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European Urology Dec 2018Urologists regularly develop clinical risk prediction models to support clinical decisions. In contrast to traditional performance measures, decision curve analysis... (Review)
Review
CONTEXT
Urologists regularly develop clinical risk prediction models to support clinical decisions. In contrast to traditional performance measures, decision curve analysis (DCA) can assess the utility of models for decision making. DCA plots net benefit (NB) at a range of clinically reasonable risk thresholds.
OBJECTIVE
To provide recommendations on interpreting and reporting DCA when evaluating prediction models.
EVIDENCE ACQUISITION
We informally reviewed the urological literature to determine investigators' understanding of DCA. To illustrate, we use data from 3616 patients to develop risk models for high-grade prostate cancer (n=313, 9%) to decide who should undergo a biopsy. The baseline model includes prostate-specific antigen and digital rectal examination; the extended model adds two predictors based on transrectal ultrasound (TRUS).
EVIDENCE SYNTHESIS
We explain risk thresholds, NB, default strategies (treat all, treat no one), and test tradeoff. To use DCA, first determine whether a model is superior to all other strategies across the range of reasonable risk thresholds. If so, that model appears to improve decisions irrespective of threshold. Second, consider if there are important extra costs to using the model. If so, obtain the test tradeoff to check whether the increase in NB versus the best other strategy is worth the additional cost. In our case study, addition of TRUS improved NB by 0.0114, equivalent to 1.1 more detected high-grade prostate cancers per 100 patients. Hence, adding TRUS would be worthwhile if we accept subjecting 88 patients to TRUS to find one additional high-grade prostate cancer or, alternatively, subjecting 10 patients to TRUS to avoid one unnecessary biopsy.
CONCLUSIONS
The proposed guidelines can help researchers understand DCA and improve application and reporting.
PATIENT SUMMARY
Decision curve analysis can identify risk models that can help us make better clinical decisions. We illustrate appropriate reporting and interpretation of decision curve analysis.
Topics: Attitude of Health Personnel; Biopsy; Clinical Decision-Making; Comprehension; Decision Support Techniques; Digital Rectal Examination; Health Knowledge, Attitudes, Practice; Humans; Kallikreins; Male; Neoplasm Grading; Patient Selection; Predictive Value of Tests; Prostate-Specific Antigen; Prostatic Neoplasms; Risk Assessment; Risk Factors; Ultrasonography; Urologists; Urology
PubMed: 30241973
DOI: 10.1016/j.eururo.2018.08.038 -
European Urology Dec 2022
Topics: Humans; Mpox (monkeypox); Urologists; Disease Outbreaks
PubMed: 36167597
DOI: 10.1016/j.eururo.2022.09.006 -
Current Urology Reports Dec 2021Residency training is a pivotal educational step on the road to becoming a urologist. It combines both clinical and surgical instruction with the goal of producing... (Review)
Review
PURPOSE OF REVIEW
Residency training is a pivotal educational step on the road to becoming a urologist. It combines both clinical and surgical instruction with the goal of producing proficient and compassionate surgeons and clinicians. In this review, we employ a SWOT analysis (Strengths, Weaknesses, Opportunities, and Threats) to investigate the current state of urologic residency training.
RECENT FINDINGS
Urology remains an attractive and competitive residency with varied and complex surgical and medical training. Areas for improvement include standardization of evaluation and feedback, improving resident wellness, and expanding the use of surgical simulation. Workforce issues such as the predicted urologist supply deficit and poor readiness to enter the business of medicine can be addressed at the residency level. Failure to attract and retain underrepresented minorities, increasing burden of student debt, and resident burnout are serious threats to our field. Using a SWOT analysis we identify key areas for expansion, underscore valuable strengths, and provide a working roadmap for improvement of these formative years.
Topics: Burnout, Professional; Humans; Internship and Residency; Urologists; Urology
PubMed: 34913100
DOI: 10.1007/s11934-021-01080-8 -
BJUI Compass Jul 2020To summarize the available literature regarding bacillus Calmette-Guerin (BCG) administration, severe acute respiratory syndrome conoravirus-2 (SARS-CoV-2), and the... (Review)
Review
OBJECTIVES
To summarize the available literature regarding bacillus Calmette-Guerin (BCG) administration, severe acute respiratory syndrome conoravirus-2 (SARS-CoV-2), and the resulting clinical condition coronavirus disease (COVID-19) in light of recent epidemiologic work suggesting decreased infection severity in BCG immunized populations while highlighting the potential role of the urologist in clinical trials and ongoing research efforts.
MATERIALS AND METHODS
We reviewed the available literature regarding COVID-19 and BCG vaccination. Specifically, the epidemiologic evidence for decreased COVID-19 morbidity in countries with BCG vaccination programs, current clinical trials for BCG vaccination to protect against COVID-19, potential mechanisms and rationale for this protection, and the role of the urologist and urology clinic in providing support and/or leading ongoing efforts.
RESULTS
Epidemiologic evidence suggests that the crude case fatality rates are lower for countries with BCG vaccination compared to those without such programs. Four prospective, randomized clinical trials for BCG vaccination were identified including NCT04348370 (BADAS), NCT04327206 (BRACE), NCT04328441 (BCG-CORONA), and NCT04350931. BCG administration may contribute to innate and adaptive immune priming with several opportunities for translational research.
CONCLUSIONS
The urologist's expertise with BCG and the infrastructure of urologic clinics may afford several opportunities for collaboration and leadership to evaluate and understand the potential role of BCG in the current COVID-19 pandemic.
PubMed: 32835353
DOI: 10.1002/bco2.21 -
Urologie (Heidelberg, Germany) Jun 2022A multitude of treatment options for the systemic treatment of urologic cancer have become available in recent years. In addition to classical chemotherapy or... (Review)
Review
BACKGROUND
A multitude of treatment options for the systemic treatment of urologic cancer have become available in recent years. In addition to classical chemotherapy or androgen-deprivation therapy, other approaches like targeted therapies (e.g., tyrosine kinase inhibitors), checkpoint inhibitors, and new approaches like radioligand therapies are increasingly used. Whether treating their own patients or caring for patients who receive these compounds from other physicians in the field, urologists will inevitably be confronted with adverse events associated with these diverse therapies. This development will continue to grow as new compounds are continuously being registered and even new drug classes are being developed. Therefore, every urologist should know the basics regarding prophylaxis, control of adverse events, and especially management of emergency situations associated with systemic treatment in uro-oncology.
OBJECTIVES
To provide an overview of typical emergency situations and their management in genitourinary cancers.
METHODS
Summary of common uro-oncological emergency situations associated with systemic therapy.
RESULTS
The urologist requires expert knowledge in the management of emergencies within systemic treatment of genitourinary cancers like neutropenic fever during chemotherapy, hand-foot syndrome with tyrosine kinase inhibitors, immune-related adverse events, but also of side effects occurring in patients treated by other physicians, e.g., during radioligand therapies administered by nuclear physicians.
CONCLUSIONS
Basic knowledge on the typical side effects and emergencies that are associated with compounds used in the treatment of genitourinary cancers is essential. Continuous medical education to be able to handle the new developments in this rapidly evolving field is mandatory.
Topics: Androgen Antagonists; Emergencies; Humans; Immunotherapy; Male; Prostatic Neoplasms; Protein Kinase Inhibitors
PubMed: 35925079
DOI: 10.1007/s00120-022-01835-2 -
Korean Journal of Urology Jul 2015Tissue transfer techniques are an essential part of the reconstructive urologist's armamentarium. Flaps and graft techniques are widely used in genital and urethral... (Review)
Review
Tissue transfer techniques are an essential part of the reconstructive urologist's armamentarium. Flaps and graft techniques are widely used in genital and urethral reconstruction. A graft is tissue that is moved from a donor site to a recipient site without its native blood supply. The main types of grafts used in urology are full thickness grafts, split thickness skin grafts and buccal mucosa grafts. Flaps are transferred from the donor site to the recipient site on a pedicle containing its native blood supply. Flaps can be classified based on blood supply, elevation methods or the method of transfer. The most used flaps in urology include penile, preputial, and scrotal skin. We review the various techniques used in reconstructive urology and the outcomes of these techniques.
Topics: Genitalia; Humans; Mouth Mucosa; Plastic Surgery Procedures; Skin Transplantation; Surgical Flaps; Tissue Transplantation; Ureter; Urethra; Urologic Surgical Procedures
PubMed: 26175866
DOI: 10.4111/kju.2015.56.7.478 -
Urologia Internationalis 2019Werner Forssmann (1904-1979) was awarded the Nobel Prize for his self-experiments in catheterization of the heart and thus entered the annals of medicine. But he had... (Review)
Review
Werner Forssmann (1904-1979) was awarded the Nobel Prize for his self-experiments in catheterization of the heart and thus entered the annals of medicine. But he had turned to urology long before he received the Nobel Prize. Who was this person associated with both cardiology and urology? It is precisely this question that the present article explores with the help of both new and reevaluated primary sources. In 1999 Truss et al. already published an article in the World Journal of Urology about the many and varied facets of Forssmann's life and work. Our article ties in with that of Truss et al. and expands the body of knowledge concerning Forssmann and his work. Werner Forssmann as one of the 2 urologists besides Charles B. Huggins who have ever won the Nobel Prize deserves a complete and comprehensive analysis of his life and his life's work. Within -German Urology, the culture of remembrance on Werner Forssmann is an important component and with every newly revealed and interpreted source we get to know better who this urologist was and what role he played in the scientific community.
Topics: Cardiology; Germany; History, 20th Century; Humans; Nobel Prize; Urology
PubMed: 30917372
DOI: 10.1159/000499093 -
Canadian Urological Association Journal... Jun 2021The rate of burnout among physicians appears to be on the rise and urologist are no exception. In fact, urology appears to be one of the specialties most affected, with... (Review)
Review
The rate of burnout among physicians appears to be on the rise and urologist are no exception. In fact, urology appears to be one of the specialties most affected, with European urologists reporting burnout rates of up to 54% and those working in the United States up to 68%.Herein, we review the relatively few studies looking at burnout in European urologists to estimate its prevalence and discuss what could be done to reverse the trend. A total of seven studies were identified assessing burnout in urologists in Europe and Turkey. While the rates vary (9.3-68%), they indicate that burnout is prevalent within urology, with data from other studies suggesting there is a rising trend. Although the topic has been studied for many years, with an increased focus in the last decade, little seems to have been done to improve the situation.
PubMed: 34406927
DOI: 10.5489/cuaj.7227 -
Current Urology Reports Jun 2023This paper aims to survey current literature on urologic graduate medical education focusing on surgical autonomy. (Review)
Review
PURPOSE OF REVIEW
This paper aims to survey current literature on urologic graduate medical education focusing on surgical autonomy.
RECENT FINDINGS
Affording appropriate levels of surgical autonomy has a key role in the education of urologic trainees and perceived preparedness for independent practice. Recent studies in surgical resident autonomy have demonstrated a reduction in autonomy for trainees in recent years. Efforts to advance the state of modern surgical training include creation of targeted curricula, enhanced with use of surgical simulation, and structured feedback. Decline in surgical autonomy for urology residents may influence confidence after completion of their residency. Further study is needed into the declining levels of urology resident autonomy, how it affects urologists entering independent practice, and what interventions can advance autonomy in modern urologic training.
Topics: Humans; Urology; Education, Medical, Graduate; Internship and Residency; Urologists; Surveys and Questionnaires; Clinical Competence
PubMed: 36917339
DOI: 10.1007/s11934-023-01152-x -
Current Urology May 2019Seminal vesicle (SV) stones are a rare, and thus readily misdiagnosed condition in practice. Understanding the etiology, diagnosis, and management are crucial to guide a... (Review)
Review
BACKGROUND/AIMS
Seminal vesicle (SV) stones are a rare, and thus readily misdiagnosed condition in practice. Understanding the etiology, diagnosis, and management are crucial to guide a urologist's care, and are provided in this literature review.
METHODS
The inclusion criteria for the literature search, using the search engines MEDLINE® and PubMed was conducted using a combined query of "seminal vesicle stone" and the following keywords: calculi, hematospermia, calcification, and transrectal ultrasound (TRUS).
RESULTS
The etiology of SV stones is currently unknown where majority of the patients present with having painful ejaculation and hematospermia. However, clinicians have reported potential etiologies by categorization as an inflammatory or non-in-flammatory. A majority of the previous cases had shown multiple stones being present in the SV duct system that are typically diagnosed through radiological examination such as TRUS, MRI, or plain radiographs. Amongst the many imaging approaches, TRUS remains the primary imaging diagnoses of SV calculi. Transurethral seminal vesiculoscopy has shown to be used in an abundant of the case reports to be an ideal surgical approach for managing small SV stones. In regard to larger stones, a transperitoneal laparoscopic protocol is proper.
CONCLUSION
The current imaging techniques have increased the case reports and diagnosis of SV calculi; however, more research is warranted for understanding the pathogenesis of the formation of SV stones. An optimal management of the extraction of SV stones depends on a number of factors such as size and location.
PubMed: 31316318
DOI: 10.1159/000489429