Have You Read?

By: Craig Niederberger, MD, FACS, College of Medicine and College of Engineering, University of Illinois at Chicago | Posted on: 09 Mar 2023

Sunaryo PL, May PC, Holt SK, Sorensen MD, Sweet RM, Harper JD. Ureteral strictures following ureteroscopy for kidney stone disease: a population-based assessment. J Urol. 2022;208(6):1268-1275.

Special thanks to Drs Ahmad Hefnawy and Omer Acar at the University of Illinois at Chicago.

Ureteroscopy is the most common procedure to treat renal and ureteral stones in the U.S., but we have lacked information about ureteral strictures following it on a large population level. These authors used the IBM MarketScan research database to study the outcomes of over 300,000 patients who underwent ureteroscopy or shock wave lithotripsy for treatment of upper tract stones between 2008 and 2019. Those receiving ureteroscopy or shock wave lithotripsy were nearly evenly split a bit under half and half, and about a tenth were treated with both.

Patients undergoing ureteroscopy alone or with shock wave lithotripsy had a near 3% rate of ureteric stricture, nearly twice that of those who had shock wave lithotripsy alone. Risk factors for stricture included concurrent kidney and ureteral stones, preoperative hydronephrosis, history of ureteroscopy and shock wave lithotripsy in the past year, and age. More than half of those who developed ureteral stricture following ureteroscopy or shock wave lithotripsy underwent a secondary procedure to manage stricture-related problems. Interestingly, during the decade studied, ureteroscopy to treat upper tract urolithiasis climbed from about 2 out of 5 to nearly 3 out of 5.

What do we do with this information? Ureteroscopy is obviously here to stay, but the prevalence and morbidity of ureteral stricture disease following it feels higher than anticipated. Let’s keep this in the back of our minds as we plan our approaches for upper tract stones and counsel our patients.

Mulloy E, Li S, Belladelli F, Del Giudice F, Glover F, Eisenberg ML. The risk of cardiovascular and cerebrovascular disease in men with a history of priapism. J Urol. 2023;209(1):253-260.

Special thanks to Drs Jason Huang and Mahmoud Mima at the University of Illinois at Chicago.

Erectile dysfunction has a well-established correlation with future cardiovascular disease and is a clear indicator of vascular health. But what about erections that last too long? Here for the first time investigators studied the association of priapism and the development of cardiovascular and other vascular diseases by applying advanced statistics to evaluate a cohort of over 10,000 men in a commercial insurance database.

Across the board compared to control groups men who had priapism had about a quarter higher risk of future cardiovascular disease, nearly a third higher risk of cerebrovascular disease, and about a quarter higher risk of other forms of heart disease. These conclusions were consistent throughout subgroup analyses, such as including only those with ischemic priapism or excluding patients with sickle cell disease. Recurrence of priapism was associated with increased risk of vascular diseases in a dose-dependent fashion, which further validates the association.

This first study of its kind is definitely thought provoking and begs for others to investigate it. If confirmed, recommendations of the American Urological Association and Sexual Medicine Society of North America guidelines for ischemic priapism could include evaluation for vascular disease as well.

Shee K, Washington SL III, Cowan JE, et al. Gleason grade 1 prostate cancer volume at biopsy is associated with upgrading but not adverse pathology or recurrence after radical prostatectomy: results from a large institutional cohort. J Urol. 2023;209(1):198-207.

Special thanks to Drs Marcin Zuberek and Simone Crivellaro at the University of Illinois at Chicago.

What is the real clinical significance of Gleason grade group 1 prostate cancer? Its management and guidelines have greatly evolved: once it was believed to be a malignancy that needed immediate treatment; now it can be watched over a period of time. Yet urologists and pathologists continue to struggle with sampling and diagnostic inadequacies that may leave clinically meaningful cancer behind. What happens to patients in whom clinically significant cancer is missed on the premise of being characterized as Gleason grade group 1? That’s the question these authors sought to answer.

In this retrospective study of over 1,000 patients with Gleason grade group 1 on initial biopsy, patients with 20% of positive cores or more were 1.31 times more likely to be upstaged to Gleason grade group 2 after radical prostatectomy. Yet despite the upstaging of pathology, there was no difference in the recurrence rate or adverse pathology.

The authors acknowledge several limitations to their study, namely its retrospective nature and lack of a uniform testing protocol. Still, these findings provide another important piece to the puzzle of Gleason grade group 1 prostate cancer. High-volume disease should prompt discussion with patients that there might be remaining undiscovered clinically significant cancer and consideration of more active surveillance, additional testing to further characterize the disease, or treatment.