/j.urpr.2018.03.002

  View details for PubMedID 37312323

• The Research Implications of Prostate Specific Antigen Registry Errors: Data from the Veterans Health Administration JOURNAL OF UROLOGY Guo, D. P., Thomas, I., Mittakanti, H. R., Shelton, J. B., Makarov, D. V., Skolarus, T. A., Cooperberg, M. R., Sonn, G. A., Chung, B. I., Brooks, J. D., Leppert, J. T. 2018; 200 (3): 541–47

  View details for DOI 10.1016/j.juro.2018.03.127

  View details for Web of Science ID 000441294600074

• Charge-to-Cost Ratio Varies among Common Urological Surgery Procedures UROLOGY PRACTICE McClintock, T. R., Mossanen, M., Shah, M. A., Wang, Y., Chung, B. I., Chang, S. L. 2018; 5 (5): 349–50

  View details for DOI 10.1016/j.urpr.2018.03.002

  View details for Web of Science ID 000444509300011

• Comparative Effectiveness of Transurethral Resection Techniques in the Inpatient Setting for Benign Prostatic Hyperplasia UROLOGY PRACTICE Meyer, C. P., Friedlander, D. F., Wang, Y., Hollis, M., Lipsitz, S. R., Eswara, J., Kathrins, M., Bhojani, N., Chughtai, B., Sun, M., Chung, B. I., Chang, S. L., Quoc-Dien Trinh 2018; 5 (5): 377–82

  View details for DOI 10.1016/j.urpr.2017.08.006

  View details for Web of Science ID 000444509300020

• National trends of preoperative imaging modalities before partial nephrectomy for renal masses in the U.S. from 2007-2015. Canadian Urological Association journal = Journal de l'Association des urologues du Canada Kim, J. H., Li, S., Khandwala, Y., Giudice, F. D., Chung, K. J., Park, H. K., Chung, B. I. 2018

  Abstract

  INTRODUCTION: Although the performance of partial nephrectomies (PNx) for renal masses has increased rapidly over the years, only a few studies investigated the frequency and patterns of preoperative imaging modalities. The aim of this study was to investigate the frequency and patterns in preoperative imaging modalities before PNx.METHODS: A total of 21 445 patients who underwent PNx between 2007 and 2015 were selected from a national representative population in the MarketScan database and included in this study. The annual incidence and proportion of PNx, as well as the use of each preoperative imaging modality were analyzed.RESULTS: Both annual crude number and frequency rate of PNx decreased or became static since 2012. Computed tomography (CT) shows the greatest proportion of the crude number and percentage; despite a slight decrease in percentage, it is still >80%. Among the combinations, CT alone and CT combined with ultrasonography showed the highest performance rate during the complete observational period. The proportion of all other combinations, which include other complex combinations except CT alone, CT plus ultrasonography, CT plus magnetic resonance imaging (MRI), and CT plus MRI plus ultrasonography, was 13.95% in 2007, but increased to 19.04% in 2014.CONCLUSIONS: CT still plays a major role in preoperative imaging for renal masses, whereby CT alone and CT combined with ultrasonography account for a major proportion of the preoperative imaging patterns. The use of other imaging combinations, as well as renal biopsies, shows an increasing trend. Additional studies are needed to investigate whether this trend in preoperative imaging is related to the frequency rate of PNx.

  View details for PubMedID 30169151

• Has the robot caught up? National trends in utilization, perioperative outcomes, and cost for open, laparoscopic, and robotic pediatric pyeloplasty in the United States from 2003 to 2015 JOURNAL OF PEDIATRIC UROLOGY Varda, B. K., Wang, Y., Chung, B., Lee, R. S., Kurtz, M. P., Nelson, C. P., Chang, S. L. 2018; 14 (4): 336.e1–336.e8

  Abstract

  Since 2010, there have been few new data comparing perioperative outcomes and cost between open (OP) and robotic pyeloplasty (RP). In a post-adoption era, the value of RP may be converging with that of OP.To 1) characterize national trends in pyeloplasty utilization through 2015, 2) compare adjusted outcomes and median costs between OP and RP, and 3) determine the primary cost drivers for each procedure.We performed a retrospective cohort study using the Premier database, which provides a nationally representative sample of U.S. hospitalizations between 2003 and 2015. ICD9 codes and itemized billing were used to abstract our cohorts. Trends in utilization and cost were calculated and then stratified by age. We used propensity scores to weight our cohorts and then applied regression models to measure differences in the probability of prolonged operative time (pOT), prolonged length of stay (pLOS), complications, and cost.During the study period 11,899 pyeloplasties were performed: 75% open, 10% laparoscopic, and 15% robotic. The total number of pyeloplasty cases decreased by 7% annually; OP decreased by a rate of 10% while RP grew by 29% annually. In 2015, RP accounted for 40% of cases. The largest growth in RPs was among children and adolescents. The average annual rate of change in cost for RP and OP was near stagnant: -0.5% for open and -0.2% for robotic. The summary table provides results from our regression analyses. RP conferred an increased likelihood of pOT, but a reduced likelihood of pLOS. The odds of complications were equivalent. RP was associated with a significantly higher median cost, but the absolute difference per case was $1060.Despite advantages in room and board costs for RP, we found that the cost of equipment and OR time continue to make it more expensive. Although the absolute difference may be nominal, we likely underestimate the true cost because we did not capture amortization, hidden or down-stream costs. In addition, we did not measure patient satisfaction and pain control, which may provide the non-monetary data needed for comparative value.Despite an overall decline in pyeloplasties, RP utilization continues to increase. There has been little change in cost over time, and RP remains more expensive because of equipment and OR costs. The robotic approach confers a reduced likelihood of pLOS, but an increased likelihood of pOT. Complication rates are low and similar in each cohort.

  View details for DOI 10.1016/j.jpurol.2017.12.010

  View details for Web of Science ID 000449186800023

  View details for PubMedID 29530407

  View details for PubMedCentralID PMC6105565

• The Research Implications of PSA Registry Errors: Data from the Veterans Health Administration. The Journal of urology Guo, D. P., Thomas, I., Mittakanti, H. R., Shelton, J. B., Makarov, D. V., Skolarus, T. A., Cooperberg, M. R., Sonn, G. A., Chung, B. I., Brooks, J. D., Leppert, J. T. 2018

  Abstract

  INTRODUCTION: We sought to characterize the effects of PSA registry errors on clinical research by comparing cohorts based on cancer registry PSA values with those based directly on results in the electronic health record.METHODS: We defined example cohorts of men with prostate cancer using data from the Veterans Health Administration: those with a PSA values less than 4.0 ng/mL, 4.0 to 10.0 ng/mL, 10.0 to 20.0 ng/mL, and 20.0 to 98.0 ng/mL. We compared the composition of each cohort and overall patient survival when using PSA values from either the VA Central Cancer Registry versus the gold standard electronic health record laboratory file results.RESULTS: There was limited agreement between cohorts defined using either the cancer registry PSA values versus the laboratory file of the electronic health record. The least agreement was seen in patients with PSA values < 4.0 ng/mL (58%) and greatest among patients with PSA values between 4.0 and 10.0 ng/mL (89%). In each cohort, patients assigned to a cohort based only on the cancer registry PSA value had significantly different overall survival when compared with patients assigned based on both the registry and laboratory file PSA values.CONCLUSIONS: Cohorts based exclusively on cancer registry PSA values may have high rates of misclassification that can introduce concerning differences in key characteristics and result in measurable differences in clinical outcomes.

  View details for PubMedID 29630980

• Re: The Risks and Benefits of Cavernous Neurovascular Bundle Sparing during Radical Prostatectomy: A Systematic Review and Meta-Analysis JOURNAL OF UROLOGY Kim, J., Chung, B. I. 2018; 199 (4): 1070–71

  View details for PubMedID 29305837

• Robotic-Assisted vs Laparoscopic Radical Nephrectomy Reply JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Jeong, I., Khandwala, Y. S., Chung, B. I. 2018; 319 (11): 1166

  View details for PubMedID 29558551

• Utilization and outcomes of chemoprophylaxis for the prevention of venous thromboembolism following radical cystectomy: A population-based study. Reese, S., Mossanen, M., Zlatev, D. V., Pucheril, D., Chung, B. I., Chang, S. AMER SOC CLINICAL ONCOLOGY. 2018

  View details for DOI 10.1200/JCO.2018.36.6_suppl.491

  View details for Web of Science ID 000436179500484

• Trends and morbidity for minimally invasive versus open cytoreductive nephrectomy in the management of metastatic renal cell carcinoma. Zlatev, D. V., Ozambela, M., Salari, K., Wang, Y., Mossanen, M., Pucheril, D., Ingham, M. D., Chung, B. I., Chang, S. AMER SOC CLINICAL ONCOLOGY. 2018

  View details for DOI 10.1200/JCO.2018.36.6_suppl.632

  View details for Web of Science ID 000436179500626

• Impact of intravenous acetaminophen on outcomes following radical nephrectomy. Zlatev, D. V., Friedlander, D. F., Tinay, I., Wang, Y., Pucheril, D., Chung, B. I., Chang, S. AMER SOC CLINICAL ONCOLOGY. 2018

  View details for DOI 10.1200/JCO.2018.36.6_suppl.663

  View details for Web of Science ID 000436179500657

• Exploring Patterns of Mitomycin C Use in Community Practice Urology UROLOGY PRACTICE Mossanen, M., Ingham, M. D., Leow, J. J., Tinay, I., Wang, Y., Krasnow, R. E., Preston, M. A., Bellmunt, J., Chung, B. I., Rosenberg, J. E., Chang, S. L. 2018; 5 (1): 7–13

  View details for DOI 10.1016/j.urpr.2017.02.002

  View details for Web of Science ID 000437130800002

• Non-ischemic priapism following recurrent idiopathic ischemic priapism treated successfully with selective arterial embolization and postoperative vacuum therapy before delayed inflatable penile prosthesis placement: A single case report. IJU case reports Del Giudice, F. n., Busetto, G. M., Chung, B. I., Conti, S. L., Ferro, M. n., Maggi, M. n., Sciarra, A. n., Perito, P. E., Gross, M. S., Antonini, G. n., De Berardinis, E. n. 2018; 1 (1): 13–15

  Abstract

  Priapism is defined as a persistent tumescence or erection of the penis not associated to sexual desire and/or stimulation. Idiopathic recurrent priapism may also occasionally follow treatment of veno-occlusive priapism and represents a diagnostic and therapeutic challenge.We report a single case of non-ischemic priapism that resulted after distal shunting procedure for severe and prolonged ischemic priapism and yet occurred without evidence of a cavernosal-sinusoidal fistula that was successfully treated with a bilateral selective arterial embolization. Our protocol of delayed inflatable penile prosthesis placement after a vacuum erectile device program was implemented.The continuing use of a vacuum erectile device represented a bridge and an adjuvant therapy useful to facilitate later prosthesis placement. Anatomical and functional outcomes were optimal. No postoperative complaints or complications were reported.

  View details for DOI 10.1002/iju5.12019

  View details for PubMedID 32743355

  View details for PubMedCentralID PMC7292072

• Exploring Patterns of Mitomycin C Use in Community Practice Urology. Urology practice Mossanen, M., Ingham, M. D., Leow, J. J., Tinay, I., Wang, Y., Krasnow, R. E., Preston, M. A., Bellmunt, J., Chung, B. I., Rosenberg, J. E., Chang, S. L. 2018; 5 (1): 7-14

  Abstract

  Although evidence supports the use of mitomycin C after transurethral bladder tumor resection in reducing recurrent disease, its adoption has been limited. Examinations of claims data may help in exploring patterns of care and barriers to use. Thus, we analyzed a contemporary population based cohort to determine recent trends in mitomycin C use in community practice urology.Using the Premier Hospital database we identified patients who underwent transurethral bladder tumor resection between January 1, 2003 and December 31, 2015. Multivariable logistic regression was used to evaluate the association of receiving mitomycin C with patient, hospital and surgical characteristics. We also assessed the effect of age and comorbidities on use.Mitomycin C use increased from 3.3% in 2003 to 5.5% in 2013 and then decreased to 4.5% in 2015. After adjusting for baseline characteristics mitomycin C was more likely to be used in patients who were older (65 years or more vs less than 65: OR 1.31, 1.01-1.67, p <0.05). Patients with a higher Charlson comorbidity index had lower odds of mitomycin C use (1 or more vs 0: OR 0.86, 0.75-0.98, p <0.05 and more than 2 vs 0: OR 0.84, 0.72-0.98, p <0.05). Top 75% annual surgeon volume (yes vs no: OR 1.68, 1.34-2.1, p <0.001) was associated with mitomycin C use.Mitomycin C remains underused, although its use has increased. Patients with increased comorbidities are less likely to receive mitomycin C while high volume surgeons are more likely to administer mitomycin C. Understanding patterns of care in mitomycin C use may inform quality improvement initiatives and guide future efforts to promote appropriate use.

  View details for DOI 10.1016/j.urpr.2017.02.002

  View details for PubMedID 37300180

• Efficacy and safety of 5 alpha-reductase inhibitor monotherapy in patients with benign prostatic hyperplasia: A meta-analysis. PloS one Kim, J. H., Baek, M. J., Sun, H. Y., Lee, B., Li, S., Khandwala, Y., Del Giudice, F., Chung, B. I. 2018; 13 (10): e0203479

  Abstract

  BACKGROUND: Although combination therapy with 5 alpha-reductase inhibitor (5ARI) and alpha-blocker is one of the standard interventions in symptomatic benign prostatic hyperplasia (BPH), 5ARI monotherapy is seldom the focus of attention. Adverse events associated with 5ARI include depression and suicidal attempts in addition to persistent erectile dysfunction. The aim of this study is to update our knowledge of clinical efficacy and incidence of adverse events associated with 5ARI treatment in symptomatic BPH.METHODS AND FINDINGS: A meta-analysis of randomized controlled clinical trials (RCTs) from 1966 until March, 2017 was performed using database from PubMed, Cochrane Collaboration and Embase. A total of 23395 patients were included in this study and the inclusion criteria were: RCTs with 5ARI and placebo in symptomatic BPH patients. Parameters included prostate specific antigen (PSA), prostate volume (PV), International Prostate Symptom Score (IPPS), post-void residual urine (PVR), voiding symptoms of IPSS (voiding IPSS), maximum urinary flow rate (Qmax), and adverse events (AEs). A meta-analysis with meta-regression was performed for each effect size and adverse events, sensitivity analysis, cumulative analysis along with the analysis of ratio of means (ROM) in the placebo group. A total of 42 studies were included in this study for review, and a total of 37 studies were included in the meta-analysis, including a total of 23395 patients (treatment group: 11392, placebo group: 12003). The effect size of all variables except PVR showed a significant improvement following 5ARI treatment compared with placebo. However, the effect size of differences showed declining trend in PV, IPSS and Qmax according to recent years of publication. In ROM analysis, PV showed no significant increase in the placebo group, with a ROM of 1.00 (95% CI, 0.88, 1.14). The 5ARI treatment resulted in a significantly higher incidence of decreased libido (OR = 1.7; 95% CI, 1.36, 2.13), ejaculatory disorder (OR = 2.94; 95% CI, 2.15, 4.03), gynecomastia (OR = 2.32; 95% CI, 1.41, 3.83), and impotence (OR = 1.74; 95% CI, 1.32, 2.29). Our study has the following limitations: included studies were heterogeneous and direct comparison of efficacy between alpha blocker and 5ARI was not performed. Adverse events including depression or suicidal attempt could not be analyzed in this meta-analysis setting.CONCLUSIONS: Although there was a significant clinical benefit of 5ARI monotherapy compared with placebo, the effective size was small. Moreover, the risk of adverse events including sexually related complications were high. Additional head-to-head studies are needed to re-evaluate the clinical efficacy of 5ARI compared with alpha-adrenergic receptor blockers.

  View details for PubMedID 30281615

• Performance of multiparametric MRI appears better when measured in patients who undergo radical prostatectomy RESEARCH AND REPORTS IN UROLOGY Wang, N. N., Fan, R. E., Leppert, J. T., Ghanouni, P., Kunder, C. A., Brooks, J. D., Chung, B., Sonn, G. A. 2018; 10: 233–35

  View details for DOI 10.2147/RRU.S178064

  View details for Web of Science ID 000451113100001

• Re: Sungmin Woo, Chong Hyun Suh, Sang Youn Kim, Jeong Yeon Cho, Seung Hyup Kim. Diagnostic Performance of Magnetic Resonance Imaging for the Detection of Bone Metastasis in Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2017.03.042 EUROPEAN UROLOGY Kim, J., Lee, B., Chung, B. I. 2017; 72 (6): E164–E165

  View details for PubMedID 28689900

• The incidence of unsuccessful partial nephrectomy within the United States: A nationwide population-based analysis from 2003 to 2015 UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS Khandwala, Y. S., Jeong, I., Kim, J., Han, D., Li, S., Wang, Y., Chang, S. L., Chung, B. I. 2017; 35 (12)

  View details for DOI 10.1016/j.urolonc.2017.08.014

  View details for Web of Science ID 000415298200010

• Comparative rates of upstaging and upgrading in Caucasian and Korean prostate cancer patients eligible for active surveillance PLOS ONE Jeon, H., Yoo, J., Jeong, B., Seo, S., Jeon, S., Choi, H., Lee, H., Ferrari, M., Brooks, J. D., Chung, B. I. 2017; 12 (11)

  View details for DOI 10.1371/journal.pone.0186026

  View details for Web of Science ID 000415121200003

• Comparative rates of upstaging and upgrading in Caucasian and Korean prostate cancer patients eligible for active surveillance. PloS one Jeon, H. G., Yoo, J. H., Jeong, B. C., Seo, S. I., Jeon, S. S., Choi, H. Y., Lee, H. M., Ferrari, M., Brooks, J. D., Chung, B. I. 2017; 12 (11): e0186026

  Abstract

  To investigate the impact of race on the risk of pathological upgrading and upstaging at radical prostatectomy (RP) in an Asian (Korean) and Western (Caucasian) cohort eligible for active surveillance (AS).We performed a retrospective cohort study of 854 patients eligible for AS who underwent RP in United States (n = 261) and Korea (n = 593) between 2006 and 2015. After adjusting for age, PSA level, and prostate volume, we utilized multivariate logistic regression analysis to assess the effect of race on upgrading or upstaging.There were significant differences between Caucasian and Korean patients in terms of age at surgery (60.2 yr. vs. 64.1 yr.), PSA density (0.115 ng/mL/mL vs. 0.165 ng/mL/mL) and mean number of positive cores (3.5 vs. 2.4), but not in preoperative PSA values (5.11 ng/mL vs. 5.05 ng/mL). The rate of upstaging from cT1 or cT2 to pT3 or higher was not significantly different between the two cohorts (8.8% vs. 11.0%, P = 0.341). However, there were higher rates of upgrading to high-grade cancer (Gleason 4+3 or higher) in Korean patients (9.1%) when compared to Caucasian counterparts (2.7%) (P = 0.003). Multivariate logistic regression analysis showed that age (OR 1.07, P < 0.001) and smaller prostate volume (OR 0.97, P < 0.001), but not race, were significantly associated with upstaging or upgrading.There were no differences in rates of upgrading or upstaging between Caucasian and Korean men eligible for active surveillance.

  View details for DOI 10.1371/journal.pone.0186026

  View details for PubMedID 29136019

  View details for PubMedCentralID PMC5685613

• Re: Jim C. Hu, David M. Nanus, Art Sedrakyan. Increase in Prostate Cancer Metastases at Radical Prostatectomy in the United States. Eur Urol 2017; 71: 147-9 EUROPEAN UROLOGY Kim, J., Khandwala, Y. S., Chung, B. I. 2017; 72 (2): E41–E42

  View details for PubMedID 28365161

• Bisphosphonate Use and Risk of Renal Cell Carcinoma: A Population Based Case-Control Study Hellfritzsch, M., Chung, B. I., Ulrichsen, S. P., Sorensen, H. T., Ehrenstein, V. WILEY. 2017: 548–49

  View details for Web of Science ID 000437104300506

• Prophylactic Antibiotics and Postoperative Complications of Radical Cystectomy: A Population Based Analysis in the United States JOURNAL OF UROLOGY Krasnow, R. E., Mossanen, M., Koo, S., Kubiak, D. W., Preston, M. A., Chung, B. I., Kibel, A. S., Chang, S. L. 2017; 198 (2): 297–304

  Abstract

  Infectious, wound and soft tissue events contribute to the morbidity of radical cystectomy but the association between these events and antibiotic prophylaxis is not clear. We sought to describe the contemporary use of antibiotic prophylaxis in radical cystectomy and adherence to published guidelines, and identify regimens with the lowest rates of infectious events.We identified the intraoperative antibiotic prophylaxis regimen in a population based, retrospective cohort study of patients who underwent radical cystectomy across the United States between 2003 and 2013. Multivariable regression was done to evaluate 90-day infectious events and length of stay.In a weighted cohort of 52,349 patients there were 579 unique antibiotic prophylaxis regimens. Cefazolin was the most commonly used antibiotic (16% of cases). The overall infectious event rate was 25%. Only 15% of patients received antibiotic prophylaxis based on guidelines. Of guideline based antibiotic prophylaxis ampicillin/sulbactam had the lowest odds of infectious events (OR 0.34, p <0.001). In 2.7% of patients a penicillin based regimen with a β-lactamase inhibitor was associated with a prominent reduction in the odds of infectious events (OR 0.45, p = 0.001) and decreased length of stay (-1.3 days, p = 0.016).Antibiotic prophylaxis practices are highly heterogeneous in radical cystectomy. There is a lack of adherence to published guidelines. We observed decreased infectious event rates and shorter length of stay with regimens that included broad coverage of common skin, genitourinary and gastrointestinal flora. The ideal antibiotic regimen requires further study to optimize perioperative outcomes.

  View details for PubMedID 28267603

• Distal Corporal Anchoring Stitch: A Technique to Address Distal Corporal Crossovers and Impending Lateral Extrusions of a Penile Prosthesis. journal of sexual medicine Antonini, G., Busetto, G. M., Del Giudice, F., Ferro, M., Chung, B. I., Conti, S. L., Suarez Sarmiento, A., Pacchiarotti, A., De Berardinis, E., Perito, P. E. 2017; 14 (6): 767-773

  Abstract

  Unidentified distal crossovers, delayed distal crossovers, and impending lateral extrusion are complications of penile prosthesis implant insertion but are not as common as prosthesis infection or mechanical failure.To evaluate results of a surgical technique, the distal corporal anchoring stitch, that addresses fixation of the penile prosthesis in patients with these complications.A lateral sub-coronal incision is used on the side where the crossover or laterally extruding cylinder should be positioned. Dissection is carried through the Buck fascia, followed by a transverse incision of the tunica albuginea, where the distal aspect of the affected cylinder is delivered. A 4-0 PDS suture is threaded through the distal cylinder ring of the implant. A new, properly positioned intracorporal channel is created and the suture is passed through the distal end of the channel. Once the suture is through the glans and the cylinder is in the correct position, a small cruciate incision is made on the glans at the location of the anchor stitch. The suture is tied with the knot buried in the glans tissue.Fifty-three patients underwent treatment of their distal penile implant crossover with a distal corporoplasty using this method and their anatomic and functional outcomes and overall satisfaction were evaluated.This technique ensured that the cylinder remained in the newly created, appropriately positioned channel. No patients developed infections, wound-healing defect, glandular hypoesthesia, anesthesia, or altered sensation or pain in the glans related to the suture and only two reported recurrence of a lateral herniation that did not require further treatment.Distal fixation of the penile prosthesis is a useful surgical adjunct to treating patients with prosthetic lateral extrusions or crossovers that can be applied in almost all cases.Considering these rare complications, our experience is based on a relatively large number of patients and showed a low incidence of complications and a high satisfaction rate. The main limitation of this study is the retrospective nature of the data and the series included patients from two high-volume surgeons that might not be generalizable to all practices.The distal corporal anchoring stitch is safe and effective in securing distal fixation of the extruding inflatable penile prosthesis. Antonini G, Busetto GM, Del Giudice F, et al. Distal Corporal Anchoring Stitch: A Technique to Address Distal Corporal Crossovers and Impending Lateral Extrusions of a Penile Prosthesis. J Sex Med 2017;14:767-773.

  View details for DOI 10.1016/j.jsxm.2017.04.669

  View details for PubMedID 28583338

• Contemporary Trends In Utilization And Perioperative Outcomes Of Percutaneous Nephrolithotomy In The United States From 2003 To 2014. Journal of endourology Leow, J. J., Meyer, C. P., Wang, Y., Chang, S., Chung, B. I., Trinh, Q., Korets, R., Bhojani, N. 2017

  Abstract

  To investigate contemporary trends and perioperative outcomes of PCNL using a population-based cohort.Using the Premier Healthcare Database, we identified 225,321 patients diagnosed with kidney/ureter calculus who underwent PCNL at 447 different hospitals across the United States from 2003 to 2014. Outcomes included 90-day postoperative complications (as classified by the Clavien-Dindo system), prolonged hospital length of stay, operating room time, blood transfusions and direct hospital costs. Temporal trends were quantified by estimated annual percent change (EAPC) using least squares linear regression analysis. Multivariable logistic regression was performed to identify predictors of outcomes.PCNL utilization rates initially increased from 6.7% (2003) to 8.9% (2008) (EAPC +5.60%, p=0.02), before plateauing at 9.0% (2008-2011), then declining to 7.2% in 2014 (EAPC -4.37%, p=0.02). Overall (Clavien≥1) and major complication (Clavien≥3) rates rose significantly (EAPC: +12.2% and +16.4% respectively, both p<0.001). Overall/major complication and blood transfusion rates were 23.1%/4.8% and 3.3% respectively. Median operating room time and 90-day costs were 221 mins (IQR 4) and $12734 (IQR $9419), respectively. Significant predictors of overall complications include higher Charlson comorbidity index (CCI) (CCI≥2: OR 2.08, p<0.001) and more recent year of surgery (2007-2010: OR 3.20, 2011-2014: OR 4.39, both p<0.001). Higher surgeon volume was significantly associated with decreased overall (OR 0.992, p<0.001) and major (OR 0.991, p=0.01) complications.Our contemporary analysis shows a decrease in utilization of PCNL in recent years, along with an increase in complication rates. Numerous patient, hospital and surgical characteristics affect complication rates.

  View details for DOI 10.1089/end.2017.0225

  View details for PubMedID 28557565

• The Impact of Surgeon Volume on Perioperative Outcomes and Cost for Patients Receiving Robotic Partial Nephrectomy. Journal of endourology Khandwala, Y. S., Jeong, I. G., Kim, J. H., Han, D. H., Li, S., Wang, Y., Chang, S. L., Chung, B. I. 2017

  Abstract

  Little is known about the impact of surgeon volume on the success of the robot-assisted partial nephrectomy (RAPN). The objective of this study was to compare the perioperative outcomes and cost related to RAPN by annual surgeon volumes.Using the Premier Hospital Database, we retrospectively analyzed 39,773 patients who underwent RAPN between 2003 and 2015 in the United States. Surgeons for each index case were grouped into quintiles for each respective year. Outcomes were 90-day postoperative complications, operating room time (ORT), blood transfusion, length of stay, and direct hospital costs. Logistic regression and generalized linear models were used to identify factors predicting complications and cost.After accounting for patient and hospital demographics, high- and very high-volume surgeons had 40% and 42% decreased odds of having major complications (p = 0.045 and p = 0.027, respectively). Surgeons with higher volumes were associated with fewer odds of prolonged ORT (0.68 for low, 0.72 for intermediate, 0.56 for high, 0.44 for very high volume, all p < 0.05) and length of hospital stay (0.67 for intermediate, 0.51 for high, 0.45 for very high volume, all p < 0.01) compared with very low-volume surgeons. The 90-day hospital cost was also significantly lower for the surgeons with higher volume, but the statistical significance diminished after consideration of hospital clustering.Surgeons with very high RAPN volumes were found to have superior perioperative outcomes. Although cost of care appeared to correlate with surgeon volume, there may be other more influential factors predicting cost.

  View details for DOI 10.1089/end.2017.0207

  View details for PubMedID 28537505

• Androgen Deprivation Therapy and Subsequent Dementia. JAMA oncology Kim, J. H., Chung, B. I. 2017

  View details for DOI 10.1001/jamaoncol.2017.0509

  View details for PubMedID 28472205

• The Decline of the Open Ureteral Reimplant in the United States: National Data From 2003 to 2013. Urology Kurtz, M. P., Leow, J. J., Varda, B. K., Logvinenko, T., McQuaid, J. W., Yu, R. N., Nelson, C. P., Chung, B. I., Chang, S. L. 2017; 100: 193-197

  Abstract

  To examine trends in the number of cases of primary vesicoureteral reflux managed by ureteral reimplantation nationally over the last decade. Substantial changes have occurred in management of vesicoureteral reflux (VUR) over time, but trends in use of ureteral reimplantation have yet to be investigated on a national scale with annualized data.Using the Premier Healthcare Database, we extracted hospital discharge data for pediatric patients (age ≤ 18 years) with a procedure code for ureteroneocystostomy (International Classification of Diseases, Ninth Revision, 56.74) between January 1, 2003 and December 31, 2013. We excluded patients with secondary VUR. The presence of a temporal trend in reimplantation was examined via regression using generalized estimating equations.In 4301 cases of primary VUR (23,602 weighted), there was a substantial decrease in the number of reimplantations performed, with an estimated decline in the rate of 0.239 cases per attending per year (P = .006). Average patient age declined 1.2 months in each year (P < .0001) due largely to a decline in reimplantation in those over age 2, which fell by 0.15 reimplantations per attending per year (P = .026). There was no difference between rates of decline in reimplantation for children with and without reflux nephropathy (P = .21) CONCLUSION: Nationally there has been a marked decrease in the incidence of ureteral reimplantation among children with primary VUR. The potential factors contributing to this are broad, including changes in diagnostic patterns, treatment recommendations, and the rise of endoscopic intervention.

  View details for DOI 10.1016/j.urology.2016.07.024

  View details for PubMedID 27473557

• Contemporary Use of Partial Nephrectomy: Are Older Patients With Impaired Kidney Function Being Left Behind? UROLOGY Leppert, J. T., Mittakanti, H. R., Thomas, I., Lamberts, R. W., Sonn, G. A., Chung, B. I., Skinner, E. C., Wagner, T. H., Chertow, G. M., Brooks, J. D. 2017; 100: 65-71

  View details for DOI 10.1016/j.urology.2016.08.044

  View details for Web of Science ID 000397168900017

• The Prognostic Role of Circulating Tumor Cells (CTC) in High-risk Non-muscle-invasive Bladder Cancer. Clinical genitourinary cancer Busetto, G. M., Ferro, M., Del Giudice, F., Antonini, G., Chung, B. I., Sperduti, I., Giannarelli, D., Lucarelli, G., Borghesi, M., Musi, G., De Cobelli, O., De Berardinis, E. 2017

  Abstract

  The purpose of this study was to evaluate the impact of circulating tumor cells (CTCs) as a prognostic marker in patients with high-risk non-muscle-invasive bladder cancer (NMIBC) and assess the efficacy and reliability of 2 different CTC isolation methods.Globally, 155 patients with a pathologically confirmed diagnosis of high-risk NMIBC were included (pT1G3 with or without carcinoma in situ) and underwent transurethral resection of bladder tumor (TURB) after a blood withdrawal for CTC evaluation. A total of 101 patients (Group A) had their samples analyzed with the CellSearch automated system, and 54 (Group B) had their samples analyzed with the CELLection Dynabeads manual system.Patients were followed for 28 months, and during this interval, there were a total of 65 (41.9%) recurrences, 27 (17.4%) disease progressions, and 9 (5.8%) lymph node and/or bone metastasis. In our CTC analysis, there were 20 (19.8%) positive patients in Group A and 24 in Group B (44.4%). In our analysis, we found a strong correlation between CTC presence and time to first recurrence; in Group A, we observed an incidence of recurrence in 75% of CTC-positive patients and in Group B of 83% of CTC-positive patients. The time to progression was also strongly correlated with CTCs: 65% and 29%, respectively, of those patients who progressed in those with CTCs in Group A and B.The study demonstrates the potential role of CTCs as a prognostic marker for risk stratification in patients with NMIBC, to predict both recurrence and progression.

  View details for DOI 10.1016/j.clgc.2017.01.011

  View details for PubMedID 28188046

• Incident CKD after Radical or Partial Nephrectomy. Journal of the American Society of Nephrology : JASN Leppert, J. T., Lamberts, R. W., Thomas, I. C., Chung, B. I., Sonn, G. A., Skinner, E. C., Wagner, T. H., Chertow, G. M., Brooks, J. D. 2017

  Abstract

  The comparative effectiveness of partial nephrectomy versus radical nephrectomy to preserve kidney function has not been well established. We determined the risk of clinically significant (stage 4 and higher) CKD after radical or partial nephrectomy among veterans treated for kidney cancer in the Veterans Health Administration (2001-2013). Among patients with preoperative eGFR≥30 ml/min per 1.73 m(2), the incidence of CKD stage 4 or higher after radical (n=9759) or partial nephrectomy (n=4370) was 7.9% overall. The median time to stage 4 or higher CKD after surgery was 5 months, after which few patients progressed. In propensity score-matched cohorts, partial nephrectomy associated with a significantly lower relative risk of incident CKD stage 4 or higher (hazard ratio, 0.34; 95% confidence interval [95% CI], 0.26 to 0.43, versus radical nephrectomy). In a parallel analysis of patients with normal or near-normal preoperative kidney function (eGFR≥60 ml/min per 1.73 m(2)), partial nephrectomy was also associated with a significantly lower relative risk of incident CKD stage 3b or higher (hazard ratio, 0.15; 95% CI, 0.11 to 0.19, versus radical nephrectomy) in propensity score-matched cohorts. Competing risk regression models produced consistent results. Finally, patients treated with a partial nephrectomy had reduced risk of mortality (hazard ratio, 0.55; 95% CI, 0.49 to 0.62). In conclusion, compared with radical nephrectomy, partial nephrectomy was associated with a marked reduction in the incidence of clinically significant CKD and with enhanced survival. Postoperative decline in kidney function occurred mainly in the first year after surgery and appeared stable over time.

  View details for PubMedID 29018140

• Re: Suppressed Recurrent Bladder Cancer after Androgen Suppression with Androgen Deprivation Therapy or 5α-Reductase Inhibitor: M. Shiota, K. Kiyoshima, A. Yokomizo, A. Takeuchi, E. Kashiwagi, T. Dejima, R. Takahashi, J. Inokuchi, K. Tatsugami and M. Eto J Urol 2017;197:308-313. The Journal of urology Kim, J. H., Chung, B. I. 2017; 198 (1): 211–12

  View details for PubMedID 28365365

• Re: Maria Carmen Mir, Ithaar Derweesh, Francesco Porpiglia, Homayoun Zargar, Alexandre Mottrie, Riccardo Autorino. Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1b and T2 Renal Tumors: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol 2017;71:606-17. European urology Kim, J. H., Chung, B. I. 2017; 72 (5): e127–e128

  View details for PubMedID 28545840

• Re: Julien Dagenais, Matthew J. Maurice, Pascal Mouracade, Onder Kara, Ercan Malkoc, Jihad J. Kaouk. Excisional Precision Matters: Understanding the Influence of Excisional Volume Loss on Renal Function After Partial Nephrectomy. Eur Urol 2017;72:168-70. European urology Kim, J. H., Chung, B. I. 2017; 72 (5): e131–e132

  View details for PubMedID 28549807

• Expected Next-Generation Drugs Under Development in Relation to Voiding Symptoms. International neurourology journal Chung, K. J., Chung, B. I. 2017; 21 (2): 97–101

  Abstract

  New drug development is a high-risk venture, but if successful, will bring great revenues to those willing to accept the risk. In the field of urology, in particular for lower urinary tract symptoms (LUTS), the recent successful landing of drugs (e.g., mirabegron, botulinum toxin A, and tadalafil) has resulted in increased interest in new drug development. Benign prostatic hyperplasia and overactive bladder syndrome, representative LUTS diseases, are attractive targets because of their prevalence and market size in the field of urology. Additionally, the awareness about new stream of research is very important not only because of the market size and economic factors, but also because to keep steady attention to these research for the researcher's. We have reviewed a selection of new drugs currently under development for the treatment of the two aforementioned diseases and hope to offer urologists an overview of the current situation and future directions in the field of urology.

  View details for PubMedID 28673067

  View details for PubMedCentralID PMC5497200

• Adoption of Robot-Assisted Partial Nephrectomies: A Population-Based Analysis of U.S. Surgeons from 2004 to 2013. Journal of endourology Cheung, H. n., Wang, Y. n., Chang, S. L., Khandwala, Y. n., Del Giudice, F. n., Chung, B. I. 2017; 31 (9): 886–92

  Abstract

  Urological surgeries have contributed to the increasing prevalence of minimally invasive robotic procedures. Although factors influencing the adoption of robot-assisted radical prostatectomy have previously been identified, the explanation for the rapid rise in robotic partial nephrectomies remains unknown. Using a retrospective population-based sample, we attempt to determine hospital and surgeon-specific factors influencing a surgeon's decision to utilize robotic assistance for partial nephrectomies.A nationally representative weighted sample of all men who underwent a partial nephrectomy in the United States between 2003 and 2014 was identified within the Premier Hospital Database. Hospital, surgeon, and patient characteristics for each operation were analyzed. Descriptive statistics and a multivariate regression model stratified according to the Law of Diffusion of Innovation were performed.A weighted sample of 14,890 nephrectomies was included in the study. Patient demographics were similar between the two groups. The adoption of robotic technology followed the Law of Diffusion of Innovation with the percentage of partial nephrectomies with robotic assistance increasing yearly, reaching 64.1% by 2013. Surgical volume was a significant factor driving the use of robotic assistance, with high volume surgeons (>5 partial nephrectomies/year) performing 23.2% more robotic partial nephrectomies per year than their low volume colleagues (< = 5 partial nephrectomies/year) from 2009 to 2013 (p < 0.001).This retrospective population-based study examines key factors influencing the diffusion of robotic technology for partial nephrectomies. Surgical volume and year of surgery were found to be the most significant factor in robotic adoption, with other patient and hospital-specific characteristics playing a minor role. Future studies are needed to correlate adoption rates with the clinical or cost-effectiveness of novel technologies within the medical field to determine whether rapid adoption is a patient-centered vs a clinician-centered decision point.

  View details for PubMedID 28699357

• The incidence of unsuccessful partial nephrectomy within the United States: A nationwide population-based analysis from 2003 to 2015. Urologic oncology Khandwala, Y. S., Jeong, I. G., Kim, J. H., Han, D. H., Li, S. n., Wang, Y. n., Chang, S. L., Chung, B. I. 2017

  Abstract

  Partial nephrectomy (PN) remains underutilized within the United States and few reports have attempted to explain this trend. The aim of this study is to evaluate the nationwide incidence of unsuccessful PN and factors that predict its occurrence.Using the Premier Healthcare Database, we retrospectively analyzed a weighted sample of 66,432 patients undergoing curative surgery for renal mass between 2003 and 2015. PN intent was denoted by presence of insurance claims for the administration of mannitol. Unsuccessful PN was defined as an event in which patients were administered mannitol but received radical nephrectomy. A multivariate logistic regression model was generated to identify factors predicting unsuccessful PN.Overall rates of unsuccessful PN declined from 33.5% to 14.5% since 2003. Conversion to radical nephrectomy occurred most frequently during laparoscopic (34.7%) and least frequently during robotic approach (13.6%). There was significant difference in the rate of unsuccessful PN between very high and very low volume surgeons (open: 39.4% vs. 13.3%, laparoscopic: 51.2% vs. 32.2%, and robot assisted: 27.1% vs. 9.4%, all P<0.001). After adjustment for patient- and hospital-related factors, surgical approach (laparoscopic vs. open, odds ratio = 1.74, 95% CI: 1.31-2.30, P<0.001) and annual surgeon volume (very high vs. very low, odds ratio = 0.27, 95% CI: 0.21-0.34 P<0.001) were associated with unsuccessful PN.Although the rate of unsuccessful PN appears to be declining, it still remains common for low volume surgeons and with the laparoscopic surgical approach. Further evaluation of its effect on health care outcomes is necessary.

  View details for PubMedID 28889920

• Discrepancies on the association between androgen deprivation therapy for prostate cancer and subsequent dementia: meta-analysis and meta-regression. Oncotarget Kim, J. H., Lee, B. n., Han, D. H., Chung, K. J., Jeong, I. G., Chung, B. I. 2017; 8 (42): 73087–97

  Abstract

  Limited literature exists on the association between androgen deprivation therapy (ADT) for prostate cancer (PCa) and subsequent dementia and the study conclusions are in conflicts with one another. We searched several cohort databases from 1960 to 2017 for observational or prospective studies that reported on an association between ADT for PCa and subsequent dementia. A meta-analysis was performed to cumulatively determine the association between ADT and dementia including Alzheimer's disease using an incidence rate ratio (IRR), crude hazard ratio (HR), and adjusted HR. Seven studies were eligible for the meta-analysis, with the inclusion of a total of 90, 543 prostate cancer patients. The pooled overall IRR, crude HR, and adjusted HR were 1.78 [95% confidence interval (CI): 1.51-2.10)], 1.80 (95% CI: 1.05-3.10), and 1.59 (95% CI: 1.16-2.18), respectively. A meta-regression analysis showed that the crude HR was affected by both follow -up duration and lag time in the univariate model (p = < 0.001). However, IRR and adjusted HR were not affected by these moderators. The overall outcomes of IRR, crude HR, and adjusted HR were found to be balanced in the sensitivity analysis. A positive association was demonstrated between ADT and the subsequent incidence of dementia in this meta-analysis. Methodological difference including follow-up duration and the time lag could be related with the discrepancies.

  View details for PubMedID 29069851

• Adrenalectomy for benign and malignant disease: utilization and outcomes by surgeon specialty and surgical approach from 2003-2013. The Canadian journal of urology Faiena, I. n., Tabakin, A. n., Leow, J. n., Patel, N. n., Modi, P. K., Salmasi, A. H., Chung, B. I., Chang, S. L., Singer, E. A. 2017; 24 (5): 8990–97

  Abstract

  Data on the utilization of open, laparoscopic and robotic adrenalectomy on a national level is limited.Data on patients who underwent open, laparoscopic, or robotic adrenalectomy for benign or malignant disease in the US from 2003-2013 were extracted using ICD-9 codes from the Premier Hospital Database. Surgeon specialty, patient demographics, hospital characteristics, and complications were compared. Data were analyzed using univariate and multivariable logistic regression analyses.A total of 8,831 adrenalectomies were performed for benign and malignant tumors. There was no significant difference in rate of adrenalectomy with regards to comorbidities, insurance status, or hospital characteristics. Non-urologists performed adrenalectomy more often for both benign (57% versus 43%; p = 0.011) and malignant disease (66% versus 34%; p = 0.011). Across all indications, non-urologists performed open surgery most often followed by laparoscopic and robotic approaches (56.3% versus 37.4% versus 6.4%, respectively), compared to urologists (48.8% versus 38.4% versus 12.9%, respectively). Overall, urologists were more likely to use laparoscopic or robotic approaches (p = 0.001). There was no difference in complication rates or operative times between surgical specialties or by surgeon/hospital case volume. On multivariable regression analysis, the best predictor of major complication was a Charlson Comorbidity Index (CCI) ≥ 2 (OR 3.9, 95%CI 2.1-7.1; p = < 0.001). Compared to open surgery, laparoscopy had significantly reduced odds of major complication (OR 0.6, 95%CI 0.3-0.9; p = 0.03). Patients undergoing robotic procedures had the shortest length of stay.In this retrospective study, adrenalectomy was more commonly performed by non-urologists via an open approach. Patients with CCI ≥ 2 were more likely to have postoperative complications while surgeon volume, hospital volume, and surgical approach did not influence complication rates.

  View details for PubMedID 28971785

• Re: Philipp Mandel, Felix Preisser, Markus Graefen, et al. High Chance of Late Recovery of Urinary and Erectile Function Beyond 12 Months After Radical Prostatectomy. Eur Urol 2017;71:848-50. European urology Kim, J. H., Lee, B. n., Chung, B. I. 2017

  View details for PubMedID 28709728

• Variations in the Costs of Radical Cystectomy for Bladder Cancer in the USA. European urology Leow, J. J., Cole, A. P., Seisen, T. n., Bellmunt, J. n., Mossanen, M. n., Menon, M. n., Preston, M. A., Choueiri, T. K., Kibel, A. S., Chung, B. I., Sun, M. n., Chang, S. L., Trinh, Q. D. 2017

  Abstract

  Radical cystectomy (RC) for muscle-invasive bladder cancer (BCa) has potential for serious complications, prolonged length of stay and readmissions-all of which may increase costs. Although variations in outcomes are well described, less is known about determinants driving variation in costs.To assess surgeon- and hospital-level variations in costs and predictors of high- and low-cost RC.Cohort study of 23 173 patients who underwent RC for BCa in 208 hospitals in the USA from 2003 to 2015 in the Premier Healthcare Database.Ninety-day direct hospital costs; multilevel hierarchal linear models were constructed to evaluate contributions of each variable to costs.Mean 90-d direct hospital costs per RC was $39 651 (standard deviation $34 427), of which index hospitalization accounted for 87.8% ($34 803) and postdischarge readmission(s) accounted for 12.2% ($4847). Postoperative complications contributed most to cost variations (84.5%), followed by patient (49.8%; eg, Charlson Comorbidity Index [CCI], 40.5%), surgical (33.2%; eg, year of surgery [25.0%]), and hospital characteristics (8.0%). Patients who suffered minor complications (odds ratio [OR] 2.63, 95% confidence interval [CI]: 2.03-3.40), nonfatal major complications (OR 12.7, 95% CI: 9.63-16.8), and mortality (OR 13.5, 95% CI: 9.35-19.4, all p<0.001) were significantly associated with high costs. As for low-cost surgery, sicker patients (CCI=2: OR 0.41, 95% CI: 0.29-0.59; CCI=1: OR 0.58, 95% CI: 0.46-0.75, both p<0.001), those who underwent continent diversion (vs incontinent diversion: OR 0.29, 95% CI: 0.16-0.53, p<0.001), and earlier period of surgery were inversely associated with low costs.This study provides insight into the determinants of costs for RC. Postoperative morbidity, patient comorbidities, and year of surgery contributed most to observed variations in costs, while other hospital- and surgical-related characteristics such as volume, use of robot assistance, and type of urinary diversion contribute less to outlier costs.Efforts to address high surgical cost must be tailored to specific determinants of high and low costs for each operation. In contrast to robot-assisted radical prostatectomy where surgeon factors predominate, high costs in radical cystectomy were primarily determined by postoperative complication and patient comorbidities.

  View details for PubMedID 28803034

• Surgeon preference of surgical approach for partial nephrectomy in patients with baseline chronic kidney disease: a nationwide population-based analysis in the USA. International urology and nephrology Khandwala, Y. S., Jeong, I. G., Han, D. H., Kim, J. H., Li, S. n., Wang, Y. n., Chang, S. L., Chung, B. I. 2017; 49 (11): 1921–27

  Abstract

  To examine trends in utilization of open, laparoscopic and robot-assisted surgical approaches for treatment of patients with chronic kidney disease (CKD) undergoing partial nephrectomy (PN) within the USA.We analyzed a weighted sample of 112,117 patients from the Premier administrative dataset who underwent PN for renal mass between 2003 and 2015. Proportions of surgical approach utilization were evaluated by CKD status and further stratified by surgery year and surgeon volume. A multivariate logistic regression model was created to predict receipt of minimally invasive PN.Seven thousand five hundred and sixty-five (6.7%) patients with CKD were identified. The proportion of CKD patients receiving open PN decreased from 72.4% in 2003-2007 to 36.1% in 2012-2015 (p < 0.001). Although the robot-assisted PN was the dominant surgical approach for both patients with and without CKD in 2012-2015, the proportion receiving open PN was higher in patients with CKD compared to those without CKD (p = 0.018). Multivariate analysis showed that the presence of CKD was independently associated with lower odds of receiving a minimally invasive approach (OR 0.47 for the entire study cohort, OR 0.27 for high volume robot-assisted PN surgeons, and OR 0.51 for recent years, all p < 0.001). These trends remained when CKD stages were evaluated individually.Patients with CKD undergoing PN were preferentially treated with open surgery despite an overall increase in robot-assisted PN use over the past 13 years. Further studies evaluating surgical outcomes in this population are warranted for determination of optimal approach and construction of evidence-based guidelines.

  View details for PubMedID 28852937

• Robotic versus open pediatric ureteral reimplantation: Costs and complications from a nationwide sample JOURNAL OF PEDIATRIC UROLOGY Kurtz, M. P., Leow, J. J., Varda, B. K., Logvinenko, T., Yu, R. N., Nelson, C. P., Chung, B. I., Chang, S. L. 2016; 12 (6)

  Abstract

  We sought to compare complications and direct costs for open ureteral reimplantation (OUR) versus robot-assisted laparoscopic ureteral reimplantation (RALUR) in a sample of hospitals performing both procedures. Anecdotal reports suggest that use of RALUR is increasing, but little is known of the outcomes and costs nationwide.The aim was to determine the costs and 90-day complications (of any Clavien grade) in a nationwide cohort of pediatric patients undergoing OUR or RALUR.Using the Premier Hospital Database we identified pediatric patients (age < 21 years) who underwent ureteral reimplantation from 2003 to 2013. We compared 90-day complication rates and cost data for RALUR versus OUR using descriptive statistics and hierarchical models.We identified 17 hospitals in which both RALUR and OURs were performed, resulting in a cohort of 1494 OUR and 108 RALUR cases. The median operative time was 232 min for RALUR vs. 180 min for OUR (p = 0.0041). Incidence of any 90-day complications was higher in the RALUR group: 13.0% of RALUR vs. 4.5% of OUR (OR = 3.17, 95% CI: 1.46-6.91, p = 0.0037). The difference remained significant in a multivariate model accounting for clustering among hospitals and surgeons (OR, 3.14; 95% CI, 1.46-6.75; p = 0.0033) (Figure). The median hospital cost for OUR was $7273 versus $9128 for RALUR (p = 0.0499), and the difference persisted in multivariate analysis (p = 0.0043). Fifty-one percent (55/108) of the RALUR cases occurred in 2012-2013.We present the first nationwide sample comparing RALUR and OUR in the pediatric population. There is currently wide variation in the probability of complication reported in the literature. Some variability may be due to differential uptake and experience among centers as they integrate a new procedure into their practice, while some may be due to reporting bias. A strength of the current study is that cost and 90-day postoperative complication data are collected at participating hospitals irrespective of outcomes, providing some immunity from the reporting bias to which individual center surgical series' may be susceptible.Compared with OUR, RALUR was associated with a significantly higher rate of complications as well as higher direct costs even when adjusted for demographic and regional factors. These findings suggest that RALUR should be implemented with caution, particularly at sites with limited robotic experience, and that outcomes for these procedures should be carefully and systematically tracked.

  View details for DOI 10.1016/j.jpurol.2016.06.016

  View details for PubMedID 27593917

• Robot-assisted Versus Open Radical Prostatectomy: A Contemporary Analysis of an All-payer Discharge Database EUROPEAN UROLOGY Leow, J. J., Chang, S. L., Meyer, C. P., Wang, Y., Hanske, J., Sammon, J. D., Cole, A. P., Preston, M. A., Dasgupta, P., Menon, M., Chung, B. I., Quoc-Dien Trinh, Q. D. 2016; 70 (5): 837-845

  Abstract

  More than a decade since its inception, the benefits and cost efficiency of robot-assisted radical prostatectomy (RARP) continue to elicit controversy.To compare outcomes and costs between RARP and open RP (ORP).A cohort study of 629 593 men who underwent RP for localized prostate cancer at 449 hospitals in the USA from 2003 to 2013, using the Premier Hospital Database.RARP was ascertained through a review of the hospital charge description master for robotic supplies.Outcomes were 90-d postoperative complications (Clavien), blood product transfusions, operating room time (ORT), length of stay (LOS), and direct hospital costs. Propensity-weighted regression analyses accounting for clustering by hospitals and survey weighting ensured nationally representative estimates.RARP utilization rapidly increased from 1.8% in 2003 to 85% in 2013 (p<0.001). RARP patients (n=311 135) were less likely to experience any complications (odds ratio [OR] 0.68, p<0.001) or prolonged LOS (OR 0.28, p<0.001), or to receive blood products (OR 0.33, p=0.002) compared to ORP patients (n=318 458). The adjusted mean ORT was 131min longer for RARP (p=0.002). The 90-d direct hospital costs were higher for RARP (+$4528, p<0.001), primarily attributed to operating room and supplies costs. Costs were no longer signficantly different between ORP and RARP among the highest-volume surgeons (≥104 cases/yr; +$1990, p=0.40) and highest-volume hospitals (≥318 cases/yr; +$1225, p=0.39). Limitations include the lack of oncologic characteristics and the retrospective nature of the study.Our contemporary analysis reveals that RARP confers a perioperative morbidity advantage at higher cost. In the absence of large randomized trials because of the widespread adoption of RARP, this retrospective study represents the best available evidence for the morbidity and cost profile of RARP versus ORP.In this large study of men with prostate cancer who underwent either open or robotic radical prostatectomy, we found that robotic surgery has a better morbidity profile but costs more.

  View details for DOI 10.1016/j.eururo.2016.01.044

  View details for PubMedID 26874806

• Contemporary Trends in the Management of Renal Trauma in the United States: A National Community Hospital Population-based Analysis UROLOGY Dagenais, J., Leow, J. J., Haider, A. H., Wang, Y., Chung, B. I., Chang, S. L., Eswara, J. R. 2016; 97: 98-104

  Abstract

  To better define the shift in the management of renal trauma throughout the United States, with a population-based assessment of community hospital practice patterns. To investigate how hospital, patient, and injury-specific factors influence management strategy by both urologists and nonurologists.Using the Premier Hospital database, we performed a retrospective study of all patients with renal trauma between 2003 and 2013. We identified patients using International Classification of Diseases, Ninth Revision diagnosis codes (866.0x, 866.1x), determined management strategy by International Classification of Diseases, Ninth Revision procedure codes, and dichotomized grouping by surgeon specialty. We stratified hospitals by annual renal trauma volume categorized a priori into low, <10 cases per year; intermediate, 10-20 cases per year; and high, >20 cases per year. We performed descriptive statistics and univariate and multivariate regression analyses adjusting for survey weighting and for patient, hospital, and injury-specific characteristics.Our study cohort included a weighted sample size of 21,531 patients. Higher renal trauma hospitals (12.6%) were significantly less likely than low (26.4%) and intermediate (31.3%) volume hospitals to undergo surgical intervention for renal trauma on adjusted models. There was a statistically significant increase in nonoperative management from 65.2% in 2003 to 81.8% in 2013.National rates of surgical intervention for renal trauma are significantly higher than those frequently quoted by the literature, especially among low- and intermediate-volume renal trauma hospitals. Although operative rates are decreasing, further consideration may need to be given to centralization of care in higher-volume teaching hospitals to improve renal salvage.

  View details for DOI 10.1016/j.urology.2016.06.051

  View details for Web of Science ID 000389550300035

  View details for PubMedID 27421783

• Variation in the Intensity of Care for Patients with Uncomplicated Renal Colic Presenting to U.S. Emergency Departments. journal of emergency medicine Elder, J. W., Delgado, M. K., Chung, B. I., Pirrotta, E. A., Wang, N. E. 2016

  Abstract

  Renal colic results in > 1 million ED visits per year, yet there exists a gap in understanding how the majority of these visits, namely uncomplicated cases, are managed.We assessed patient- and hospital-level variation for emergency department (ED) management of uncomplicated kidney stones.We identified ED visits from non-elderly adults (aged 19-79 years) with a primary diagnosis indicating renal stone or colic from the 2011 Nationwide Emergency Department Sample. Patients with additional diagnostic codes indicating infection, sepsis, and abdominal aortic aneurysm were excluded. We used sample-weighted logistic regression to determine the association between hospital admission and having a urologic procedure with patient and hospital characteristics.Of the 1,061,462 ED visits for uncomplicated kidney stones in 2011, 8.0% of visits resulted in admission and 6.3% resulted in an inpatient urologic procedure. Uninsured patients compared to Medicaid insured patients were less likely to be admitted or have an inpatient urologic procedure (odds ratio [OR] = 0.72; 95% confidence interval [CI] 0.65-0.81 and OR = 0.80; 95% CI 0.72-0.87, respectively). Private- and Medicare-insured patients compared to Medicaid-insured patients were more likely to have an inpatient urologic procedure (OR = 1.20; 95% CI 1.11-1.30 and OR = 1.14; 95% CI 1.04-1.25, respectively).For patients with uncomplicated renal colic, there is variation in the management associated with nonclinical factors, namely insurance. No consensus guidelines exist yet to address when to admit or utilize inpatient urologic procedures.

  View details for DOI 10.1016/j.jemermed.2016.05.037

  View details for PubMedID 27720288

• Surgeon and Hospital Level Variation in the Costs of Robot-Assisted Radical Prostatectomy JOURNAL OF UROLOGY Cole, A. P., Leow, J. J., Chang, S. L., Chung, B. I., Meyer, C. P., Kibel, A. S., Menon, M., Nguyen, P. L., Choueiri, T. K., Reznor, G., Lipsitz, S. R., Sammon, J. D., Sun, M., Quoc-Dien Trinh, Q. D. 2016; 196 (4): 1090-1095

  Abstract

  We assessed surgeon and hospital level variation in robot-assisted radical prostatectomy costs and predictors of high and low cost surgery.The study population consisted of a weighted sample of 291,015 men who underwent robot-assisted radical prostatectomy for prostate cancer by 667 surgeons at 197 U.S. hospitals from 2003 to 2013. We evaluated 90-day direct hospital costs (2014 USD) in the Premier Hospital Database. High costs per robot-assisted radical prostatectomy were those above the 90th percentile and low costs were those below the 10th percentile.Mean hospital cost per robot-assisted radical prostatectomy was $11,878 (95% CI $11,804-$11,952). Mean cost was $2,837 (95% CI $2,805-$2,869) in the low cost group vs $25,906 (95% CI $24,702-$25,490) in the high cost group. Nearly a third of the variation in robot-assisted radical prostatectomy cost was attributable to hospital characteristics and more than a fifth was attributable to surgeon characteristics (R-squared 30.43% and 21.25%, respectively). High volume surgeons and hospitals (90th percentile or greater) had decreased odds of high cost surgery (surgeons: OR 0.24, 95% CI 0.11-0.54; hospitals: OR 0.105, 95% CI 0.02-0.46). The performance of robot-assisted radical prostatectomy at a high volume hospital was associated with increased odds of low cost robot-assisted radical prostatectomy (OR 839, 95% CI 122-greater than 999).This study provides insight into the role of surgeons and hospitals in robot-assisted radical prostatectomy costs. Given the substantial variability, identifying and remedying the root cause of outlier costs may yield substantial benefits.

  View details for DOI 10.1016/j.juro.2016.04.087

  View details for PubMedID 27157376

• Contemporary Use of Partial Nephrectomy: Are Older Patients With Impaired Kidney Function Being Left Behind? Urology Leppert, J. T., Mittakanti, H. R., Thomas, I., Lamberts, R. W., Sonn, G. A., Chung, B. I., Skinner, E. C., Wagner, T. H., Chertow, G. M., Brooks, J. D. 2016

  Abstract

  To assess whether patient factors, such as age and preoperative kidney function, were associated with receipt of partial nephrectomy in a national integrated healthcare system.We identified patients treated with a radical or partial nephrectomy from 2002 to 2014 in the Veterans Health Administration. We examined associations among patient age, sex, race or ethnicity, multimorbidity, baseline kidney function, tumor characteristics, and receipt of partial nephrectomy. We estimated the odds of receiving a partial nephrectomy and assessed interactions between covariates and the year of surgery to explore whether patient factors associated with partial nephrectomy changed over time.In our cohort of 14,186 patients, 4508 (31.2%) received a partial nephrectomy. Use of partial nephrectomy increased from 17% in 2002 to 32% in 2008 and to 38% in 2014. Patient race or ethnicity, age, tumor stage, and year of surgery were independently associated with receipt of partial nephrectomy. Black veterans had significantly increased odds of receipt of partial nephrectomy, whereas older patients had significantly reduced odds. Partial nephrectomy utilization increased for all groups over time, but older patients and patients with worse baseline kidney function showed the least increase in odds of partial nephrectomy.Although the utilization of partial nephrectomy increased for all groups, the greatest increase occurred in the youngest patients and those with the highest baseline kidney function. These trends warrant further investigation to ensure that patients at the highest risk of impaired kidney function are considered for partial nephrectomy whenever possible.

  View details for DOI 10.1016/j.urology.2016.08.044

  View details for PubMedID 27634733

• Overall Survival in Patients with Localized Prostate Cancer in the US Veterans Health Administration: Is PIVOT Generalizable? EUROPEAN UROLOGY Barbosa, P. V., Thomas, I., Srinivas, S., Buyyounouski, M. K., Chung, B. I., Chertow, G. M., Asch, S. M., Wagner, T. H., Brooks, J. D., Leppert, J. T. 2016; 70 (2): 227-230

  Abstract

  A better understanding of overall survival among patients with clinically localized prostate cancer (PCa) in the US Veterans Health Administration (VHA) is critical to inform PCa treatment decisions, especially in light of data from the Prostate Intervention Versus Observation Trial (PIVOT). We sought to describe patterns of survival for all patients with clinically localized PCa treated by the VHA. We created an analytic cohort of 35 954 patients with clinically localized PCa diagnosed from 1995 to 2001, approximating the PIVOT inclusion criteria (age of diagnosis ≤75 yr and clinical stage T2 or lower). Mean patient age was 65.9 yr, and median follow-up was 161 mo. Overall, 22.5% of patients were treated with surgery, 16.6% were treated with radiotherapy, and 23.1% were treated with androgen deprivation. Median survival of the entire cohort was 14 yr (25th, 75th percentiles, range: 7.9-20 yr). Among patients who received treatment with curative intent, median survival was 17.9 yr following surgery and 12.9 yr following radiotherapy. One-third of patients died within 10 yr of diagnosis compared with nearly half of the participants in PIVOT. This finding sounds a note of caution when generalizing the mortality data from PIVOT to VHA patients and those in the community.More than one-third of patients diagnosed with clinically localized prostate cancer treated through the US Veterans Health Administration from 1995 to 2001 died within 10 yr of their diagnosis. Caution should be used when generalizing the estimates of competing mortality data from PIVOT.

  View details for DOI 10.1016/j.eururo.2016.02.037

  View details for PubMedID 26948397

• Trends in utilisation, perioperative outcomes, and costs of nephroureterectomies in the management of upper tract urothelial carcinoma: a 10-year population-based analysis BJU INTERNATIONAL Tinay, I., Gelpi-Hammerschmidt, F., Leow, J. J., Allard, C. B., Rodriguez, D., Wang, Y., Chung, B. I., Chang, S. L. 2016; 117 (6): 954-960

  Abstract

  To perform a population-based study to evaluate contemporary utilization trends, morbidity and costs associated with nephroureterectomies (NU). Contemporary data for NU are largely derived from single academic institution series describing the experience of high-volume surgeons. It is unclear if the same favorable results occur on a national level.Using the Premier Hospital Database, we captured patients undergoing a NU with diagnoses of renal pelvis or ureteral neoplasms from 2004 to 2013. We fitted regression models, adjusting for clustering by hospitals and survey weighting to evaluate 90-day postoperative complications, operating-room-time (OT), prolonged length-of-stay (pLOS) and direct hospital costs among open, laparoscopic (LNU) and robotic (RNU) approaches.After applying sampling and propensity weights we derived a final study cohort of 17,254 ONU, 13,317 LNU and 3,774 RNU for UTUC in the US between 2004 and 2013. During that period, minimally invasive NU (miNU) increased from 36%-to-54% while the total number of NUs decreased by nearly 20%. No differences were noted in perioperative outcomes between three surgical approaches, including when the analysis was restricted to highest-volume hospitals and highest-volume surgeons. OT was longer for LNU and RNU (p<0.001), where the pLOS rates were decreased for LNU and RNU (p <0.001). Adjusted 90-day median direct-hospital-costs were higher for LNU and RNU (p<0.001), which disappear when adjusting for the highest-volume groups except in RNUs performed by high-volume surgeons.During this contemporary 10-year study, miNU is replacing open surgery for UTUC with a recent surge in RNU, along with a concurrent reduction in total NUs performed. Despite not being associated with a clinically significant improvement in perioperative outcomes, the costs for miNU were consistently higher. However, higher hospital volumes suggest a potential cost containment strategy when performing miNUs. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/bju.13375

  View details for Web of Science ID 000376009800021

  View details for PubMedID 26573216

• Robot-assisted versus open radical prostatectomy utilization in hospitals offering robotics CANADIAN JOURNAL OF UROLOGY Yanamadala, S., Chung, B. I., Hernandez-Boussard, T. M. 2016; 23 (3): 8280-8285

  Abstract

  Prostate cancer is an extremely prevalent cause of morbidity and mortality among American men. Several different treatments exist, but differences in utilization between these treatments are not well understood.We performed an observational study using administrative datasets linked to hospital survey data, which included non-metastatic prostate cancer patients receiving robot-assisted radical prostatectomy (RARP) or open radical prostatectomy (ORP) in California, Florida, or New York from 2009-2011. We developed two hierarchical regression models with fixed effect accounting for hospital clustering and physician clustering to determine factors associated with utilization of RARP versus ORP at hospitals offering robotic surgery.A total of 36,694 patients were identified, with 77.13% receiving RARP and 22.87% receiving ORP. African American patients had lower RARP rates than White patients (OR = 0.80, p < 0.001). Patients using Medicare (OR = 0.91, p = 0.028), Medicaid (OR = 0.68, p < 0.001), or self-pay (OR = 0.72, p = 0.046) had lower RARP rates than patients using private insurance. Patients in Florida had lower RARP rates than patients in California (OR = 0.48, p = 0.010). Patients treated at teaching hospitals had lower RARP rates than patients treated at non-teaching hospitals (OR = 0.50, p = 0.006). The average cost of RARP was $13,614.83, and the average cost of ORP was $12,167.44 (p < 0.001).This population based study suggests that both patient and hospital characteristics are associated with utilization of RARP versus ORP in hospitals where robotic surgery is offered.

  View details for Web of Science ID 000379635800006

• Robot-assisted versus open radical prostatectomy utilization in hospitals offering robotics. Canadian journal of urology Yanamadala, S., Chung, B. I., Hernandez-Boussard, T. M. 2016; 23 (3): 8279-8284

  Abstract

  Prostate cancer is an extremely prevalent cause of morbidity and mortality among American men. Several different treatments exist, but differences in utilization between these treatments are not well understood.We performed an observational study using administrative datasets linked to hospital survey data, which included non-metastatic prostate cancer patients receiving robot-assisted radical prostatectomy (RARP) or open radical prostatectomy (ORP) in California, Florida, or New York from 2009-2011. We developed two hierarchical regression models with fixed effect accounting for hospital clustering and physician clustering to determine factors associated with utilization of RARP versus ORP at hospitals offering robotic surgery.A total of 36,694 patients were identified, with 77.13% receiving RARP and 22.87% receiving ORP. African American patients had lower RARP rates than White patients (OR = 0.80, p < 0.001). Patients using Medicare (OR = 0.91, p = 0.028), Medicaid (OR = 0.68, p < 0.001), or self-pay (OR = 0.72, p = 0.046) had lower RARP rates than patients using private insurance. Patients in Florida had lower RARP rates than patients in California (OR = 0.48, p = 0.010). Patients treated at teaching hospitals had lower RARP rates than patients treated at non-teaching hospitals (OR = 0.50, p = 0.006). The average cost of RARP was $13,614.83, and the average cost of ORP was $12,167.44 (p < 0.001).This population based study suggests that both patient and hospital characteristics are associated with utilization of RARP versus ORP in hospitals where robotic surgery is offered.

  View details for PubMedID 27347621

• PROSTATE CANCER YIELD IN MRI LESIONS VARIES ACROSS RADIOLOGISTS Sonn, G., Fan, R., Li, S., Ghanouni, P., Loening, A., Daniel, B., To'o, K., Gill, H., Chung, B., Brooks, J. ELSEVIER SCIENCE INC. 2016: E42

  View details for DOI 10.1016/j.juro.2016.02.1992

  View details for Web of Science ID 000375278600096

• The Contemporary Incidence and Sequelae of Rhabdomyolysis Following Extirpative Renal Surgery: A Population Based Analysis JOURNAL OF UROLOGY Gelpi-Hammerschmidt, F., Tinay, I., Allard, C. B., Su, L., Preston, M. A., Quoc-Dien Trinh, Q. D., Kibel, A. S., Wang, Y., Chung, B. I., Chang, S. L. 2016; 195 (2): 399-405

  Abstract

  To evaluate the contemporary incidence and consequences of postoperative rhabdomyolysis (PRM) following extirpative renal surgery (ERS).We conducted a population-based, retrospective cohort study of patients who underwent ERS with a diagnosis of a renal mass or renal cell carcinoma in the United States between 2004 and 2013. Regression analysis was performed to evaluate 90-day mortality (Clavien grade 5), non-fatal major complications (Clavien grade 3-4), readmission rates, direct costs and length of stay (LOS).The final weighted cohort included 310,880 open, 174,283 laparoscopic, and 69,880 robotic ERS during the 10-year study period, with 745 (0.001%) experiencing PRM. Presence of PRM led to a significantly higher incidence of 90-day non-fatal major complications (34.7% vs. 7.3%, p<0.05) and higher 90-day mortality (4.4% vs. 1.02%, p<0.05). LOS was twice as long for patients with PRM (incidence risk ratio: 1.83, 95% CI: 1.56-2.15, p<0.001). Robotic approach was associated with a higher likelihood for PRM (vs. laparoscopic approach, odds ratio: 2.43, p<0.05). Adjusted 90-day median direct hospital costs were USD 7515 higher for patients with PRM (p<0.001). Our model revealed that the combination of obesity and prolonged surgery (>5 hours) was associated with a higher likelihood of developing PRM.Our study confirms that PRM is an uncommon complication among patients undergoing ERS but has a potentially detrimental impact on surgical morbidity, mortality and costs. Male gender, comorbidities as well as obesity, prolonged surgery (>5 hours), and a robotic approach appear to place patients at a higher risk for PRM.

  View details for DOI 10.1016/j.juro.2015.08.084

  View details for Web of Science ID 000368054800052

• Accuracy of Prostate-Specific Antigen Values in Prostate Cancer Registries. Journal of clinical oncology : official journal of the American Society of Clinical Oncology Mittakanti, H. R., Thomas, I. C., Shelton, J. B., Makarov, D. V., Skolarus, T. A., Cooperberg, M. R., Chung, B. I., Sonn, G. A., Brooks, J. D., Leppert, J. T. 2016

  View details for PubMedID 27458297

• Contemporary rends in high-dose interleukin-2 use for metastatic renal cell carcinoma in the United States UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS Allard, C. B., Gelpi-Hammerschmidt, F., Harshman, L. C., Choueiri, T. K., Faiena, I., Modi, P., Chung, B. I., Tinay, I., Singer, E. A., Chang, S. L. 2015; 33 (11)

  Abstract

  Targeted therapies (TTs) have revolutionized metastatic renal cell carcinoma (mRCC) treatment in the past decade, largely replacing immunotherapy including high-dose interleukin-2 (HD IL-2) therapy. We evaluated trends in HD IL-2 use for mRCC in the TT era.Our cohort comprised a weighted estimate of all patients undergoing HD IL-2 treatment for mRCC from 2004 to 2012 using the Premier Hospital Database. We assessed temporal trends in HD IL-2 use including patient, disease, and hospital characteristics stratified by era (pre-TT uptake: 2004-2006, uptake: 2007-2009, and post-TT uptake: 2010-2012) and fitted multivariable regression models to identify predictors of treatment toxicity and tolerability.An estimated 2,351 patients received HD IL-2 therapy for mRCC in the United States from 2004 to 2012. The use decreased from 2004 to 2008. HD IL-2 therapy became increasingly centralized in teaching hospitals (24% of treatments in 2004 and 89.5% in 2012). Most patients who received HD IL-2 therapy were men, white, younger than 60 years, had lung metastases, and were otherwise healthy. Vasopressors, intensive care unit admission, and hemodialysis were necessary in 53.4%, 33.0%, and 7.1%, respectively. Factors associated with toxicities in multivariable analyses included being unmarried, male sex, and multiple metastatic sites. African Americans and patients with single-site metastases were less likely to receive multiple treatment cycles.HD IL-2 therapy is used infrequently for mRCC in the United States, and its application has diminished with the uptake of TT. Patients are being increasingly treated in teaching hospitals, suggesting a centralization of care and possible barriers to access. A recent slight increase in HD IL-2 therapy use likely reflects recognition of the inability of TT to effect a complete response.

  View details for DOI 10.1016/j.urolonc.2015.06.014

  View details for Web of Science ID 000364404400013

  View details for PubMedID 26210683

• The Contemporary Incidence and Sequelae of Rhabdomyolysis Following Extirpative Renal Surgery: A Population-Based Analysis. The Journal of urology Gelpi-Hammerschmidt, F., Tinay, I., Allard, C. B., Su, L. M., Preston, M. A., Trinh, Q. D., Kibel, A. S., Wang, Y., Chung, B. I., Chang, S. L. 2015

  Abstract

  To evaluate the contemporary incidence and consequences of postoperative rhabdomyolysis (PRM) following extirpative renal surgery (ERS).We conducted a population-based, retrospective cohort study of patients who underwent ERS with a diagnosis of a renal mass or renal cell carcinoma in the United States between 2004 and 2013. Regression analysis was performed to evaluate 90-day mortality (Clavien grade 5), non-fatal major complications (Clavien grade 3-4), readmission rates, direct costs and length of stay (LOS).The final weighted cohort included 310,880 open, 174,283 laparoscopic, and 69,880 robotic ERS during the 10-year study period, with 745 (0.001%) experiencing PRM. Presence of PRM led to a significantly higher incidence of 90-day non-fatal major complications (34.7% vs. 7.3%, p<0.05) and higher 90-day mortality (4.4% vs. 1.02%, p<0.05). LOS was twice as long for patients with PRM (incidence risk ratio: 1.83, 95% CI: 1.56-2.15, p<0.001). Robotic approach was associated with a higher likelihood for PRM (vs. laparoscopic approach, odds ratio: 2.43, p<0.05). Adjusted 90-day median direct hospital costs were USD 7515 higher for patients with PRM (p<0.001). Our model revealed that the combination of obesity and prolonged surgery (>5 hours) was associated with a higher likelihood of developing PRM.Our study confirms that PRM is an uncommon complication among patients undergoing ERS but has a potentially detrimental impact on surgical morbidity, mortality and costs. Male gender, comorbidities as well as obesity, prolonged surgery (>5 hours), and a robotic approach appear to place patients at a higher risk for PRM.

  View details for DOI 10.1016/j.juro.2015.08.084

  View details for PubMedID 26321407

• Re: Nationwide prevalence of lymph node metastases in Gleason score 3?+?3?=?6 prostate cancer: authors' reply. Pathology Sieh, W., Lichtensztajn, D. Y., Gomez, S. L., Liu, J., Chung, B. I., Cheng, I., Brooks, J. D. 2015; 47 (4): 394-395

  View details for DOI 10.1097/PAT.0000000000000264

  View details for PubMedID 25938367

• Re: Nationwide prevalence of lymph node metastases in Gleason score 3+3=6 prostate cancer: authors' reply PATHOLOGY Sieh, W., Lichtensztajn, D. Y., Gomez, S., Liu, J., Chung, B. I., Cheng, I., Brooks, J. D. 2015; 47 (4): 394-395

  View details for DOI 10.1097/PAT.0000000000000264

  View details for Web of Science ID 000354070000025

• The impact of robotic surgery on the surgical management of prostate cancer in the USA BJU INTERNATIONAL Chang, S. L., Kibel, A. S., Brooks, J. D., Chung, B. I. 2015; 115 (6): 929-936

  Abstract

  To describe the surgeon characteristics associated with RARP adoption and determine the possible impact of this adoption on practice patterns and cost.A retrospective cohort study with a weighted sample size of 489,369 men who underwent non-RARP (i.e., open or laparoscopic radical prostatectomy [RP]) or RARP in the United States from 2003 to 2010 was performed. We evaluated predictors for RARP adoption, defined as performing >50% of annual RP with the robotic approach. Additionally, we identified the resulting changes in prostate cancer surgery practice patterns and expenditures.From 2003 to 2010, RARP adoption increased from 0.7% to 42% of surgeons performing RP. High-volume surgeons, defined as performing >24 RP annually, had statically significantly higher odds of adopting RARP throughout the study period. From 2005 to 2007, adoption was more common among surgeons at teaching (OR: 2.4; 95% CI: 1.7-3.4), intermediate- (200-399 beds; OR: 5.96; 95% CI: 1.3-26.5) and large-sized hospitals (≥400 beds; OR: 6.1; 95% CI: 1.4-25.8); after 2007, adoption was more common among surgeons at urban hospitals (OR: 3.3; 95% CI: 1.7 to 6.4). RARP adoption was generally associated with increased RP volume, greatest for high-volume surgeons and least for low-volume surgeons (<5 RP annually). The annual number of surgeons performing RP decreased from approximately 10,000 to 8,200, with the proportion of cases performed by high-volume surgeons increasing from 10% to 45%. RARP was more costly, disproportionally contributing to the 40% increase in annual prostate cancer surgery expenditures. RARP costs generally decreased plateauing at over $10,000 while non-RARP costs increased to nearly $9,000 by the end of the study.There was widespread RARP adoption in the United States between 2003 and 2010, particularly among high-volume surgeons. The diffusion of RARP was associated with a centralization of care and an increased economic burden for prostate cancer surgery.

  View details for DOI 10.1111/bju.12850

  View details for Web of Science ID 000355275600019

  View details for PubMedID 24958338

• Racial Disparities in Postoperative Complications After Radical Nephrectomy: A Population-based Analysis UROLOGY Chung, B. I., Leow, J. J., Gelpi-Hammerschmidt, F., Wang, Y., Del Giudice, F., De, S., Chou, E. P., Song, K. H., Almario, L., Chang, S. L. 2015; 85 (6): 1411-1416

  Abstract

  To perform a population-based study that evaluates contemporary racial disparities in the morbidity profile of patients undergoing radical nephrectomy in the United States.Using the Premier hospital database (Premier Inc, Charlotte, NC), which collects data from over 600 nonfederal hospitals throughout the United States, we identified patients undergoing a total nephrectomy as their primary procedure and also had a concurrent diagnosis of a kidney mass or cancer from 2003 to 2010. The primary outcome was 90-day major complication rates, based on the Clavien classification system. Multivariate logistic regression models were performed, adjusting for clustering by hospitals and survey weighting to ensure nationally representative estimates.The study population included 25,517 patients translating into a weighted sample of 185,135 radical nephrectomies. In a multivariate model including patient, hospital, and surgical characteristics, blacks were more commonly associated with a major complication (odds ratio, 2.1; P <.0001). When we incorporated Charlson comorbidity score into the model, the racial disparity in major complications was attenuated by 36% (odds ratio, 1.7; P <.0001). Adjusting for annual surgical volume in the multivariate model did not alter results.Our contemporary evaluation of patients undergoing radical nephrectomy in the United States demonstrates that blacks are associated with a markedly elevated rate of major complications as compared to whites. This disparity is possibly a result of unequal access to routine health care.

  View details for DOI 10.1016/j.urology.2015.03.001

  View details for Web of Science ID 000360158900054

• Impact of surgeon volume on the morbidity and costs of radical cystectomy in the USA: a contemporary population-based analysis BJU INTERNATIONAL Leow, J. J., Reese, S., Quoc-Dien Trinh, Q. D., Bellmunt, J., Chung, B. I., Kibel, A. S., Chang, S. L. 2015; 115 (5): 713-721

  Abstract

  To evaluate the relationship between surgeon volume of radical cystectomy (RC) and postoperative morbidity as well as the economic burden of bladder cancer in the United States.We captured all patients who underwent a RC (ICD-9 code 57.71) from 2003 to 2010, using a nationwide hospital discharge database. Patient, hospital, and surgical characteristics were evaluated. Annual volume of RC for surgeons was divided into quintiles. Multivariable regression models were developed adjusting for clustering and survey weighting to evaluate the outcomes including 90-day major complications (Clavien 3-5) and direct patient costs. We adjusted for clustering and weighting to achieve a nationally representative analysis.The weighted cohort included 49,792 RC patients with an overall 90-day major complication rate of 16.2%. Compared to surgeons performing one RC annually, surgeons performing ≥7 RC each year had a 45% decreased odds of major complications (OR: 0.55, p<0.001) and a reduction in costs by $1690 (p=0.02). Results were consistent when we analyzed surgeon volume as a continuous variable and when we examined the highest volume surgeons (≥28 cases annually), which found a marked decreased odds of major complications compared to the lowest volume surgeons (OR: 0.45, 95% CI: 0.31-0.67, p<0.0001). Compared to patients who did not have any complications, those who suffered a major complication had significantly higher 90-day median direct hospital costs ($43965 vs. $24341, p<0.0001).We demonstrate an inverse relationship between surgeon volume and the development of postoperative 90-day major complication rates as well as direct hospital costs. Centralization of RC to higher volume surgeons may reduce the development of postoperative major complications thereby decreasing the burden of bladder cancer on the health care system.

  View details for DOI 10.1111/bju.12749

  View details for Web of Science ID 000353230500011

  View details for PubMedID 24674655

• Racial Disparities in Postoperative Complications After Radical Nephrectomy: A Population-based Analysis. Urology Chung, B. I., Leow, J. J., Gelpi-Hammerschmidt, F., Wang, Y., Del Giudice, F., De, S., Chou, E. P., Song, K. H., Almario, L., Chang, S. L. 2015

  Abstract

  To perform a population-based study that evaluates contemporary racial disparities in the morbidity profile of patients undergoing radical nephrectomy in the United States.Using the Premier hospital database (Premier Inc, Charlotte, NC), which collects data from over 600 nonfederal hospitals throughout the United States, we identified patients undergoing a total nephrectomy as their primary procedure and also had a concurrent diagnosis of a kidney mass or cancer from 2003 to 2010. The primary outcome was 90-day major complication rates, based on the Clavien classification system. Multivariate logistic regression models were performed, adjusting for clustering by hospitals and survey weighting to ensure nationally representative estimates.The study population included 25,517 patients translating into a weighted sample of 185,135 radical nephrectomies. In a multivariate model including patient, hospital, and surgical characteristics, blacks were more commonly associated with a major complication (odds ratio, 2.1; P <.0001). When we incorporated Charlson comorbidity score into the model, the racial disparity in major complications was attenuated by 36% (odds ratio, 1.7; P <.0001). Adjusting for annual surgical volume in the multivariate model did not alter results.Our contemporary evaluation of patients undergoing radical nephrectomy in the United States demonstrates that blacks are associated with a markedly elevated rate of major complications as compared to whites. This disparity is possibly a result of unequal access to routine health care.

  View details for DOI 10.1016/j.urology.2015.03.001

  View details for PubMedID 25881864

• Adrenalectomy for malignant disease: Utilization and outcomes by surgeon specialty and surgical approach. Faiena, I., Tabakin, A., Leow, J., Patel, N., Modi, P. K., Salmasi, A. H., Chung, B. I., Chang, S. L., Singer, E. A. AMER SOC CLINICAL ONCOLOGY. 2015

  View details for DOI 10.1200/jco.2015.33.7_suppl.489

  View details for Web of Science ID 000356886700486

• Open versus robot-assisted radical prostatectomy: A contemporary analysis of an all-payer discharge database Leow, J. J., Quoc-Dien Trinh, Chung, B. I., Chang, S. L. AMER SOC CLINICAL ONCOLOGY. 2015

  View details for DOI 10.1200/jco.2015.33.7_suppl.33

  View details for Web of Science ID 000356886700034

• High-dose interleukin-2 (HD IL-2) for metastatic renal Cell carcinoma (mRCC): Contemporary utilization trends in the United States Allard, C. B., Gelpi-Hammerschmidt, F., Harshman, L., Faiena, I., Modi, P. K., Chung, B. I., Singer, E. A., Chang, S. L. AMER SOC CLINICAL ONCOLOGY. 2015

  View details for DOI 10.1200/jco.2015.33.7_suppl.449

  View details for Web of Science ID 000356886700446

• Propensity-Matched Comparison of Morbidity and Costs of Open and Robot-Assisted Radical Cystectomies: A Contemporary Population-Based Analysis in the United States EUROPEAN UROLOGY Leow, J. J., Reese, S. W., Jiang, W., Lipsitz, S. R., Bellmunt, J., Quoc-Dien Trinh, Q. D., Chung, B. I., Kibel, A. S., Chang, S. L. 2014; 66 (3): 569-576

  Abstract

  Radical cystectomy (RC) is a morbid procedure associated with high costs. Limited population-based data exist on the complication profile and costs of robot-assisted RC (RARC) compared with open RC (ORC).To evaluate morbidity and cost differences between ORC and RARC.We conducted a population-based, retrospective cohort study of patients who underwent RC at 279 hospitals across the United States between 2004 and 2010.Multivariable logistic and median regression was performed to evaluate 90-d mortality, postoperative complications (Clavien classification), readmission rates, length of stay (LOS), and direct costs. To reduce selection bias, we used propensity weighting with survey weighting to obtain nationally representative estimates.The final weighted cohort included 34 672 ORC and 2101 RARC patients. RARC use increased from 0.6% in 2004 to 12.8% in 2010. Major complication rates (Clavien grade ≥3; 17.0% vs 19.8%, p=0.2) were similar between ORC and RARC (odds ratio [OR]: 1.32; p=0.42). RARC had 46% decreased odds of minor complications (Clavien grade 1-2; OR: 0.54; p=0.03). RARC had $4326 higher adjusted 90-d median direct costs (p=0.004). Although RARC had a significantly shorter LOS (11.8 d vs 10.2 d; p=0.008), no significant differences in room and board costs existed (p=0.20). Supply costs for RARC were significantly higher ($6041 vs $3638; p<0.0001). Morbidity and cost differences were not present among the highest-volume surgeons (≥7 cases per year) and hospitals (≥19 cases per year). Limitations include use of an administrative database and lack of oncologic characteristics.The use of RARC has increased between 2004 and 2010. Compared with ORC, RARC was associated with decreased odds of minor but not major complications and with increased expenditures attributed primarily to higher supply costs. Centralization of ORC and RARC to high-volume providers may minimize these morbidity and cost differences.Using a US population-based cohort, we found that robotic surgery for bladder cancer decreased minor complications, had no impact on major complications and was more costly than open surgery.

  View details for DOI 10.1016/j.eururo.2014.01.029

  View details for Web of Science ID 000340260900038

• Nationwide prevalence of lymph node metastases in Gleason score 3?+?3?=?6 prostate cancer. Pathology Liu, J., Lichtensztajn, D. Y., Gomez, S. L., Sieh, W., Chung, B. I., Cheng, I., Brooks, J. D. 2014; 46 (4): 306-310

  Abstract

  Based on revisions of Gleason scoring in 2005, it has been reported that nodal metastases at radical prostatectomy in Gleason 3 + 3 = 6 (GS6) prostate cancer are extremely rare, and that GS6 cancers with nodal metastases are invariably upgraded upon review by academic urological pathologists. We analysed the prevalence and determinants of nodal metastases in a national sample of patients with GS6 cancer.We utilised the SEER database to identify patients diagnosed with GS6 prostate cancer during 2004-2010 who had radical prostatectomy and ≥1 lymph node(s) examined. We calculated the prevalence of nodal metastases and constructed a multivariable logistic regression model to identify factors associated with nodal metastases.Among 21,960 patients, the prevalence of nodal metastases was 0.48%. Older age, preoperative PSA >10 ng/mL, and advanced stage were positively associated with nodal metastases.Lymph node metastases in GS6 cancer are more prevalent in a nationwide population compared to academic centres. Revised guidelines for Gleason scoring have made GS6 cancer a more homogeneously indolent disease, which may be relevant in the era of active surveillance. We submit that lymph node metastases in GS6 cancer be used as a proxy for adherence to the 2005 ISUP consensus on Gleason grading.

  View details for DOI 10.1097/PAT.0000000000000097

  View details for PubMedID 24798166

• Nationwide prevalence of lymph node metastases in Gleason score 3+3=6 prostate cancer PATHOLOGY Liu, J., Lichtensztajn, D. Y., Gomez, S., Sieh, W., Chung, B. I., Cheng, I., Brooks, J. D. 2014; 46 (4): 306-310

  View details for DOI 10.1097/PAT.0000000000000097

  View details for Web of Science ID 000335956200006

• Trends and perioperative outcomes for laparoscopic and robotic nephrectomy using the National Surgical Quality Improvement Program (NSQIP) database UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS Liu, J., Leppert, J. T., Maxwell, B. G., Panousis, P., Chung, B. I. 2014; 32 (4): 473-479

  Abstract

  We sought to examine the trends in perioperative outcomes of kidney cancer surgery stratified by type (radical nephrectomy [RN] vs. partial nephrectomy [PN]) and approach (open vs. minimally invasive).We queried the National Surgical Quality Improvement Program database to identify kidney cancer operations performed from 2005 to 2011. We examined 30-day perioperative outcomes including operative time, transfusion rate, length of stay, major morbidity (cardiovascular, pulmonary, renal, and infectious), and mortality.A total of 2,902 PN and 5,459 RN cases were identified. The use of PN increased over time, accounting for 39% of all nephrectomies in 2011. Minimally invasive approaches also increased over time for both RN and PN. Open surgery was associated with increased length of stay, receipt of transfusion, major complications, and perioperative mortality. Resident involvement and open approach were independent predictors of major complications for both PN and RN. Additionally, the presence of a medical comorbidity was also a risk factor for complications after RN. The overall complication rates decreased for all approaches over the study period.Minimally invasive approaches to kidney cancer renal surgery have increased with favorable outcomes. The safety of open and minimally invasive PN improved significantly over the study period. Although pathologic features cannot be determined from this data set, these data show that complications from renal surgical procedures are decreasing in an era of increasing use.

  View details for DOI 10.1016/j.urolonc.2013.09.012

  View details for Web of Science ID 000335422300015

  View details for PubMedID 24332644

• Prostate cancer risk profiles of asian-american men: disentangling the effects of immigration status and race/ethnicity. journal of urology Lichtensztajn, D. Y., Gomez, S. L., Sieh, W., Chung, B. I., Cheng, I., Brooks, J. D. 2014; 191 (4): 952-956

  Abstract

  Asian-American men with prostate cancer have been reported to present with higher grade and later stage disease than White Americans. However, Asian Americans comprise a heterogeneous population with distinct health outcomes. We compared prostate cancer risk profiles among the diverse racial and ethnic groups in California.We used data from the California Cancer Registry for 90,845 Non-Hispanic White, Non-Hispanic Black, and Asian-American men diagnosed with prostate cancer between 2004 and 2010. Patients were categorized into low, intermediate, or high-risk groups based on clinical stage, Gleason score, and PSA value at diagnosis. Using polytomous logistic regression, we estimated adjusted odds ratios for the association of race/ethnicity and nativity with risk group.In addition to Non-Hispanic Blacks, six Asian-American groups (US-born Chinese, foreign-born Chinese, US-born Japanese, foreign-born Japanese, foreign-born Filipino, and foreign-born Vietnamese) were more likely to have an unfavorable risk profile compared to Non-Hispanic Whites. The odds ratios for high vs. intermediate-risk disease ranged from 1.23 (95% CI, 1.02-1.49) for US-born Japanese to 1.45 (95% CI, 1.31-1.60) for foreign-born Filipinos. These associations appeared to be driven by higher grade and PSA values, rather than advanced clinical stage at diagnosis.In this large, ethnically diverse population-based cohort, we found that Asian-American men were more likely to have unfavorable risk profiles at diagnosis. This association varied by racial/ethnic group and nativity, and was not attributable to later stage at diagnosis, suggesting that Asian men may have biological differences that predispose to the development of more severe disease.

  View details for DOI 10.1016/j.juro.2013.10.075

  View details for PubMedID 24513166

• AGE-STRATIFIED RETURN OF URINARY AND SEXUAL FUNCTION FOLLOWING RADICAL PROSTATECTOMY: OLDER MEN DO NOT DO WORSE Lee, J., Li, S., Leppert, J., Chung, B. ELSEVIER SCIENCE INC. 2014: E149

  View details for DOI 10.1016/j.juro.2014.02.564

  View details for Web of Science ID 000350277900338

• Relating prognosis in chromophobe renal cell carcinoma to the chromophobe tumor grading system. Korean journal of urology Weinzierl, E. P., Thong, A. E., McKenney, J. K., Jeon, S. H., Chung, B. I. 2014; 55 (4): 239-244

  Abstract

  The chromophobe subtype of renal cell carcinoma (chRCC) has generally been associated with a better prognosis than the clear cell type; however, debate continues as to absolute prognosis as well as the significance of certain prognostic variables. We investigated the significance of pathologic stage and a recently proposed chromophobe tumor grading (CTG) scheme in predicting chRCC outcomes.All available chRCCs were identified from our surgical pathology archives from 1987-2010. Original slides were reviewed to verify diagnoses and stage, and each case was graded following a novel chromophobe tumor grade system criteria. Disease status was obtained from a clinical outcome database, and cancer specific deaths and recurrences were recorded.Eighty-one cases of chRCC were identified, and 73 had adequate follow-up information available. There were only 3 instances of cancer related recurrence or mortality, which included 1 disease specific mortality and 2 disease recurrences. Pathologic stage and CTG 3 were found to be significantly associated with the recurrences or death from chRCC, but there was no association with CTG 1 and CTG 2.chRCC is associated with a very low rate of cancer specific events (4.1%) even at a tertiary referral center. In our study, pathologic stage and CTG 3, but not CTG 1 or 2, were significantly associated with the development of these events.

  View details for DOI 10.4111/kju.2014.55.4.239

  View details for PubMedID 24741411

• Utilization of Renal Mass Biopsy in Patients With Renal Cell Carcinoma Reply UROLOGY Leppert, J. T., Hanley, J., Wagner, T. H., Chung, B. I., Brooks, J. D., Srinivas, S., Chertow, G. M., Saigal, C. S. 2014; 83 (4): 779-780

  View details for DOI 10.1016/j.urology.2013.10.077

  View details for Web of Science ID 000333984000027

• Utilization of renal mass biopsy in patients with renal cell carcinoma. Urology Leppert, J. T., Hanley, J., Wagner, T. H., Chung, B. I., Srinivas, S., Chertow, G. M., Brooks, J. D., Saigal, C. S. 2014; 83 (4): 774-780

  Abstract

  To examine the patient, tumor, and temporal factors associated with receipt of renal mass biopsy (RMB) in a contemporary nationally representative sample.We queried the Surveillance, Epidemiology, and End Results-Medicare data set for incident cases of renal cell carcinoma diagnosed between 1992 and 2007. We tested for associations among receipt of RMB and patient and tumor characteristics, type of therapy, and procedure type. Temporal trends in receipt of RMB were characterized over the study period.Approximately 1 in 5 (20.7%) patients diagnosed with renal cell carcinoma (n = 24,702) underwent RMB before instituting therapy. There was a steady and modest increase in RMB utilization, with the highest utilization (30%) occurring in the final study year. Of patients who underwent radical (n = 15,666) or partial (n = 2211) nephrectomy, 17% and 20%, respectively, underwent RMB in advance of surgery. Sixty-five percent of patients who underwent ablation (n = 314) underwent RMB before or in conjunction with the procedure. Roughly half of patients (50.4%) treated with systemic therapy alone underwent RMB. Factors independently associated with use of RMB included younger age, black race, Hispanic ethnicity, tumor size <7 cm, and metastatic disease at presentation.At present, most patients who eventually undergo radical or partial nephrectomy do not undergo RMB, whereas most patients who eventually undergo ablation or systemic therapy do. The optimal use of RMB in the evaluation of kidney tumors has yet to be determined.

  View details for DOI 10.1016/j.urology.2013.10.073

  View details for PubMedID 24529579

• National Trends of Perioperative Outcomes and Costs for Open, Laparoscopic and Robotic Pediatric Pyeloplasty JOURNAL OF UROLOGY Varda, B. K., Johnson, E. K., Clark, C., Chung, B. I., Nelson, C. P., Chang, S. L. 2014; 191 (4): 1090-1095

  Abstract

  We performed a population based study comparing trends in perioperative outcomes and costs for open, laparoscopic and robotic pediatric pyeloplasty. Specific billing items contributing to cost were also investigated.Using the Perspective database (Premier, Inc., Charlotte, North Carolina), we identified 12,662 pediatric patients who underwent open, laparoscopic and robotic pyeloplasty (ICD-9 55.87) in the United States from 2003 to 2010. Univariate and multivariate statistics were used to evaluate perioperative outcomes, complications and costs for the competing surgical approaches. Propensity weighting was used to minimize selection bias. Sampling weights were used to yield a nationally representative sample.A decrease in open pyeloplasty and an increase in minimally invasive pyeloplasty were observed. All procedures had low complication rates. Compared to open pyeloplasty, laparoscopic and robotic pyeloplasty had longer median operative times (240 minutes, p <0.0001 and 270 minutes, p <0.0001, respectively). There was no difference in median length of stay. Median total cost was lower among patients undergoing open vs robotic pyeloplasty ($7,221 vs $10,780, p <0.001). This cost difference was largely attributable to robotic supply costs.During the study period open pyeloplasty made up a declining majority of cases. Use of laparoscopic pyeloplasty plateaued, while robotic pyeloplasty increased. Operative time was longer for minimally invasive pyeloplasty, while length of stay was equivalent across all procedures. A higher cost associated with robotic pyeloplasty was driven by operating room use and robotic equipment costs, which nullified low room and board cost. This study reflects an adoption period for robotic pyeloplasty. With time, perioperative outcomes and cost may improve.

  View details for DOI 10.1016/j.juro.2013.10.077

  View details for PubMedID 24513164

• Reply. Urology Leppert, J. T., Hanley, J., Wagner, T. H., Chung, B. I., Brooks, J. D., Srinivas, S., Chertow, G. M., Saigal, C. S. 2014; 83 (4): 779-780

  View details for DOI 10.1016/j.urology.2013.10.077

  View details for PubMedID 24529590

• Editorial comment. Urology Liu, J., Chung, B. I. 2014; 83 (2): 356-?

  View details for DOI 10.1016/j.urology.2013.09.057

  View details for PubMedID 24468510

• Surgeon volume and disparities in post-operative complications among black men Konijeti, R., Ruhotina, N., Reese, S., Chung, B. I., Kibel, A. S., Chang, S. L. AMER SOC CLINICAL ONCOLOGY. 2014

  View details for DOI 10.1200/jco.2014.32.4_suppl.66

  View details for Web of Science ID 000335318100069

• Racial disparities in the morbidity of radical cystectomy in the United States Borza, T., Feng, C., Leow, J., Chung, B. I., Chang, S. L. AMER SOC CLINICAL ONCOLOGY. 2014

  View details for DOI 10.1200/jco.2014.32.4_suppl.304

  View details for Web of Science ID 000335318100305

• Postoperative complications of radical nephrectomy with atrial thrombectomy: A contemporary population-based analysis. Borza, T., Chung, B. I., Chang, S. L. AMER SOC CLINICAL ONCOLOGY. 2014

  View details for DOI 10.1200/jco.2014.32.4_suppl.423

  View details for Web of Science ID 000335318100421

• Propensity-Matched Comparison of Morbidity and Costs of Open and Robot-Assisted Radical Cystectomies: A Contemporary Population-Based Analysis in the United States. European urology Leow, J. J., Reese, S. W., Jiang, W., Lipsitz, S. R., Bellmunt, J., Trinh, Q. D., Chung, B. I., Kibel, A. S., Chang, S. L. 2014

  Abstract

  Radical cystectomy (RC) is a morbid procedure associated with high costs. Limited population-based data exist on the complication profile and costs of robot-assisted RC (RARC) compared with open RC (ORC).To evaluate morbidity and cost differences between ORC and RARC.We conducted a population-based, retrospective cohort study of patients who underwent RC at 279 hospitals across the United States between 2004 and 2010.Multivariable logistic and median regression was performed to evaluate 90-d mortality, postoperative complications (Clavien classification), readmission rates, length of stay (LOS), and direct costs. To reduce selection bias, we used propensity weighting with survey weighting to obtain nationally representative estimates.The final weighted cohort included 34 672 ORC and 2101 RARC patients. RARC use increased from 0.6% in 2004 to 12.8% in 2010. Major complication rates (Clavien grade ≥3; 17.0% vs 19.8%, p=0.2) were similar between ORC and RARC (odds ratio [OR]: 1.32; p=0.42). RARC had 46% decreased odds of minor complications (Clavien grade 1-2; OR: 0.54; p=0.03). RARC had $4326 higher adjusted 90-d median direct costs (p=0.004). Although RARC had a significantly shorter LOS (11.8 d vs 10.2 d; p=0.008), no significant differences in room and board costs existed (p=0.20). Supply costs for RARC were significantly higher ($6041 vs $3638; p<0.0001). Morbidity and cost differences were not present among the highest-volume surgeons (≥7 cases per year) and hospitals (≥19 cases per year). Limitations include use of an administrative database and lack of oncologic characteristics.The use of RARC has increased between 2004 and 2010. Compared with ORC, RARC was associated with decreased odds of minor but not major complications and with increased expenditures attributed primarily to higher supply costs. Centralization of ORC and RARC to high-volume providers may minimize these morbidity and cost differences.Using a US population-based cohort, we found that robotic surgery for bladder cancer decreased minor complications, had no impact on major complications and was more costly than open surgery.

  View details for DOI 10.1016/j.eururo.2014.01.029

  View details for PubMedID 24491306

• Risk factors for postoperative hemorrhage after partial nephrectomy. Korean journal of urology Jung, S., Min, G. E., Chung, B. I., Jeon, S. H. 2014; 55 (1): 17-22

  Abstract

  To evaluate the frequency and clinical characteristics of postoperative hemorrhage as a complication of partial nephrectomy.The demographics, physical statistics, tumor size, R.E.N.A.L. nephrometry score, operative method, warm ischemic time, and presence of postoperative hemorrhage and its severity and method of intervention were examined in 300 partial nephrectomy patients in two medical centers (Stanford Medical Center and Kyung Hee University Medical Center) between March 2000 and March 2012.Of the 300 subjects, 13 (4.3%) experienced postoperative hemorrhage severe enough to require intervention more invasive than transfusion (Clavien grade III or higher). Univariate analysis of the bleeding and nonbleeding groups showed that whereas age, ischemic time, tumor size and stage, body mass index, American Society of Anesthesiologists class, and operative method did not differ significantly, the exophyticity (E) score was significantly higher for severe postoperative hemorrhage (p=0.04). However, multivariate analysis showed none of the factors to differ significantly. In most of the cases requiring intervention, selective embolization was sufficient, but in one case explorative laparotomy and nephrectomy were required. Clinical characteristics varied significantly among severe hemorrhage cases, with time of onset ranging from the first to the 30th postoperative day and symptoms presenting in a diverse manner, such as gross hematuria and pleuritic chest pain. Computed tomography and angiographic findings were consistent with either arteriovenous fistula or pseudoaneurysms.Severe hemorrhage after partial nephrectomy is rare. Nonetheless, with the great variability in presenting symptoms and time of onset after surgery, surgeons should exercise great vigilance during the postoperative care of partial nephrectomy patients.

  View details for DOI 10.4111/kju.2014.55.1.17

  View details for PubMedID 24466392

• Estimating the risk of chronic kidney disease after nephrectomy CANADIAN JOURNAL OF UROLOGY Ngo, T. C., Hurley, M. P., Thong, A. E., Jeon, S. H., Leppert, J. T., Chung, B. I. 2013; 20 (6): 7035-7041

  Abstract

  To identify factors associated with the development of chronic kidney disease (CKD) after nephrectomy and to create a clinical model to predict CKD after nephrectomy for kidney cancer for clinical use.We identified 144 patients who had normal renal function (eGFR > 60) prior to undergoing nephrectomy for kidney cancer. Selected cases occurred between 2007 and 2010 and had at least 30 days follow up. Sixty-six percent (n = 95) underwent radical nephrectomy and 62.5% (n = 90) developed CKD (stage 3 or higher) postoperatively. We used univariable analysis to screen for predictors of CKD and multivariable logistic regression to identify independent predictors of CKD and their corresponding odds ratios. Interaction terms were introduced to test for effect modification. To protect against over-fitting, we used 10-fold cross-validation technique to evaluate model performance in multiple training and testing datasets. Validation against an independent external cohort was also performed.Of the variables associated with CKD in univariable analysis, the only independent predictors in multivariable logistic regression were patient age (OR = 1.27 per 5 years, 95% CI: 1.07-1.51), preoperative glomerular filtration rate (GFR), (OR = 0.70 per 10 mL/min, 95% CI: 0.56-0.89), and receipt of radical nephrectomy (OR = 4.78, 95% CI: 2.08-10.99). There were no significant interaction terms. The resulting model had an area under the curve (AUC) of 0.798. A 10-fold cross-validation slightly attenuated the AUC to 0.774 and external validation yielded an AUC of 0.930, confirming excellent model discrimination.Patient age, preoperative GFR, and receipt of a radical nephrectomy independently predicted the development of CKD in patients undergoing nephrectomy for kidney cancer in a validated predictive model.

  View details for Web of Science ID 000328717300007

  View details for PubMedID 24331345

• Utilization of cytoreductive nephrectomy and patient survival in the targeted therapy era 12th International Kidney Cancer Symposium Conti, S. L., Thomas, I., Hagedorn, J. C., Chung, B. I., Chertow, G. M., Wagner, T. H., Brooks, J. D., Srinivas, S., Leppert, J. T. WILEY-BLACKWELL. 2013: 14–16

  View details for Web of Science ID 000325992100026

• Utilization of renal mass biopsy in patients with renal cell carcinoma 12th International Kidney Cancer Symposium Leppert, J. T., Hanley, J., Wagner, T. H., Chung, B. I., Srinivas, S., Chertow, G. M., Brooks, J. D., Saigal, C. S. WILEY-BLACKWELL. 2013: 14–14

  View details for Web of Science ID 000325992100024

• Reply. Urology Liu, J., Chung, B. I. 2013; 82 (3): 583-?

  View details for DOI 10.1016/j.urology.2013.03.083

  View details for PubMedID 23876587

• Perioperative Outcomes for Laparoscopic and Robotic Compared With Open Prostatectomy Using the National Surgical Quality Improvement Program (NSQIP) Database UROLOGY Liu, J., Maxwell, B. G., Panousis, P., Chung, B. I. 2013; 82 (3): 579-583

  Abstract

  To examine contemporary outcomes of minimally invasive radical prostatectomy (MIRP) compared with open prostatectomy, using a national, prospective perioperative database reflecting diverse practice settings.The National Surgical Quality Improvement Program database was queried from 2005 to 2010 for laparoscopic or robotic prostatectomy (Current Procedural Terminology code 55866) and open retropubic prostatectomy (Current Procedural Terminology codes 55840, 55842, 55845). Perioperative outcomes examined were surgical and total operation duration, transfusion rates, length of stay, major morbidity (cardiovascular, pulmonary, renal, and infectious), and mortality.The study identified 5319 radical prostatectomies: 4036 MIRP and 1283 open. Although operative time was significantly longer in the MIRP group, there were significantly fewer perioperative blood transfusions and shorter mean length of stay. Major postoperative morbidity and mortality were 5% in the MIRP group and 9% in the open group (P <.001). Age, body mass index, presence of medical comorbidities, and open surgical technique were all independently predictive of major complications and mortality on multivariate analysis.In a nationwide database of diverse medical centers, MIRP was associated with longer operative time, but a significantly decreased rate of blood transfusions, length of stay, perioperative complication rate, and mortality compared with open prostatectomy. The minimally invasive surgical approach was independently associated with significantly fewer complications and deaths on multivariate analysis. Compared with other administrative databases that capture only inpatient events, the National Surgical Quality Improvement Program identifies complications up to 30 days postoperatively, providing more detailed characterization of complications after prostatectomy. These data reflect contemporary practice patterns and suggest that MIRP can be performed with low perioperative morbidity.

  View details for DOI 10.1016/j.urology.2013.03.080

  View details for Web of Science ID 000323790800031

  View details for PubMedID 23876584

• Photoacoustic imaging of the bladder: a pilot study. Journal of ultrasound in medicine Kamaya, A., Vaithilingam, S., Chung, B. I., Oralkan, O., Khuri-Yakub, B. T. 2013; 32 (7): 1245-1250

  Abstract

  Photoacoustic imaging is a promising new technology that combines tissue optical characteristics with ultrasound transmission and can potentially visualize tumor depth in bladder cancer. We imaged simulated tumors in 5 fresh porcine bladders with conventional pulse-echo sonography and photoacoustic imaging. Isoechoic biomaterials of different optical qualities were used. In all 5 of the bladder specimens, photoacoustic imaging showed injected biomaterials, containing varying degrees of pigment, better than control pulse-echo sonography. Photoacoustic imaging may be complementary to diagnostic information obtained by cystoscopy and urine cytologic analysis and could potentially obviate the need for biopsy in some tumors before definitive treatment.

  View details for DOI 10.7863/ultra.32.7.1245

  View details for PubMedID 23804347

• The unidirectional barbed suture for renorrhaphy during laparoscopic partial nephrectomy: stanford experience. Journal of laparoendoscopic & advanced surgical techniques. Part A Jeon, S. H., Jung, S., Son, H., Kimm, S. Y., Chung, B. I. 2013; 23 (6): 521-525

  Abstract

  Abstract Purpose: Using barbed suture represents a novel technical modification in the performance of minimally invasive partial nephrectomy. Our purpose of this study was to evaluate the safety and efficacy of this suture for renorrhaphy during laparoscopic partial nephrectomy (LPN). Patients and Methods: Thirteen consecutive patients underwent LPN using V-Loc™ 180 (Covidien, Dublin, Ireland) suture, and a nonconsecutive control group of 24 patients, matched according to tumor size and R.E.N.A.L. nephrometry score, underwent LPN using absorbable polyglactin suture. All 37 patients underwent LPN performed by a single surgeon. Perioperative and postoperative indicators of morbidity, estimated blood loss, and warm ischemia time (WIT) were compared between the groups. Results: Baseline characteristics including age, body mass index, American Society of Anesthesiologists score, tumor size, laterality, and R.E.N.A.L nephrometry score were identical between the groups. On multivariable analysis, there were no significant differences between the two groups with regard to operative time, estimated blood loss, transfusion rates, rates of surgical complications, and length of hospital stay. However, mean WIT was significantly shorter in the V-Loc group compared with the control group (24.5±5.3 minutes versus 31.9±8.9 minutes, P=.01). Conclusions: The use of V-Loc sutures for renorrhaphy during LPN is safe and feasible and, in our series, significantly reduces WIT. Further studies are needed to corroborate these findings, but these results indicate a promising development in reducing WIT during minimally invasive partial nephrectomy.

  View details for DOI 10.1089/lap.2012.0405

  View details for PubMedID 23414123

• The Accordion Antiretropulsive Device Improves Stone-Free Rates During Ureteroscopic Laser Lithotripsy JOURNAL OF ENDOUROLOGY Wu, J. A., Ngo, T. C., Hagedorn, J. C., Macleod, L. C., Chung, B. I., Shinghal, R. 2013; 27 (4): 438-441

  Abstract

  The Accordion is a novel endoscopic device that prevents retropulsion of ureteral stones and their fragments during ureteroscopic laser lithotripsy. We describe our experience with its use focusing on three main endpoints: operating time, fluoroscopy time, and stone-free rates.Of 308 consecutive cases of unilateral ureteroscopic laser lithotripsy from 2006-2010, we analyzed 235 cases of ureteral stones. Chart review was performed to document patient demographics (age, sex, and race), stone characteristics (stone size, density, laterality, location, and multiplicity), operative characteristics (use of preoperative and/or postoperative stents, ureteral balloon dilators, ureteral access sheaths, the Holmium laser, and the Accordion device), and surgical outcomes (operative time, fluoroscopy time, stone-free status, and complications).The baseline characteristics between the Accordion and non-Accordion group were statistically similar. In univariate nonparametric tests of medians, Accordion device usage was not associated with a significant reduction in fluoroscopy time (median 1.68 vs. 1.95 minutes, p=0.28) or operating time (median 52.5 vs. 61 minutes, p=0.19). However, the stone-free rate for the Accordion group was significantly higher compared to the non-Accordion group (84.2% vs. 53.6%, p=0.001). In multivariate generalized linear models, Accordion usage was not associated with decreased operating or fluoroscopy times. Accordion use was associated with statistically significant greater odds of stone-free status (odds ratio 4.35, 95% confidence interval 2.36-8.00). Complication severity and rates were comparable between the two groups.The Accordion antiretropulsive device improves stone-free rates during ureteroscopic laser lithotripsy. Prospective studies are needed to validate these results.

  View details for DOI 10.1089/end.2012.0332

  View details for Web of Science ID 000317353000009

  View details for PubMedID 23387558

• TEMPORAL TRENDS IN UTILIZATION OF CYTOREDUCTIVE NEPHRECTOMY AND PATIENT SURVIVAL IN THE TARGETED THERAPY ERA Annual Meeting of the American-Urological-Association (AUA) Conti, S. L., Hagedorn, J., Chung, B. I., Srinivas, S., Leppert, J. ELSEVIER SCIENCE INC. 2013: E753–E753

  View details for Web of Science ID 000320281602402

• Surgical outcomes and complications associated with presurgical tyrosine kinase inhibition for advanced renal cell carcinoma (RCC) UROLOGIC ONCOLOGY-SEMINARS AND ORIGINAL INVESTIGATIONS Harshman, L. C., Yu, R. J., Allen, G. I., Srinivas, S., Gill, H. S., Chung, B. I. 2013; 31 (3): 379-385

  Abstract

  Tyrosine kinase inhibitors (TKI) have dramatically changed the management paradigm of advanced renal cell carcinoma (RCC) and are increasingly being used preoperatively to achieve cytoreduction.To review our case series of post-TKI surgical procedures to add to the current perioperative efficacy and complication profile.Between October 2006 and February 2010, 14 cytoreductive nephrectomies, radical nephrectomies, and metastectomies were performed after neoadjuvant sunitinib or sorafenib for advanced RCC. During the same time frame, a control group of 73 consecutive patients underwent radical nephrectomy, cytoreductive nephrectomy, or metastectomy in the absence of prior systemic therapy. We compared the incidence of perioperative complications and outcomes after surgical procedures between the two cohorts.Median preoperative renal mass size was 11 cm (6.7-24.2 cm). Primary tumor shrinkage was seen in 57%; median shrinkage was 18% (8%-25%). The median treatment period was 17 weeks, and the median time from TKI discontinuation was 2 weeks. Compared with a control group and after adjusting for confounding covariates, presurgical TKI use was not associated with a significant increase in perioperative complications (50% vs. 40%, P = 0.25) or perioperative bleeding (36% vs. 34%, P = 0.97) but was associated with increased incidence and grade of intraoperative adhesions (86% vs. 58%, P = 0.001; grade 3 vs. 1, P = 0.002).Compared with the published reports, we observed less hemorrhagic and wound healing issues but a significant increase in incidence and severity of intraoperative adhesions, which can present a formidable technical challenge. Potential reasons for our lower complication rate could be increased time from TKI discontinuation to surgery, longer time to postoperative TKI re-initiation, increased use of preoperative angioembolization, and the lack of preoperative bevacizumab administration. Presurgical TKI therapy can permit effective surgical cytoreduction with a safety and complication profile equivalent to that of non-TKI-nephrectomy; however safety data continue to evolve, and preoperative TKI use requires further prospective investigation.

  View details for DOI 10.1016/j.urolonc.2011.01.005

  View details for PubMedID 21353796

• ESTIMATING THE RISK OF CHRONIC KIDNEY DISEASE AFTER NEPHRECTOMY Tin Ngo, Hurley, M., Thong, A., Jeon, S., Leppert, J., Chung, B. ELSEVIER SCIENCE INC. 2012: E584

  View details for DOI 10.1016/j.juro.2012.02.1912

  View details for Web of Science ID 000302912502300

• CLINICOPATHOLOGIC FEATURES AND OUTCOMES OF A CHROMOPHOBE RENAL CELL CARCINOMA SERIES FROM A SINGLE INSTITUTION Thong, A., Tin Ngo, Weinzierl, E., Leppert, J., McKenney, J., Chung, B. ELSEVIER SCIENCE INC. 2012: E240

  View details for DOI 10.1016/j.juro.2012.02.664

  View details for Web of Science ID 000302912501024

• Trends in the adoption of robotic technology for radical cystectomy: A population-based analysis Chang, S., Jiang, W., Chung, B. I. AMER SOC CLINICAL ONCOLOGY. 2012

  View details for DOI 10.1200/jco.2012.30.5_suppl.311

  View details for Web of Science ID 000208892400310

• Trends in the adoption of robotic technology in the surgical management of prostate cancer: A population-based analysis Chang, S., Jiang, W., Chung, B. I. AMER SOC CLINICAL ONCOLOGY. 2012

  View details for DOI 10.1200/jco.2012.30.5_suppl.258

  View details for Web of Science ID 000208892400259

• Three differentiation states risk-stratify bladder cancer into distinct subtypes PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA Volkmer, J., Sahoo, D., Chin, R. K., Ho, P. L., Tang, C., Kurtova, A. V., Willingham, S. B., Pazhanisamy, S. K., Contreras-Trujillo, H., Storm, T. A., Lotan, Y., Beck, A. H., Chung, B. I., Alizadeh, A. A., Godoy, G., Lerner, S. P., van de Rijng, M., Shortliffe, L. D., Weissman, I. L., Chan, K. S. 2012; 109 (6): 2078-2083

  Abstract

  Current clinical judgment in bladder cancer (BC) relies primarily on pathological stage and grade. We investigated whether a molecular classification of tumor cell differentiation, based on a developmental biology approach, can provide additional prognostic information. Exploiting large preexisting gene-expression databases, we developed a biologically supervised computational model to predict markers that correspond with BC differentiation. To provide mechanistic insight, we assessed relative tumorigenicity and differentiation potential via xenotransplantation. We then correlated the prognostic utility of the identified markers to outcomes within gene expression and formalin-fixed paraffin-embedded (FFPE) tissue datasets. Our data indicate that BC can be subclassified into three subtypes, on the basis of their differentiation states: basal, intermediate, and differentiated, where only the most primitive tumor cell subpopulation within each subtype is capable of generating xenograft tumors and recapitulating downstream populations. We found that keratin 14 (KRT14) marks the most primitive differentiation state that precedes KRT5 and KRT20 expression. Furthermore, KRT14 expression is consistently associated with worse prognosis in both univariate and multivariate analyses. We identify here three distinct BC subtypes on the basis of their differentiation states, each harboring a unique tumor-initiating population.

  View details for DOI 10.1073/pnas.1120605109

  View details for PubMedID 22308455

• Laparoscopic Partial Nephrectomy for Completely Intraparenchymal Tumors JOURNAL OF UROLOGY Chung, B. I., Lee, U. J., Kamoi, K., Canes, D. A., Aron, M., Gill, I. S. 2011; 186 (6): 2182-2187

  Abstract

  Management for intraparenchymal renal tumors represents a technical challenge during laparoscopic partial nephrectomy since, unlike exophytic tumors, there are no external visual cues on the renal surface to guide tumor localization or excision. Also, hemostatic renorrhaphy and pelvicalyceal suture repair in these completely intrarenal tumors create additional challenges. We examined the safety and technical feasibility of this procedure in this cohort.Of 800 patients who underwent laparoscopic partial nephrectomy 55 (6.9%) had completely intraparenchymal tumors. Technical steps included intraoperative ultrasound guidance of tumor resection, en bloc hilar clamping, cold excision of tumor and sutured renal reconstruction.Mean tumor size was 2.3 cm (range 1.0 to 4.5), mean blood loss was 236 cc (range 25 to 1,000) and mean warm ischemia time was 29.9 minutes (range 7 to 57). There were no positive margins. When we compared laparoscopic partial nephrectomy for intraparenchymal tumors to the same procedure in another 3 tumor groups, including completely exophytic tumors, tumors infiltrating up to sinus fat and tumors infiltrating but not up to sinus fat, there were no statistically significant differences among the groups in complications, positive margin rate, blood loss, or tumor excision or warm ischemia time.Laparoscopic partial nephrectomy for completely intrarenal tumors is a technically advanced but effective, safe procedure. Facility and experience with the technique, effective use of intracorporeal laparoscopic ultrasound and adherence to sound surgical principles are the keys to success. Most recently we have performed laparoscopic and robotic partial nephrectomy for such completely intrarenal tumors using a zero ischemia technique.

  View details for DOI 10.1016/j.juro.2011.07.106

  View details for Web of Science ID 000296758600009

  View details for PubMedID 22014808

• Editorial comment. journal of urology Chung, B. I. 2011; 186 (5): 1848-?

  View details for DOI 10.1016/j.juro.2011.07.120

  View details for PubMedID 21944988

• Comparison of Outpatient Narcotic Prescribing Patterns After Minimally Invasive Versus Retropubic and Perineal Radical Prostatectomy EDITORIAL COMMENT JOURNAL OF UROLOGY Chung, B. I. 2011; 186 (5): 1848-1848

  View details for Web of Science ID 000296022200029

• Management of intraoperative splenic injury during laparoscopic urological surgery BJU INTERNATIONAL Chung, B. I., Desai, M. M., Gill, I. S. 2011; 108 (4): 572-576

  Abstract

  Study Type - Therapy (case series). Level of Evidence: 4. What's known on the subject? and What does the study add? The exact incidence of splenic injury during laparoscopic urologic procedures is not known; however, it is an uncommon occurrence. Also, the optimal treatment algorithm is not well delineated and the efficacy of successfully treating minor injuries to the spleen without resorting to splenectomy is not well described in the urologic literature. This study outlines the rate of splenic injury during a variety of laparoscopic urologic procedures and we outline a treatment algorithm that has been successfully employed in the management of these patients, which in all cases, did not lead to splenectomy. An important point is also that multiple adjunctive hemostatic measures should be used when a splenic injury is recognized and that a thorough search should ensue when suspicion of an occult splenic injury exists, as an unrecognized splenic injury may lead to severe post operative haemorrhagic complications.• To evaluate incidence, risk factors for, and management of intraoperative splenic injury in our laparoscopic patient cohort.• All patients undergoing laparoscopic urological upper tract procedures at two institutions between January 2001 and April 2006 and January 2000 and December 2008, respectively, were retrospectively examined for complications. • From these patients, those with intraoperative splenic injuries were selected and examined. • Possible factors predisposing patients to splenic injury were evaluated and the management plan for each patient was analysed to identify optimal treatment efficacy.• Of 2620 patients undergoing upper tract urological laparoscopic surgery, 14 patients (0.5%) sustained splenic injury and underwent left-sided surgery, 13 via a transperitoneal approach. • In 12 of the 14 patients, the splenic injury was recognized intraoperatively and all were effectively managed laparoscopically with a combination of argon beam coagulation, biological haemostatic agent FloSeal(TM) (Baxter, Deerfield, IL, USA), and bio-absorbable Surgicel® (Johnson and Johnson, Somerville, NJ, USA); none of these patients required splenectomy or developed any postoperative complications. • In two patients, the splenic injury was not recognized intraoperatively; both patients presented with delayed haemorrhage necessitating open splenectomy in each instance.• Splenic injuries are uncommon during laparoscopic urological surgery, but when a significant splenic injury occurs, it can be effectively managed laparoscopically, using conservative measures, without need for splenectomy. • If the splenic injury is not recognized intraoperatively, delayed haemorrhage is likely to occur necessitating emergent re-exploration and splenectomy. • Prompt and accurate intraoperative diagnosis of splenic injury is critical for achieving a good outcome.

  View details for DOI 10.1111/j.1464-410X.2010.09821.x

  View details for Web of Science ID 000294109500025

  View details for PubMedID 21062394

• Cost-Effectiveness Analysis of Nephron Sparing Options for the Management of Small Renal Masses JOURNAL OF UROLOGY Chang, S. L., Cipriano, L. E., Harshman, L. C., Garber, A. M., Chung, B. I. 2011; 185 (5): 1591-1597

  Abstract

  A recent increase in the detection of contrast enhancing renal masses 4 cm or smaller suspicious for malignancy has led to the widespread use of nephron sparing options. Limited data exist to help clinicians decide which of these competing nephron sparing therapies is most appropriate. We performed a cost-effectiveness analysis to evaluate the relative clinical and economic merits of commonly available nephron sparing strategies for small renal masses.We developed a decision analytic Markov model estimating the costs and health outcomes of treating a healthy 65-year-old patient with an asymptomatic unilateral small renal mass using competing nephron sparing options of immediate intervention (ie open and laparoscopic partial nephrectomy as well as laparoscopic and percutaneous ablation), active surveillance with possible delayed intervention and nonsurgical management with observation. Benefits were measured in quality adjusted life-years. We used a societal perspective, lifetime horizon and willingness to pay threshold of $50,000 per quality adjusted life-year gained. Model results were assessed with sensitivity analyses.In the base case scenario the least costly option was observation and the optimal option was immediate laparoscopic partial nephrectomy, which had an incremental cost-effectiveness ratio of $36,645 per quality adjusted life-year gained compared to surveillance with possible delayed percutaneous ablation. Results were sensitive to age at diagnosis, health status and tumor size.Immediate laparoscopic partial nephrectomy is the preferred nephron sparing option for healthy patients younger than 74 years old with a small renal mass. Surveillance with possible delayed percutaneous ablation is a cost-effective alternative for patients with advanced age or significant comorbidities. Observation maximizes quality adjusted life-years in patients who are poor surgical candidates or with limited life expectancy (less than 3 years).

  View details for DOI 10.1016/j.juro.2010.12.100

  View details for Web of Science ID 000289279600013

  View details for PubMedID 21419445

• Comparison of prostate cancer tumor volume and percent cancer in prediction of biochemical recurrence and cancer specific survival 103rd Annual Meeting of the American-Urological-Association Chung, B. I., Tarin, T. V., Ferrari, M., Brooks, J. D. ELSEVIER SCIENCE INC. 2011: 314–18

  Abstract

  Tumor volume and percent cancer (ratio of tumor volume/prostate volume) have been proposed as predictors of biochemical recurrence and cancer specific survival after radical prostatectomy. However, their relative merits as prognosticators have not been tested. We therefore evaluated and compared tumor volume and percent cancer as independent predictors of biochemical recurrence and prostate cancer specific death after radical prostatectomy.A retrospective review of 739 patients who underwent radical prostatectomy for prostate cancer between 1984 and 2004 was conducted. Median follow-up was 91.7 months, and 22 patients died of prostate cancer. Univariate and multivariate analysis evaluated the following factors in predicting biochemical recurrence and prostate cancer specific death: tumor volume, prostate volume, percent cancer, Gleason score, percentage of Gleason grade 4/5, margin status, capsular invasion status, seminal vesicle invasion status, preoperative PSA, and lymph node status.In univariate analysis, both tumor volume (P<0.001) and percent cancer (P<0.001) significantly correlated with biochemical recurrence. Since they are highly correlated, they did not predict outcome independently when included in the same model; however, both were highly predictive for biochemical recurrence in separate multivariate models (P=0.01 for both). Both also correlated with cancer specific survival as single variables; however, in separate multivariate models, only tumor volume (P=0.03) predicted death, while percent cancer did not (P=0.09).Tumor volume and percent cancer are independent predictors of recurrence after radical prostatectomy. However, in our series, tumor volume predicted cancer specific death better than percent cancer. Therefore, accurate determination of tumor volume, along with other accepted pathologic indices, is sufficient and preferred over percent cancer for prognostication after radical prostatectomy.

  View details for DOI 10.1016/j.urolonc.2009.06.017

  View details for Web of Science ID 000290779400016

  View details for PubMedID 19837617

• COST-EFFECTIVENESS ANALYSIS OF NEPHRON-SPARING OPTIONS IN THE MANAGEMENT OF SMALL RENAL MASSES Chang, S., Cipriano, L., Harshman, L., Chung, B. ELSEVIER SCIENCE INC. 2010: E526

  View details for DOI 10.1016/j.juro.2010.02.990

  View details for Web of Science ID 000209829402478

• Comparison of Holding Strength of Suture Anchors on Human Renal Capsule JOURNAL OF ENDOUROLOGY Kimm, S., Tarin, T., Chung, B., Shinghal, R., Reese, J. 2010; 24 (2): 293-297

  Abstract

  The use of surgical clips as suture anchors has made laparoscopic partial nephrectomy (LPN) technically simpler by eliminating the need for intracorporeal knot tying. However, the holding strength of these clips has not been analyzed in the human kidney. Therefore, the safety of utilizing suture anchors is unknown as the potential for clip slippage or renal capsular tears during LPN could result in postoperative complications including hemorrhage and urinoma formation. With the above in mind, we sought to compare the ability of Lapra-Ty clips and Hem-o-lok clips to function as suture anchors on human renal capsule.Fresh human cadaveric kidneys with intact renal capsules were obtained. A Lapra-Ty clip (Ethicon, Cincinnati, OH) or a Hem-o-lok clip (Weck, Raleigh, NC) was secured to a no. 1 Vicryl suture (Ethicon) with and without a knot, as is typically utilized during the performance of LPN. The suture was then placed through the renal capsule and parenchyma and attached to an Imada Mechanical Force Tester (Imada, Northbrook, IL). The amount of force required both to violate the renal capsule and to dislodge the clip was recorded separately.Six Lapra-Ty clips and six Hem-o-lok clips were tested. The mean force in newtons required to violate the renal capsule for the Lapra-Ty group was 7.33 N and for the Hem-o-lok group was 22.08 N (p < 0.001). The mean force required to dislodge the clip from the suture for the Lapra-Ty group was 9.0 N and for the Hem-o-lok group was 3.4 N (p < 0.001). When two Hem-o-lok clips were placed on the suture in series, the mean force required to dislodge the clips was 10.6 N.When compared with Lapra-Ty clips, using two Hem-o-lok clips may provide a more secure and cost-effective method to anchor sutures on human renal capsule when performing LPN.

  View details for DOI 10.1089/end.2009.0211

  View details for Web of Science ID 000274423500021

  View details for PubMedID 20050785

• Laparoscopic Radical Nephrectomy in a Pelvic Ectopic Kidney: Keys to Success JSLS-JOURNAL OF THE SOCIETY OF LAPAROENDOSCOPIC SURGEONS Chung, B. I., Liao, J. C. 2010; 14 (1): 126-129

  Abstract

  Laparoscopic radical nephrectomy of a pelvic kidney for renal cell carcinoma is a procedure with little precedent, but one that offers the advantages of the minimally invasive approach. We present our experience with this unique procedure.A 64-year-old male with a history of end-stage renal disease was diagnosed with a 2.6-cm enhancing mass in a pelvic left kidney with 2 separate sources of blood supply. He was offered either an open radical nephrectomy or a laparoscopic radical nephrectomy and opted for the minimally invasive approach.The procedure was performed successfully without complications and with minimal blood loss. The case was marked both by difficulty in mobilizing the sigmoid colon and the limited working space of the pelvis, which made localization of the numerous hilar vessels challenging.Laparoscopic radical nephrectomy for a pelvic ectopic kidney appears to be safe and efficacious. Success is dependent on familiarity with pelvic anatomy, optimal port placement, and preprocedure knowledge of the often-complicated vascular anatomy of the ectopic kidney. Preoperative imaging to delineate anomalous vascular anatomy is mandatory, and ureteral catheter placement is helpful for intraoperative identification purposes.

  View details for DOI 10.4293/108680810X12674612765623

  View details for Web of Science ID 000278761200023

  View details for PubMedID 20529537

  View details for PubMedCentralID PMC3021314

• Laparoscopic radical nephrectomy after shrinkage of a caval tumor thrombus with sunitinib NATURE REVIEWS UROLOGY Harshman, L. C., Srinivas, S., Kamaya, A., Chung, B. I. 2009; 6 (6): 338-343

  Abstract

  A 57-year-old woman presented to the emergency department at a community hospital with a 2-month history of fatigue and right-sided flank and abdominal pain. Noncontrast CT of the abdomen and pelvis revealed a 9.1 cm right renal mass.Contrast CT of the chest, abdomen and pelvis, MRI of the abdomen and pelvis with gadolinium, radionuclide bone scan, lung nodule biopsy, complete blood count, comprehensive metabolic profile, and measurement of serum lactate dehydrogenase.Stage IV, T3bN0M1 clear cell renal cell carcinoma, with an associated tumor thrombus extending into the vena cava.The patient was treated with neoadjuvant sunitinib, which resulted in a marked response in the primary tumor and metastatic lesions as well as regression of the tumor thrombus well into the renal vein. Thus, laparoscopic radical nephrectomy was feasible and was achieved without hemorrhagic or wound healing complications. One month after surgery, she had evidence of disease progression in the lung and a periaortic lymph node. She was restarted on sunitinib with resultant disease stabilization, but discontinued the drug owing to toxicity. Eight months after cessation of sunitinib, she received a dendritic cell vaccine. She remains alive without evidence of disease progression 2 years after her diagnosis.

  View details for DOI 10.1038/nrurol.2009.84

  View details for PubMedID 19498412

• Laparoscopic splenorenal venous bypass for nutcracker syndrome JOURNAL OF VASCULAR SURGERY Chung, B. I., Gill, I. S. 2009; 49 (5): 1319-1323

  Abstract

  Nutcracker syndrome is a rare entity caused by extrinsic compression on the left renal vein as it crosses between the superior mesenteric artery and the aorta. It can clinically present with flank pain and hematuria. Accepted treatments include open vascular bypass procedures or endoluminal stenting. We present the first description, to our knowledge, of a laparoscopic splenic vein-left renal vein bypass to relieve the outflow obstruction. The patient, a 29-year-old woman with debilitating left flank pain, presented with nutcracker syndrome. Left renal vein outflow was obstructed at the level of the intersection between the aorta and the superior mesenteric artery. The option of laparoscopic splenic to left renal vein bypass was discussed and performed. A five-port transperitoneal approach was used. Meticulous vascular control was achieved with numerous laparoscopic vascular bulldog clamps. With completely intracorporeal suturing techniques, the splenic vein was anastomosed to the superior aspect of the anterior left renal vein. Total warm ischemia time was 37 minutes. The anastomosis was watertight immediately upon unclamping. Interestingly, upon unclamping, the luminal diameter of the splenic vein appeared to increase to twice its native diameter. The proximal left renal vein appeared less distended, indicating preferential venous outflow through the newly created venous bypass. Blood loss was minimal, no intraoperative or postoperative complications occurred, and the patient's symptoms improved. This report continues to augment the indications for laparoscopic surgery in even complex, urologic vascular situations.

  View details for DOI 10.1016/j.jvs.2008.11.062

  View details for Web of Science ID 000265744700038

  View details for PubMedID 19307081

• Perioperative Efficacy of Laparoscopic Partial Nephrectomy for Tumors Larger than 4 cm EUROPEAN UROLOGY Simmons, M. N., Chung, B. I., Gill, I. S. 2009; 55 (1): 199-208

  Abstract

  Laparoscopic partial nephrectomy (LPN) is typically reserved for kidney tumors < or = 4 cm in size. The use of LPN in patients with larger tumors (> 4 cm) has not been systematically evaluated.To examine technical feasibility and perioperative safety and efficacy of LPN for clinical stage pT1b-T2 tumors > 4 cm.This is a retrospective review of data from an Institutional Review Board-approved, prospectively maintained database of 425 LPN procedures over a 6-yr period (September 1999 through December 2005). Patients were grouped according to tumor size: control group 1: < 2 cm (n=89; 21% of patients); control group 2: 2-4 cm (n=278; 65% of patients); and study group 3: > 4 cm (n=58; 14% of patients).Retroperitoneal and transperitoneal LPN.Serum creatinine levels, estimated glomerular filtration rates.For groups 1, 2, and 3, mean tumor size was 1.5 cm, 2.9 cm, and 6 cm in diameter, respectively (p<0.001). Study group 3 patients more often had an American Society of Anesthesiologists score > or = 3 (p<0.05), central tumors (p<0.001), pelvicalyceal repair (p=0.004), and heminephrectomy (p<0.001). Total operative time, estimated blood loss, and duration of hospital stay were equivalent. Mean warm ischemia time was 30 min, 32 min, and 38 min in groups 1, 2, and 3, respectively (p=0.007). Tumor size > 4 cm did not increase significant risk for positive tumor margins, intraoperative complications, or postoperative genitourinary complications. In each group preoperative stage > or = 3 chronic kidney disease (CKD) was present in 31%, 35%, and 44% of patients in groups 1, 2, and 3, respectively (p=0.15); postoperatively, stage 3-5 CKD incidence increased to 52%, 52%, and 63% in groups 1, 2, and 3, respectively (p=0.20). Patients with tumor size > 4 cm and preoperative stage 3-5 CKD had an 8-fold increase in risk for CKD stage progression. Limitations of the study include retrospective analysis and a relatively low number of patients in group 3.Given laparoscopic expertise and appropriate patient selection, LPN is feasible and efficacious for kidney tumors > 4 cm. Indications for LPN should be expanded to include patients with amenable tumors > 4 cm in order to maximally preserve kidney function in these patients.

  View details for DOI 10.1016/j.eururo.2008.07.039

  View details for Web of Science ID 000262066700023

  View details for PubMedID 18684555

• Laparoscopic Dismembered Pyeloplasty of a Retrocaval Ureter: Case Report and Review of the Literature EUROPEAN UROLOGY Chung, B. I., Gill, I. S. 2008; 54 (6): 1433-1436

  Abstract

  A retrocaval ureter is a rare entity that has traditionally been treated with open pyeloplasty techniques. In this paper, we describe the successful performance of a laparoscopic dismembered pyeloplasty for a retrocaval ureter and present important technical points. In reviewing the available literature about this technique, the laparoscopic approach should be considered to be first-line treatment for this anatomic anomaly due to the good track record, quick convalescence, and relative technical ease.

  View details for DOI 10.1016/j.eururo.2008.09.010

  View details for Web of Science ID 000261677600028

  View details for PubMedID 18805629

• Comparison of holding strength of suture anchors on human renal capsule Tarin, T. V., Kimm, S., Chung, B., Shinghal, R., Reese, J. ELSEVIER SCIENCE INC. 2008: 242-243

  View details for DOI 10.1016/S0022-5347(08)60700-4

  View details for Web of Science ID 000254175301013

• Do cancer index and tumor volume predict prostate cancer specific death? Tarin, T. V., Chung, B. I., Brooks, J. D. ELSEVIER SCIENCE INC. 2008: 115

  View details for DOI 10.1016/S0022-5347(08)60330-4

  View details for Web of Science ID 000254175300323

• Fellowship in endourology, the job search, and setting up a successful practice: An insider's view JOURNAL OF ENDOUROLOGY Chung, B. I., Matin, S. F., Ost, M. C., Winfield, H. N. 2008; 22 (3): 551-557

  Abstract

  The field of endourology, which encompasses genitourinary endoscopy and percutaneous, laparoscopic, and robotic surgery, has advanced rapidly over the past quarter century, causing endourology to be considered a subspecialty of urology. The Endourological Society, which is recognized by the American Urological Association, offers numerous clinical and research fellowship opportunities throughout the world. The decision to seek postresidency fellowship training in endourology is complex as is the process of seeking subsequent employment. We offer guidance on the decision-making process to obtain fellowship training as well as on early steps into subsequent academic or private practice settings.

  View details for DOI 10.1089/end.2007.0144

  View details for Web of Science ID 000254829500030

  View details for PubMedID 18307381

• Ureteroscopic versus percutaneous treatment for medium-size (1-2-cm) renal calculi JOURNAL OF ENDOUROLOGY Chung, B. I., Aron, M., Hegarty, N. J., Desai, M. M. 2008; 22 (2): 343-346

  Abstract

  To compare the outcomes of percutaneous nephrolithotomy (PCNL) and ureterorenoscopy (URS) for 1- to 2-cm renal calculi with specific reference to the stone clearance rate and morbidity.The records of 27 patients who underwent either PCNL (N = 15) or URS (N = 12) by standard techniques over an 8-month period for renal calculi between 1 and 2 cm were reviewed retrospectively. Demographic, intraoperative, and postoperative data were accrued and compared to identify any statistically significant differences. The median stone burden was slightly but not significantly higher in the PCNL group (1.8 cm v 1.25 cm; P = 0.19). Postoperative plain films were used to confirm stone clearance.The procedure was technically successful in all 27 patients. No patient in either group required a repeat session or ancillary procedure. All 15 PCNL procedures were completed through a single percutaneous tract. The PCNL and URS groups were equivalent with respect to operative time (79.0 minutes v 68.5 minutes) and incidence of complications (2 v 0). No patient in either group had significant hemorrhage or required blood transfusion. The overall stone-free rate was 87% for PCNL and 67% for URS (P = 0.36).Both PCNL and URS are effective options for renal calculi between 1 and 2 cm. The stonefree and complication rates for PCNL are higher, but the differences were not statistically significant in our series. The operative times are statistically equivalent, despite the potentially longer fragmentation times required for URS. The choice of treatment ultimately depends on the individual surgeon's preference and level of expertise.

  View details for DOI 10.1089/end.2006.9865

  View details for Web of Science ID 000253719900021

  View details for PubMedID 18294042

• Second prize: 2006 endourological society essay competition - Preliminary experience with the Niris (TM) optical coherence tomography system during laparoscopic and robotic prostatectomy JOURNAL OF ENDOUROLOGY Aron, M., Kaouk, J. H., Hegarty, N. J., Colombo, J. R., Haber, G., Chung, B. I., Zhou, M., Gill, I. S. 2007; 21 (8): 814-818

  Abstract

  To evaluate the feasibility of high-resolution optical coherence tomography (OCT) in the identification of neurovascular bundles (NVBs) during laparoscopic and robotic radical prostatectomy (LRP).Between November 2005 and March 2006, 24 patients undergoing transperitoneal laparoscopic or robotic radical prostatectomy were enrolled in this study. Once the bladder was taken down and the prostate mobilized, the Niris imaging system was deployed. In each patient, in-vivo images were obtained to determine the image characteristics of NVBs, adipose tissue, prostate capsule, and endopelvic fascia. The NVB was imaged again in vivo, after the prostate was excised. Ex-vivo images were obtained from the prostate surface to look for the presence or absence of the NVBs and correlated with the surgeon's assessment of the adequacy of nerve sparing.From 24 patients, we obtained more than 300 OCT images of tissue structures including endopelvic fascia, prostate capsule, NVBs, fat, lateral pedicles, and lymphatics. These images were found to correlate independently with the surgeon's impression of the tissue being imaged. Preliminary comparison with parallel histologic evaluation was performed in four patients that suggested OCT could help to identify the NVBs and prostate capsule during LRP.In our preliminary experience with the Niris system during LRP, OCT was able to image the NVB in all patients. This could enhance surgical precision during nerve sparing and positively impact potency rates after radical prostatectomy. Further research will be needed, including parallel histologic evaluation and follow-up, to validate the findings of OCT imaging.

  View details for DOI 10.1089/end.2006.9938

  View details for Web of Science ID 000249550800003

  View details for PubMedID 17867934

• The use of bowel for ureteral replacement for complex ureteral reconstruction: Long-term results JOURNAL OF UROLOGY Chung, B. I., Hamawy, K. J., Zinman, L. N., Libertino, J. A. 2006; 175 (1): 179-183

  Abstract

  Ileal and intestinal ureteral replacement remains a useful procedure for complex ureteral reconstruction. We examined the long-term safety and efficacy of this procedure, especially in regard to maintaining preoperative renal function and the avoidance of major complications.A total of 56 patients underwent intestinal ureteral substitution at our institution between 1979 and 2003, including 52 with an ileal ureteral replacement, 2 with colonic replacement alone and 2 with bilateral ureteral replacement, necessitating ileum and colon for 1 ureter each. The factors reviewed were indications for surgery, type of ureteral replacement, and the presence and type of complications. Followup data included excretory urogram or equivalent imaging results, and measurement of serum chloride, bicarbonate and creatinine before and after the procedure.Overall the complication rate remained low. Mean followup was 6.04 years (median 3.2). Most postoperative complications, which occurred in 10 patients (17.9%), were minor in nature, including pyelonephritis, fever of unknown origin, neuroma, hernia, recurrent urolithiasis and deep venous thrombosis. Major complications occurred in 6 patients (10.5%), including anastomotic stricture, ileal graft obstruction, wound dehiscence and chronic renal failure. Overall patients did not experience worsening renal function after the procedure with equivalent median creatinine before and after the procedure (1.0 mg/dl).During long-term followup major complications are rare and renal function remains preserved. Ileal and intestinal ureteral substitution remains a safe and efficacious procedure in patients with complex and difficult ureteral issues not amenable to more conservative measures.

  View details for DOI 10.1016/S0022-5347(05)00061-3

  View details for Web of Science ID 000234001100047

  View details for PubMedID 16406903

• Laparoscopic Retroperitoneal Lymph Node Dissection for Stage I Nonseminomatous Germ Cell Tumors ? Do We Meet the Standards of Open Surgery? American Journal of Urology Review Chung BI, Tuerk IA 2005; 3 (9): 411-415
• Laparoscopic Partial Nephrectomy : Alternative Surgical Approach for Renal Masses < 4 cm American Journal of Urology Review Chung BI, Tuerk IA 2004; 2 (10): 477-479
• Expression of the proto-oncogene Axl in renal cell carcinoma DNA AND CELL BIOLOGY Chung, B. I., Malkowicz, S. B., Nguyen, T. B., Libertino, J. A., McGarvey, T. W. 2003; 22 (8): 533-540

  Abstract

  In this investigation, we examined the role of the Axl proto-oncogene in renal cell carcinoma (RCC). Axl is a tyrosine kinase receptor implicated in myeloid leukogenesis, and has been found to be overexpressed in lung cancers and breast cancers. Axl has been described to act as a mitogenic factor along with its ligand Gas-6. Axl has also shown to have a role in apoptosis, cell adhesion, and chemotaxis. The differential expression of the Axl RNA transcript was examined in 20 pairs of matched normal kidney and clear cell RCC patient samples. We found that there was a significant increase in the steady-state levels of Axl mRNA in the RCC compared with the normal kidney pair (Student's paired t-test P < 0.001). There was also a significant increase in Axl expression overall in RCC compared to normal kidney (P < 0.03). Western blotting was utilized to determine Axl protein levels in six out of the 20 pairs of the normal/RCC matched pairs. Overall, the level of expression was not significantly different between the paired normal kidneys and kidney tumors, but the detected Axl protein appeared to be at slightly different molecular weights. Primers were constructed for the two known Axl variant, RT-PCR performed, but no differences were observed in the expression of each variant. Next, we performed a gene silencing experiment utilizing double-stranded RNA constructed to silence the Axl gene in the 293 transformed kidney cell line. There was a 50% decrease in Axl gene expression in the RNAi transfected over control cells. In addition, flow cytometry performed to determine DNA content showed a 30% increase in G1/G0 cells, which were transfected with axl RNAi compared to control. Altogether, these findings suggest an overexpression of Axl as part of a proliferative phenotype in RCC.

  View details for Web of Science ID 000185482300007

  View details for PubMedID 14565870

• The outcome of stopping prophylactic antibiotics in older children with vesicoureteral reflux JOURNAL OF UROLOGY Cooper, C. S., Chung, B. I., Kirsch, A. J., Canning, D. A., Snyder, H. M. 2000; 163 (1): 269-272

  Abstract

  Accepted management of vesicoureteral reflux includes surgical correction or prophylactic antibiotics with the hope for resolution as the child grows. The physician must consider surgery when reflux does not resolve despite uneventful years on prophylactic antibiotics. An alternative is cessation of the antibiotics. We report on the outcome of children taken off antibiotics with persistent reflux.During a 14-year period 51 children with documented reflux were taken off antibiotic prophylaxis. Selection criteria included children who were old enough to verbalize the symptoms of a urinary tract infection, and had normal voiding patterns, a minor history of infections and minimal or no renal scarring. Routine followup included nuclear cystography and renal sonography.A total of 40 girls and 11 boys maintained on antibiotics for a mean of 4.8 years were taken off prophylaxis and followed for an average of 3.7 years. Mean patient age when prophylactic antibiotics were stopped was 8.6 years. Reflux resolved in 10 children (19.6%). A urinary tract infection developed in 5 girls and 1 boy (11.8%) (mean age 11) an average of 2.3 years (range 4 months to 9.4 years) after antibiotic discontinuation. One child had symptoms consistent with cystitis and 5 had febrile urinary tract infections. All were treated with oral antibiotics and 5 had subsequent operations. No new renal scars developed.The majority of children did well following cessation of antibiotic prophylaxis despite persistent vesicoureteral reflux. Cessation of antibiotic prophylaxis is a reasonable option in a highly select patient population with reflux.

  View details for Web of Science ID 000084324900091

  View details for PubMedID 10604374