Summary Objective To evaluate predictors of understaging in patients with presumed non-muscle invasive bladder cancer (NMIBC) identified on transurethral resection of bladder tumor (TURBT) who underwent radical cystectomy (RC) with attention to the role of a restaging TURBT. Materials and Methods We retrospectively evaluated 279 consecutive patients with clinically staged T1 (cT1) disease following TURBT who underwent RC at our institution from April 2000 to July 2011. 60 of these cT1 patients had undergone a restaging TURBT prior to RC. The primary outcome measure was pathological staging of T2 or greater disease at the time of RC. Results 134 (48.0%) patients were understaged. Of the 60 patients who remained cT1 after a restaging TURBT, 28 (46.7%) were understaged. Solitary tumor (OR 0.43, 95% CI 0.25–0.76, p = 0.004) and fewer prior TURBTs (OR 0.84, 95% CI 0.71–1.00, p = 0.05) were independent risk factors for understaging. Conclusions Despite the overall improvement in staging accuracy linked to restaging TURBTs, the risk of clinical understaging remains high in restaged patients found to have persistent T1 urothelial carcinoma who undergo RC. Solitary tumor and fewer prior TURBTs are independent risk factors for being understaged. Incorporating these predictors into preoperative risk stratification may allow for augmented identification of those patients with clinical NMIBC who stand to benefit most from RC.

Purpose-To determine whether race, gender, and number of bladder cancer risk factors are significant predictors of hematuria evaluation.Methods-We used self-reported data from the Southern Community Cohort Study linked to Medicare claims data. Evaluation of subjects diagnosed with incident hematuria was considered complete if both imaging and cystoscopy were performed within 180 days of diagnosis. Exposures of interest were race, gender, and risk factors for bladder cancer.Results-Among 1412 patients, evaluation was complete in 261 (18%). In our adjusted analyses, black patients were less likely than white patients to undergo any aspect of evaluation: urology referral (OR 0.72; 95%CI 0.56, 0.93), cystoscopy (OR 0.67; 95%CI 0.50, 0.89) and imaging (OR 0.75; 95%CI 0.59, 0.95). Women were less likely than men to be referred to a urologist (OR 0.59; 95%CI 0.46, 0.76). And although all patients with 2-3 risk factors had 31% higher odds of urology referral (OR 1.31; 95%CI 1.02, 1.69), adjusted analyses indicated that effect was only apparent among men.Conclusions-Only 18% of incident hematuria diagnoses had a complete hematuria evaluation. Gender had a substantial effect on referral to urology when controlling for socioeconomic factors but otherwise had an unclear role on quality of evaluation. Black patients had markedly lower rates of thorough evaluation than white patients. Number of risk factors predicted referral to urology among men but was otherwise a poor predictor of evaluation. There is opportunity for improvement by increasing the completion of hematuria evaluations, particularly in high-risk and vulnerable patients. KeywordsUrinary bladder neoplasm; hematuria; cystoscopy; outcome and process assessment (healthcare); urinary bladder HHS Public Access

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Purpose To determine whether bladder neck size is associated with incontinence scores after robot-assisted laparoscopic radical prostatectomy (RALP). Materials and Methods Consecutive eligible patients undergoing RALP between July 19 and December 28, 2016, were enrolled into a prospective, longitudinal, observational cohort study. The primary outcome was patient-reported urinary incontinence on the Expanded Prostate Cancer Index Composite (EPIC) scale 6 and 12 weeks post surgery. The relationship between EPIC score for urinary incontinence and bladder neck size was evaluated using multiple regression. Predicted EPIC scores for incontinence were displayed graphically after using restricted cubic splines to model bladder neck size. Results In all, 107 patients were enrolled; response rates were 98% and 87% at 6 and 12 weeks, respectively. At 6 and 12 weeks, bladder neck size was not significantly associated with incontinence scores. Comparing the 90th percentile for bladder neck size (18 mm) with the 10th percentile (7 mm) revealed no significant difference in the adjusted EPIC scores for incontinence at 6 weeks (β coefficient, 0.88; 95% CI, −10.92–12.68; P=.88) and at 12 weeks (5.80; 95% CI, −7.36–18.97; P=.39). Conclusions These findings question the merit of creating an extremely small bladder neck during RALP. We contend that doing so increases the risk of positive margins at the bladder neck without facilitating early recovery of continence.

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Renal and ureteral stone treatment has evolved from an open operation to being entirely endoscopic. Since the inception of the natural orifice treatment of stones, there have been many more advancements in multiple aspects of the case, including smaller scopes, higher-resolution imaging, and more powerful lasers. This technological evolution in ureteroscopic stone treatment has broadened its indication as a first-line therapy by helping to attenuate the learning curve and expedite stone fragmentation and extraction. This overview includes the evolution of ureteroscopic stone treatment; however, the majority is dedicated to reviewing equipment and operative techniques pertaining to ureteroscopic stone treatment of upper tract stones. This review contains 10 highly rendered figures, 5 tables, and 43 references Key words: holmium laser, kidney, lithotripsy, nephrolithiasis, ureter, ureteral stent, ureteroscopy