The coronavirus disease 2019 (COVID-19) pandemic has put a substantial burden on the Italian healthcare system, resulting in the restructuring of hospitals to care for CO-VID-19 patients. However, this has likely impacted access to care for patients experiencing other conditions. We aimed to quantify the impact of COVID-19 on access to care for patients with urgent/emergent urological conditions throughout Italy. Materials and Methods: A questionnaire was sent to 33 urological units in the AGILE consortium, asking clinicians to report on the number of urgent/emergent urological patients seen and/or undergoing surgery over a 3-week period during the peak of the COVID-19 outbreak and a reference week prior to the outbreak. ANOVA and linear regression models were used to quantify these changes. Results: Data from 27 urological centres in Italy showed a decrease from 956 patients/week seen just prior to the outbreak to 291 patients/week seen by the end of the study period. There was a difference in the number of patients with urgent/emergent urological disease seen within/during the different weeks (all p values < 0.05). A significant decrease in the number of patients presenting with haematuria, urinary retention, urinary tract infection, scrotal pain, renal colic, or trauma and urgent/emergent cases that required surgery was reported (all p values < 0.05). Conclusion: In Italy, during the COVID-19 outbreak there has been a decrease in patients seeking help for urgent/emergent urological conditions. Restructuring of hospitals and clinics is mandatory to cope with the COVID-19 pandemic; however, the healthcare system should continue to provide adequate levels of care also to patients with other conditions.

IMPORTANCEThe US Preventive Services Task Force (USPSTF) has recommended against routine prostate-specific antigen (PSA)-based prostate cancer (PCa) screening, initially for men older than 75 years in 2008, and then for all men in 2012. Concern has been raised that, by recommending against screening, and thus early detection, the USPSTF recommendations may be associated with an increase in the incidence of metastatic PCa (mPCa). OBJECTIVE To explore the incidence of mPCa before and after the USPSTF recommendations against routine PCa screening. DESIGN, SETTING, AND PARTICIPANTSThis population-based cohort study used the recently released Surveillance, Epidemiology, and End Results (SEER) 18 registry incidence data to identify men aged 45 years and older with a diagnosis

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A B FIGURE 1. Citations of postoperative (A) and intraoperative (B) adverse event classifications systems over the last decade. Web of Science citation search (09/2021) comparing the usage of standardized postoperative and intraoperative events in clinical studies. The Clavien-Dindo classification system is cited in clinical research trials at approximately 270-times the rate of all intraoperative event classification systems combined

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-naïve 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.

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INTRODUCTION AND OBJECTIVES: 21 years ago the Institute of Medicine articulated a vision of a learning healthcare system based on electronic health records (EHRs). Building on federal investment in EHRs and policy reform linking payment to quality, the American Urological Association invested in a platform to aggregate clinical data from EHRs for quality measurement and reporting. The resulting AQUA Registry is a Qualified Clinical Data Repository (QCDR) that can report quality measures to the Centers for Medicare and Medicaid Services (CMS). We describe AQUA participants and report early trends in quality scores reported to CMS through AQUA.METHODS: This is a retrospective analysis of AQUA participation from 2014-2016. We compared characteristics of urologists and practices participating in AQUA to those of the broader urologist population as reported in the 2016 AUA Census. We assessed the impact of AQUA participation on quality of care by comparing measure pass rates pre and post participation. To ensure data validity we limited our analysis to measures reported to CMS, with a denominator 10, and from practices with 180 days of participation. To evaluate the trend before and after joining AQUA, we fit a univariate linear spline regression with a knot at time 0.RESULTS: Participation in AQUA increased rapidly during the first full 3 years of operation and now includes over 125 practices and 1148 urologists (9.4%). 97.6% of AQUA participants are in private practice, 1.9% are in academic practice, and 0.5% are employed by private or public hospitals, compared with 59.1%, 25.5% and 11.2% respectively among urologists nationally. 95.9% of AQUA participants live in metropolitan areas compared with 89.9% of urologists nationally, and they are 4 years younger. Participation is distributed across regions and states. 17 quality measures were reported to CMS through AQUA, 4 of which were urology specific and 13 of which were cross-cutting measures. Figure 1 shows the mean pass rate on each of the 4 urologic measures before and after participation in AQUA.CONCLUSIONS: Early participants in the AQUA registry were mostly community practitioners in metropolitan areas. 3 of 4 urologic measures examined showed improvement and 1 showed no change, suggesting that measuring care facilitated gains in measurement and possibly quality.

We compared perioperative outcomes after on-clamp versus off-clamp robot-assisted partial nephrectomy (RAPN) for >7 cm renal masses. A multicenter dataset was queried for patients who had undergone RAPN for a cT2cN0cM0 kidney tumor from July 2007 to February 2022. The Trifecta achievement (negative surgical margins, no severe complications, and ≤ 30% postoperative estimated glomerular filtration rate (eGFR) reduction) was considered a surrogate of surgical quality. Overall, 316 cases were included in the analysis, and 58% achieved the Trifecta. A propensity-score-matched analysis generated two cohorts of 89 patients homogeneous for age, ASA score, preoperative eGFR, and RENAL score (all p > 0.21). Compared to the on-clamp approach, OT was significantly shorter in the off-clamp group (80 vs. 190 min; p < 0.001), the incidence of sRFD was lower (22% vs. 40%; p = 0.01), and the Trifecta rate higher (66% vs. 46%; p = 0.01). In a crude analysis, >20 min of hilar clamping was associated with a significantly higher risk of sRFD (OR: 2.30; 95%CI: 1.13–4.64; p = 0.02) and with reduced probabilities of achieving the Trifecta (OR: 0.46; 95%CI: 0.27–0.79; p = 0.004). Purely off-clamp RAPN seems to be a safe and viable option to treat cT2 renal masses and may outperform the on-clamp approach regarding perioperative surgical outcomes.