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OBJECTIVE: To explore the data comparing single- vs multi-use catheters for clean intermittent catheterisation (CIC), consider if the widespread use of single-use catheters is warranted given the cost and environmental impact, and put forth ideas for future consideration. METHODS: A primary literature review was performed in PubMed over the past 50 years. Studies that performed comparative analysis of single- and multi-use catheters were included in our review. All studies that reported on primary data were narratively summarised. RESULTS: A total of 11 studies were identified that reported on primary data comparing single- and multi-use catheters. There was no appreciable evidence suggesting reusable multi-use catheters were inferior to single-use catheters from an infection or usability standpoint. In addition, the environmental and monetary burden of single-use catheters is significant. CONCLUSIONS: The intermittent catheter landscape in the USA has a complex past: defined by policy, shaped by industry, yet characterised by a paucity of data demonstrating superiority of single-use over multi-use catheters. We believe that the aversion to reusable catheters by many patients and healthcare professionals is unwarranted, especially given the cost and environmental impact. Moving forward, better comparative data and more sustainable practices are needed.

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OBJECTIVE: To evaluate the cancer detection rate (CDR) between the 2 dominant spatial tracking methodologies in software-guided MRI-transrectal ultrasound fusion prostate biopsy (SGF-Bx) platforms: fixed-arm and free-hand. METHODS: We conducted a systematic review and meta-analysis on published primary analyses of prospective trials and cohort studies that enrolled biopsy-naïve patients for SFG-Bx. Inclusion criteria included the use of the Prostate Imaging Reporting & Data System (PI-RADS) v2.0 or later and the targeting of lesions graded as PI-RADS 3 or higher. Random effects models were used to assess the overall prostate cancer (PCa) CDR and the clinically significant prostate cancer (csPCa) CDR for both platforms. csPCa was standardized to a definition of Gleason Grade Group 2 or higher when possible. Subgroup analysis was performed by stratifying studies into the average number of cores taken per lesion. RESULTS: The PCa CDR was 0.674 for free-hand systems and 0.681 for fixed-arm systems. The csPCa CDR was 0.492 for free-hand systems and 0.500 for fixed-hand systems. There was no significant difference between free-hand and fixed-arm cancer detection rates for both overall PCa (P = .88) and csPCa (P = .90). Subgroup analyses revealed significant PCa CDR and csPCa CDR differences (P < .001) between free-hand and fixed-arm platforms only when 2 cores per lesion were taken, in favor of fixed-arm platforms. CONCLUSIONS: Fixed-arm platforms performed similarly in cancer detection to free-hand platforms but show a minor benefit on fewer samples. While tracking methodology differences appear subtle, further investigation into the clinical impact of platform-specific features are warranted.

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PURPOSE: Timely and appropriate discharge placement for patients who have undergone radical cystectomy (RC) remains challenging. Our objective was to improve the discharge planning process by creating a machine learning model that helps to predict the need for non-home hospital discharge to a higher level of care. MATERIALS AND METHODS: Patients undergoing elective radical cystectomy for bladder cancer from 2014-2019 were identified in the ACS-NSQIP database. A gradient boosted decision tree was trained on selected predischarge variables to predict discharge location, dichotomized into home and non-home. We used threshold-moving to calibrate model predictions and evaluated model performance on a testing set using receiver operating characteristic and precision recall curves. Model performance was further examined in subgroups of interest. RESULTS AND CONCLUSIONS: A total of 11,881 patients met inclusion criteria with a mean age of 68.6 years. 10.6% of patients undergoing RC had non-home discharges. Our model predicting non-home discharge achieved an area under the receiver operating characteristic curve of 0.80 and an average precision of 0.33. After threshold-moving, our model had a recall of 0.757 and a precision of 0.211. Top variables by importance were septic shock occurrence, ventilator-use greater than 48 hours, organ space surgical site infection and unplanned intubation. Our model shows strong performance in identifying patients who required non-home discharge to higher levels of care, outperforming commonly used clinical indices and prior work. Modern machine learning techniques may be applied to support more timely and appropriate clinical decision making.

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Smoking is a causal or contributory factor for nearly all genitourinary cancers and exerts significant influence on treatment, quality of life, and survival outcomes. In order to understand the influence smoking has on the outcomes of contemporary therapies, pertinent smoking-related data must be systematically collected and report. We sought to determine how often and how rigorously smoking status is collected and reported in publications of clinical trials in genitourinary cancers by conducting a systematic review. Our initial search yielded 622 articles, 354 of which met criteria. The vast majority of included studies (91.8%) did not report any details about trial participants' smoking status. When included, 96.3% of studies reported baseline status qualitatively. No studies used a validated measurement instrument or reported change in participants' smoking status over the study period. Absence of the collection and reporting of smoking-related data precludes further study of how smoking impacts outcomes and highlights an important deficiency in GU oncology clinical trial design.

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PURPOSE OF REVIEW: Developments in robotic reconstructive urology have introduced novel treatments for complex upper and lower urinary tract disease. Short-term and mid-term data demonstrates excellent outcomes and minimal morbidity, suggesting the advanced instrumentation and visualization of robotics represent a new treatment paradigm in patients that are historically difficult to treat. Here we review recent developments in the robotically assisted surgical management of urethral and ureteral strictures. RECENT FINDINGS: The minimally invasive approach, enhanced precision and reach, and near-infrared fluorescence imaging capabilities of robotic platforms have proven to be valuable additions in reconstructive urology where perfusion is often compromised, or anatomy is distorted. These benefits are leveraged heavily in recent descriptions of robotic-assisted posterior urethroplasty and ureteroplasty. Short-term to mid-term follow-up data for these procedures show excellent patency rates with low morbidity and complication rates when compared with open approaches. Long-term data for these procedures are not yet available. SUMMARY: The role of robotics in reconstructive urology is being actively investigated. Initial findings demonstrate excellent results with low morbidity in the treatment of upper and lower urinary tract disease. Long-term data will ultimately determine the role of robotics in the reconstructive armamentarium.

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PURPOSE: Smoking cessation after a urological cancer diagnosis significantly benefits patients. It is not well known how often patients quit after diagnosis or how urologists intervene to support patients' smoking cessation efforts. We examined rates of smoking cessation after diagnosis among patients with urological cancers, and assessed how often patients are given advice and support to quit smoking in the urology setting. MATERIALS AND METHODS: Following PRISMA guidelines, a systematic review was conducted of the available studies on smoking cessation after a urological cancer diagnosis during April 2020 by a trained medical librarian using the MEDLINE®, PsycInfo®, Embase® and Cochrane Central databases. Studies were included based on 3 independent reviews and if they met a priori inclusion/exclusion criteria. In total, 2,568 records were identified, 31 of which were included for final analysis. RESULTS: Four studies (587 patients) reported outcomes related to the prospective implementation of a smoking cessation program with patient-level quit rates ranging from 3.2% to 47.3%. A total of 21 studies (3,669 patients) reported outcomes of passive (no directed, active intervention) smoking cessation after the diagnosis of a urological cancer with widely varying quit rates. In general, the quality of included studies was poor. There was no standardization of the measurement or timing of outcomes, and few studies included validated survey instruments or biochemical confirmation of cessation. A total of 17 studies included data on whether patients received advice to quit smoking after diagnosis. The proportion of patients in each study who were told to quit ranged from 2.8% to 78.3%. CONCLUSIONS: There are few smoking cessation interventions that have been prospectively implemented and reported in the urology literature, and studies on quit rates after diagnosis are limited. The paucity of quality data and lack of smoking cessation interventions being used in routine urological oncology care underscores the need for more rigorous study and implementation of evidence-based practices in this area.

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OBJECTIVE: To describe attitudes, perceptions, and beliefs related to smoking and smoking cessation among survivors of genitourinary cancers using a theory-based framework. METHODS: We performed a cross-sectional analysis of Wave III of the PATH study, a prospective cohort survey study assessing tobacco-use patterns and attitudes among a representative population-based sample of US adults. All adult current smokers with a history of urologic cancer were included. Primary outcomes were mapped to components of the Theory of Planned Behavior (TPB) and included: attempts to quit, readiness to quit, plan to quit, being told to quit, peers views toward smoking, regret about smoking, the perceived relationship between smoking and cancer/overall health. Secondary outcomes include: time to first cigarette, utilization of smoking cessation aids. Population weighted percentages with 95% confidence intervals were estimated. RESULTS: Our cohort represents a population estimate of 461,182 adult current smokers with a history of genitourinary cancer. The majority of respondents (90%) perceived smoking to be harmful to one's health and 83% were regretful about having started smoking. An equal proportion of respondents indicated that they were "very ready to quit," "somewhat ready to quit," or "not ready to quit." Among all respondents, 73% had been told by a physician to quit in the past year but only 7% indicated that they had used prescription medication and only 21% had used nicotine replacement therapy to help with smoking cessation. CONCLUSION: There is significant variation in attitudes, behaviors, and perceptions related to smoking and smoking cessation among survivors of genitourinary malignancy. Patient-level smoking cessation interventions may need to be highly personalized for optimal success.

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Near-infrared (NIR) fluorescent nanostructured materials have emerged as novel contrast agents for non-invasive bioimaging. Here we report a class of polymer-silica nanoparticles doped with a NIR fluorescent dye prepared through a facile one-pot strategy. Hydrophobic NIR fluorescent dyes such as IR 780 iodide could be easily encapsulated into the micellar core by self-assembly of amphiphilic triblock copolymer Pluronic F127. When subsequently adding silane in aqueous solution, nanoparticles with a cross-linked core and a hydrophilic PEG shell were formed. The structure of the as-obtained nanoparticles was confirmed by transmission electron microscopy (TEM) and dynamic light scattering (DLS). The nanoparticles exhibited a well-defined spherical structure with a mean diameter of approximately 30 nm, and excellent monodispersity and stability in aqueous solution. In addition, the photo-stability of IR 780 was significantly improved by encapsulation into the nanoparticles. In vitro MTT assay with cell lines HEK293 and A431 demonstrated that the IR 780 loaded nanoparticles (termed as IR780@NPs) were biocompatible. In vivo sentinel lymph node imaging revealed that the fluorescent intensity and retention time of the IR780@NPs were clearly superior to its constituent free dye, making it amenable to in vivo bioimaging. Further in vivo tumor imaging indicated that IR780@NPs have a longer retention time and much higher accumulation on the tumor site compared to free dye after intravenous administration. Overall this hydrophilic NIR fluorescent contrast agent exhibits excellent photophysical characteristics and low cytotoxicity, and holds a strong promise for a variety of applications including bioimaging and therapy.