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Canadian Urological Association Journal
Journal Prestige (SJR): 0.626

Citation Impact (citeScore): 1
Number of Followers: 1

This is an Open Access Journal

Open Access journal
ISSN (Print) 1911-6470 - ISSN (Online) 1920-1214
Published by Canadian Urological Association

[1 journal]

On vacation
- Authors: Michael Leveridge
  Pages: 223 - 4
  PubDate: 2024-07-23
  DOI: 10.5489/cuaj.8930
  Issue No: Vol. 18, No. 8 (2024)
Fostering the continued growth of our association
- Authors: Ricardo A. Rendon
  Pages: 229 - 229
  PubDate: 2024-07-23
  DOI: 10.5489/cuaj.8938
  Issue No: Vol. 18, No. 8 (2024)
PGY2040: Beyond the digital hum
- Authors: Ioana Fugaru
  Pages: 231 - 231
  PubDate: 2024-07-23
  DOI: 10.5489/cuaj.8889
  Issue No: Vol. 18, No. 8 (2024)
2024 Canadian Urological Association endorsement of an expert report:
Kidney involvement in tuberous sclerosis complex
- Authors: Ross J. Mason, Patrick O. Richard
  Pages: 232 - 3
  Abstract: NA
  PubDate: 2024-07-23
  DOI: 10.5489/cuaj.8925
  Issue No: Vol. 18, No. 8 (2024)
Safety and efficacy of ultrasound-assisted bedside ureteric stent
placement
- Authors: David Chung, Ryan Ramjiawan, Gregory Hosier
  Pages: 234 - 8
  Abstract: INTRODUCTION: Previous studies have demonstrated the feasibility of bedside placement of ureteric stents; however, they have traditionally required two skilled operators and were associated with some stent malposition especially for proximal ureteric obstruction. We sought to investigate the efficacy and safety of a modified technique for ultrasound-assisted bedside ureteric stent insertion without the presence of a skilled assist. METHODS: A single institution prospective study was performed from April-August 2023. Indications for stenting included infection, renal insufficiency, or intractable colic. Exclusion criteria included age <18 years, hemodynamic instability, and patients with history of chronic pain. Point-of-care ultrasound (POCUS) was used to confirm wire placement in the kidney and presence of a hydronephrotic drip from a 5 French ureteric catheter was used to confirm placement beyond the level of obstruction. RESULTS: Of 28 patients, all patients underwent successful bedside ureteric stent placement. Mean age was 64.9 years and mean body mass index (BMI) was 33.2. Proximal ureter obstruction was present in 52% of patients and mid/distal obstruction in 48%. In cases with obstructing stones, the mean stone size was 8.1 mm with a range of 4–15 mm. Infection was the indication for stent placement in most patients (71%), followed by pain (4%) and acute kidney injury (AKI) (4%). All patients who underwent successful stent placement had presence of hydronephrotic drip from the ureteric catheter. CONCLUSIONS: Ultrasound-assisted bedside ureteric stent insertion without a skilled assist is a safe and feasible option for management of acute ureteral obstruction. Presence of hydronephrotic drip can indicate successful access beyond the level of obstruction as an alternative to POCUS.
  PubDate: 2024-07-23
  DOI: 10.5489/cuaj.8880
  Issue No: Vol. 18, No. 8 (2024)
Sacral neuromodulation in pediatric refractory bladder and bowel
dysfunction
- Authors: Roseanne Ferreira, Dean Elterman, Mandy Rickard, Max Freeman, Natasha Brownrig, Abby Varghese, Michael Chua, Armando Lorenzo, Joana Dos Santos
  Pages: 239 - 44
  Abstract: INTRODUCTION: Refractory bladder and bowel dysfunction (BBD) significantly affects the health and quality of life of children and their caregivers, emphasizing the need for effective and minimally invasive treatments. This study aims to present the inaugural Canadian experience using sacral neuromodulation (SNM) as a therapeutic option for children with refractory BBD. METHODS: Patients <18 years old with refractory BBD were prospectively followed from 2018 to the present. Preoperative evaluation included spinal MRI and video urodynamics. Two-stage SNM implantation was executed with a minimum two-week stage 1 trial. Functional outcomes and complication rates were measured following validated questionnaires. RESULTS: Six patients completed staged implantation at a median age of 10.8 years (range 8.2–18). The median baseline Dysfunctional Voiding Scoring System (DVSS) score was 12.5 (10–22). At six months of followup, only one patient required adjunct bladder medication. Median DVSS at one-year followup was 5.5 (0–7). Symptomatic resolution was noted in three patients at six months, sustained over one year. Early surgical complications were reported in one (infection) and late complications in three (lead fracture, battery depletion, non-traumatic malfunction), requiring reimplantation at a median of 37.5 (1–49) months. Post-SNM reimplantation, oral medication and rectal therapy decreased, and DVSS scores improved by 30% (0–63.6) at six months. CONCLUSIONS: SNM is feasible and offers promising results for refractory pediatric BBD in Canada. The significant improvement of symptoms highlights the treatment’s potential, which must be balanced against the high need for revision detected at three years, possibly related to patients’ growth and high activity level.
  PubDate: 2024-07-23
  DOI: 10.5489/cuaj.8881
  Issue No: Vol. 18, No. 8 (2024)
Robotic-assisted laparoscopic partial nephrectomy vs. laparoscopic and
open partial nephrectomy
- Authors: Kaveh Masoumi-Ravandi, Ross J. Mason, Rendon A. Ricardo
  Pages: 245 - 50
  Abstract: INTRODUCTION: In 2019, our center attempted to transition all partial nephrectomies (PNs) to robotic-assisted laparoscopic PN (RALPN). The purpose of this study was to compare RALPN outcomes to laparoscopic PN (LPN) and open PN (OPN) at our institution, as there is limited literature from Canadian centers. METHODS: In this single-center, two-surgeon, retrospective cohort study, we compared RALPN outcomes during the early phase of our robotics program to OPN and LPN performed just before the introduction of RALPN. RESULTS: A total of 106 patients underwent OPN, 83 LPN, and 82 RALPN during the study period. Median RALPN RENAL score was 7 vs. 6 for LPN (p<0.05) and 8 for OPN (p=0.10). Median RALPN length of stay (LOS) was two days vs. three and four days for LPN and OPN (p<0.05), respectively. OPN median procedure time was 104 minutes vs. 94 and 82 minutes for LPN and RALPN (p<0.05), respectively. Median OPN operating room (OR) time was 160 minutes vs. 150 and 146 minutes for LPN and RALPN (p<0.05), respectively. There were no significant differences in intraoperative (p=0.92) or postoperative complication rates (p=0.47). RALPN warm ischemia time (WIT) was 17 minutes vs. 14.5 and 15 minutes for OPN and LPN (p<0.05), respectively. Median RALPN estimated blood loss (EBL) was 165 ml vs. 250 ml for OPN (p<0.05) and 125 ml for LPN (p=0.15). CONCLUSIONS: Although patients who underwent RALPN had longer WIT, they had similar rates of complications, required less total OR time, and had shorter procedure times and LOS compared with OPN and LPN despite similar RENAL scores compared to OPN and greater scores than LPN.
  PubDate: 2024-04-02
  DOI: 10.5489/cuaj.8585
  Issue No: Vol. 18, No. 8 (2024)
Pilot study to assess the feasibility of self-administered, low-dose
methoxyflurane for cystoscopic procedures
- Authors: Jennifer A. Locke, Sarah Neu, Joanne Lawrence, Sender Herschorn
  Pages: 251 - 4
  Abstract: INTRODUCTION: Methoxyflurane (MEOF) (PenthroxTM) is an inhaled, self-administered, non-opioid analgesic approved by Health Canada for the short-term relief of moderate to severe acute pain associated with trauma or interventional medical procedures. In this pilot study, we evaluated the feasibility of using MEOF as an anesthetic agent in 11 patients undergoing outpatient cystoscopic procedures. METHODS: The average duration of the procedure was 24 (range 20–35) minutes and this included 10 minutes of administration time of the drug and five minutes of wait time before the procedure. The average monitoring time from start to end of the procedure was 23 (range 20–35) minutes and this included 15 minutes of monitoring post-procedure. On a scale of 0–10, patients on average rated the pain 4/10 (standard deviation [SD] 2.6). RESULTS: Global performance was on average 3/4 (SD 1.3) for the patients and 3/4 (SD 1.1) for the operator. Of the 11 patients, four reported adverse events; two experienced euphoria, one experienced dizziness, and one was unable to tolerate the medication. Two patients noted their adverse events to be of moderate intensity, while the other two were of mild intensity. None of the adverse events was deemed serious. CONCLUSIONS: Our findings in this pilot study provide proof of principle for the design of a randomized control trial to evaluate MEOF as an anesthetic in an outpatient cystoscopic procedural setting. As more urologic procedures are being performed in an outpatient setting, this may offer significant clinical benefit.
  PubDate: 2024-04-02
  DOI: 10.5489/cuaj.8676
  Issue No: Vol. 18, No. 8 (2024)
Comparison of outcomes in patients with and without neurologic diseases
undergoing holmium laser enucleation of the prostate
- Authors: Jenny N. Guo, Mark A. Assmus, Nicholas S. Dean, Matthew S. Lee, Clarissa Wong, Jordan Rich, Jessica Helon, Mitchell M. Huang, Amy E. Krambeck
  Pages: 255 - 61
  Abstract: INTRODUCTION: We aimed to compare holmium laser enucleation of the prostate (HoLEP) outcomes in patients with and without neurologic diseases (ND). METHODS: A prospectively maintained database of patients undergoing HoLEP from January 2021 to April 2022 was reviewed. The following NDs were included: diabetes-related neuropathy/ neurogenic bladder, Parkinson’s disease, dementia, cerebrovascular accident, multiple sclerosis, traumatic brain injury, transient ischemic attack, brain/spinal tumors, myasthenia gravis, spinal cord injury, and other. Statistical analysis was performed using t-tests, Chi-squared, and binomial tests (p<0.05). RESULTS: A total of 118 ND patients were identified with 135 different neurologic diseases. ND patients were more likely to have indwelling catheters (57% vs. 39%, p=0.012) and urinary tract infections (UTIs) preoperatively (32% vs. 19%, p=0.002). Postoperatively, ND patients were more likely to fail initial trial of void (20% vs. 8.1%, p<0.001) and experience an episode of acute urinary retention (16% vs. 8.5%, p=0.024). Within 90 days postoperative, the overall complication rate was higher in the ND group (26% vs. 13%, p=0.001). Within the ND group, 30/118 (25%) had ≥1 UTI within 90 days preoperative, which decreased to 10/118 (8.7%) 90 days postoperative (p<0.001). At last followup (mean 6.7 months [ND] vs. 5.4 months [non-ND], p=0.03), four patients (4.4%) in the ND group required persistent catheter/clean intermittent catheterization compared to none in the non-ND group (p=0.002). CONCLUSIONS: Patients with ND undergoing HoLEP are more likely to experience postoperative retention and higher complication rates compared to non-ND patients. While UTI rates are higher in this population, HoLEP significantly reduced three-month UTI and catheterization rates.
  PubDate: 2024-04-02
  DOI: 10.5489/cuaj.8683
  Issue No: Vol. 18, No. 8 (2024)
Restricted access and advanced disease in post-pandemic testicular cancer
- Authors: Mitchell Gerald Fagan, W.C. Ian Janes, Joseph Matthew Andrews, David R. Harvey, Geoff M. Warden, Michael K. Organ, Paul H. Johnston
  Pages: 262 - 7
  Abstract: INTRODUCTION: Urologists observed reduced cancer consultations and surgeries during the SARS-CoV-2 pandemic, raising concern about treatment delays. Testicular cancer serves as a particularly sensitive marker of this phenomenon, as the clinical stage of testicular cancer at presentation is predictive of cancer-specific survival. We aimed to investigate whether COVID-related restrictions to primary care access resulted in increased incidence of metastatic germ cell testis cancer. METHODS: A retrospective chart review was conducted on all cases of testicular cancer managed surgically at our center from March 1, 2018, to February 28, 2023. Patients were categorized into temporal cohorts, representing before, during, and following the implementation of COVID-19 public health restrictions in the province of Newfoundland and Labrador. RESULTS: Forty-one cases of testicular germ cell tumors were identified during the study period. The mean age at diagnosis was 40.8 years (standard deviation ±13.7). Demographics did not vary across the cohorts. Clinical stage 3 disease remained stable before and during the pandemic at 10.5% and 9.1% of cases, respectively. In the post-pandemic period, there was an increase to 27.3% (p=0.617). Surgical wait times remained stable across the pandemic (p=0.151). CONCLUSIONS: There was a 16.8% rise in clinical stage 3 disease from the pre-pandemic to post-pandemic period. Our study failed to identify a statistically significant increase in metastatic testis cancer incidence upon lifting of pandemic restrictions. Further study is necessary to confirm suspicions that pandemic restrictions contributed to increased incidence of metastatic testis cancer.
  PubDate: 2024-04-02
  DOI: 10.5489/cuaj.8648
  Issue No: Vol. 18, No. 8 (2024)
An analysis of benign prostatic hyperplasia surgical treatment
reimbursement trends across Canada
- Authors: Anindyo Chakraborty, Dean Elterman, Nicholas Corsi, David Bouhadana, Gregory Bailly, Premal Patel, Rowen McLellan, Liam Hickey, Daniel Costa, Matthew Andrews, Howard Evans, Connor M. Forbes, Hazem Elmansy, Malek Meskawi, Naeem Bhojani, Bilal Chughtai, Kevin C. Zorn
  Pages: 268 - 73
  Abstract: INTRODUCTION: A variety of procedures for the endoscopic surgical treatment of symptomatic benign prostatic hyperplasia (BPH) refractory to medical therapy have existed for decades. The present study examined trends in surgeon compensation for these treatments within Canada. METHODS: The physician fee schedule for BPH surgery across 10 Canadian provinces for the years 2010 and 2023 were obtained. A descriptive study examined first the provincial reimbursement for transurethral resection of prostate (TURP) and laser ablative/enucleation surgery; second, the difference in TURP reimbursement between 2010 and 2023; and third, the annual change in TURP reimbursement juxtaposed with the annual change in the provincial Consumer Price Index (CPI) and annual salary for the working population aged 35–44. RESULTS: Seven of 10 Canadian provinces reimburse laser BPH surgery equally to TURP. The average provincial TURP reimbursement is $545, ranging from $451 in Ontario to $688 in Saskatchewan. Since 2010, TURP reimbursement has varied by province from a 0% net change in Ontario to an increase of 21% in Nova Scotia. Reimbursement for TURP has increased at a slower pace than the local CPI, and for half of the provinces at a slower pace than the annual salary for people aged 35–44. CONCLUSIONS: The compensation model for endoscopic BPH surgery does not have a unified structure in Canada that is consistent across provinces, nor does it keep up with inflation, possibly impacting future recruitment, increasing geographic disparities, and most importantly, limiting the adoption of new BPH therapies.
  PubDate: 2024-04-02
  DOI: 10.5489/cuaj.8638
  Issue No: Vol. 18, No. 8 (2024)
Standardizing male pelvic anatomy teaching using a clinical enrichment
video
- Authors: Landan MacDonald, Jesse Ory, Thejodhar Pulakunta, Dawn L. MacLellan
  Pages: 274 - 9
  Abstract: INTRODUCTION: Evolving trends in medical education and modern curricular changes have reduced the amount of time and resources allocated for anatomy education. As the amount of dedicated anatomy education time decreases, more self-directed learning is required. Cadaveric dissection and didactic teaching have been supplemented with multimedia, clinical anatomy, and imaging for over 20 years, with mixed results. Specifically, the use of videobased anatomy teaching increases medical learning, if done methodically. METHODS: A 20-minute video was produced highlighting surgical anatomy using the following operative cases: perineal anatomy (artificial urinary sphincter case), inguinal and testicular anatomy (scrotal orchidopexy for acute testicular torsion), prostate anatomy (robotic radical prostatectomy), and bladder anatomy (endoscopy). The annotated video was shown to first-year medical students. Pre- and post-video multiple choice question quizzes were given to the students. Once submitted, the students completed a survey. RESULTS: Overall, 191 first-year medical students participated in our study. Average scores were similar between each quiz (50±16% vs. 49±17%) and there was no statistically significant change. Seventy-seven percent of participants felt the video improved their knowledge of urologic anatomy and 83% agreed the video should be shown to future classes. Sixty percent of participants felt the video solidified their anatomy knowledge, 78% felt the video was stimulating and entertaining, and 43% of the students felt the video increased their interest in pursuing urology as a career choice. CONCLUSIONS: Anatomy teaching can be supplemented using surgical videos, especially in a time when in-person anatomy teaching is limited. Further study is required to determine whether this teaching modality improves long-term anatomy knowledge retention.
  PubDate: 2024-05-21
  DOI: 10.5489/cuaj.8712
  Issue No: Vol. 18, No. 8 (2024)
Treatment modalities for small-sized urolithiases and their impact on
health-related quality of life
- Authors: Nick Lee, Patricia Nadeau, Mohamad Baker Berjaoui, Anis Assad, Ben Chew, Kate Penniston, Naeem Bhojani
  Pages: 280 - 7
  Abstract: INTRODUCTION: Health-related quality of life (HRQoL) is often reduced in patients with urolithiasis. The objective of this study was to perform a systematic review to describe impact on HRQoL based on different modalities of treatment for small urolithiases with a diameter smaller or equal to 10 mm. METHODS: Electronic databases were searched with no language or date restrictions to identify studies which were included if they reported: adult patients (≥18 years old), renal or ureteral stone(s) confirmed on imagery, validated reporting of HRQoL, stone diameter equal or smaller than 10 mm undergoing active surveillance, medical expulsive therapy (MET), shockwave lithotripsy (SWL), or ureteroscopy (URS). RESULTS: Of 672 citations, nine articles were eligible. Five studies (all ureteral) reported HRQoL according to medical stone management. Three of them found that HRQoL in MET patients was better than in active surveillance patients and two studies found no difference in HRQoL between MET and active surveillance groups. Four studies (three ureteral, one renal) reported HRQoL according to surgical stone management. Of the ureteral stone studies, two reported better HRQoL in URS patients than in SWL patients, while one study found no difference between URS and SWL groups. In the renal stone study, SWL patients had better HRQoL than URS patients. CONCLUSIONS: Patients with urinary stones 10 mm or smaller have better HRQoL when treated with MET vs. active surveillance, when treated with SWL vs. URS for renal stones, and when treated with URS vs. SWL for ureteral stones. There is an important need for more studies on this topic.
  PubDate: 2024-04-02
  DOI: 10.5489/cuaj.8698
  Issue No: Vol. 18, No. 8 (2024)

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