Introduction: The accurate diagnosis of prostate cancer remains a clinical challenge, with both multiparametric magnetic resonance imaging (mpMRI) and 18F-prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) emerging as important imaging modalities. This meta-analysis aimed to compare the diagnostic performance of 18F-PSMA PET/CT vs. MRI for detecting prostate cancer. Methods: A comprehensive systematic review and meta-analysis was conducted following PRISMA guidelines. Multiple databases were searched through February 2025. Studies comparing 18F-PSMA PET/CT with MRI for prostate cancer diagnosis using histopathology as the reference standard were included. Random-effects models were used to pool sensitivity data, with heterogeneity assessed using I² statistics. Results: Six studies comprising 310 patients were included. The pooled sensitivity for MRI was 0.81 (95% confidence interval [CI] 0.08-0.99) with substantial heterogeneity (I²=93.8%). For 18F-PSMA PET/CT, the overall sensitivity was 0.50 (95% CI 0.12-0.87) with high heterogeneity (I²=96.0%). Subgroup analysis showed 18F-PSMA PET had a pooled sensitivity of 0.50 (95% CI 0.12-0.87), while MRI demonstrated 0.81 (95% CI 0.42-0.96). No significant publication bias was detected. Conclusions: Both imaging modalities showed variable diagnostic performance across studies. The combination of PSMA PET/CT and MRI may provide complementary information for optimal prostate cancer detection, although substantial heterogeneity suggests the need for standardized protocols and larger prospective trials.

Introduction: Genomic and immune analyses in sarcomatoid/rhabdoid renal cell carcinoma (S/R RCC) have been limited to bulk tumor analysis and thus lack cellular resolution and spatial perspective.Herein, we use in situ whole transcriptome profiling (WTP) to define molecular differences between tumor regions with and without S/R features, aiming to identify molecular markers of S/R tumors that could lead to better diagnosis or treatments.Methods: All patients who underwent surgical excision of RCC at the MUHC between 2010 and 2020 were screened by a uropathologist, and histologically defined regions of S/R, ccRCC, papillary, chromophobe RCC, and benign kidney were selected to construct tissue microarrays (TMAs).Whole-exome sequencing (WES) and Compartment-guided spatial WTP were applied for gene and transcriptome analysis.Results: Our cohort included 56 RCC patients and their TMAs, consisting of 403 cores representing patient-matched tumor areas with and without S/R features.For WES, 47 patients were used to identify copy number variations (CNVs) analysis.Four hundred cores of 55 patients were used for WTP and five groups of clustered with 2000 highly variable genes (HVGs) were constructed.The most variable genes of each tumor type were identified by using digital spatial transcriptome profiling.Whole-exome sequencing was used to identify mutational patterns of tumor cells using a list of specific genes of interest.Conclusions: According to current and ongoing results, WES and compartmentguided WTP should be used to generate an unprecedented resolution to the molecular and genomic characteristics of S/R RCC tumors and tumor microenvironment.

Introduction: Stress urinary incontinence (SUI) includes loss of urethral support and intrinsic sphincter deficiency (ISD).We aimed to enhance SUI by integrating intraurethral (IU) with intravaginal (IV) non-ablative Er: YAG laser therapy.The primary objective was to evaluate the safety of IU+IV laser therapy for SUI with ISD components and compare it to IV only and sham through six-and 12-month followups.The secondary objective was to assess the efficacy of the IU+IV and IV-only treatments compared to sham.Methods: Women with proven SUI with a degree of ISD were randomized into IU+IV laser treatment (n=20), IV laser treatment (n=20), and sham control (n=15).The sham subjects were offered the active treatment after a six-month followup.Subjects in both active groups were followed out to 12 months post-treatment.Tolerability and safety were assessed by VAS pain scale, recording of adverse events (AE), and measuring uroflow and post-void residual (PVR).Secondary effectiveness endpoints were assessed by 24-hour pad test, three-day voiding diary, and ICIQ-UI SF and PGI-I questionnaires. Results:We randomized 55 patients into three groups, and 53 patients completed the trial.Thirty-nine adverse events (AEs) were recorded in 23 patients.Seventeen of the 39 recorded AEs were probably related or related to the procedure.Mean (SD) duration of the AEs was 2.93 (3.2) days.The PVR results revealed no clinically meaningful differences between groups (p=0.49), the same as for voiding symptoms at six (p=0.19) or 12 months (p=0.76).At six-month and 12-month followup, >50% reduction of 24-hour pad weight was observed in 64.7% (55.6%) of patients in the IU+IV group, 36.8% (58.8%) in the IV group, and 33.3% in the sham group.The odds of observing a >50% reduction of 24-hour pad weight at six months increased by 246% in the IV+IU arm compared to IV (OR=3.46[0.89-14.9];p=0.08).Conclusions: The addition of the intraurethral treatment did not result in a higher incidence of AEs.In patients with a degree of ISD, combining intraurethral and intravaginal treatments may improve the efficacy of the laser procedure.Clinical studies with a higher number of patients should be performed to confirm the results.Funding: This trial was sponsored by Fotona d.o.o., manufacturer of the laser device used in the trial.

Introduction: Active surveillance (AS) is widely accepted as a treatment pathway for low-risk and favorable intermediate-risk localized prostate cancer.We aimed to report the long-term progression of patients on AS to treatment.Methods: In a retrospective cohort study performed at a single institution center, 2521 men with low or favorable intermediate-risk prostate cancer were managed with an active surveillance protocol from 2000-2023.Main outcomes measured were overall survival and time to treatment.Results: Of the patients enrolled, 620 (24.6%) entered treatment, 395 (15.7%) patients died, 34 (1.3%) had metastasis, and six (17.6% of those with metastasis) died with metastasis.By race, 2337 (92.7%) were White, 143 (5.7%) African-American, 20 (0.8%) American Indian/Alaskan, 14 (0.6%) Asian, and seven (0.2%) other.Median followup was four years and maximum followup time was 22.2 years.Median age of patients was 73.8 with a range of 43.8 to 98.1 years.At five, 10, and 15 years, 71.3%, 62.7%, and 52% of patients remained untreated and on AS.For patients with Gleason score (GS) 3+3=6 on AS at five and 10 years, 81.4% and 76.3% remained untreated.Similarly, patients with GS 3+4=7 demonstrated 41.5% and 27.4% untreated rates.Conclusions: To our knowledge, we report the largest AS cohort examining time to treatment.AS for favorable-risk prostate cancer seems safe and effective in the 10-year timespan.In our study, 24.6% of patients progressed to treatment and 1.3% of patient developed metastasis.Additionally, 0.2% of patients on AS died with metastasis.

Introduction: Extracorporeal shockwave lithotripsy (ESWL) is a common procedure for the management of renal stones and is usually performed using fluoroscopic (FS) guidance.The usage of ultrasound (US) guidance is emerging as an alternative with the benefit of minimizing exposure to radiation.We aimed to compare the efficacy and safety of US and FS-guided ESWL.Thus, stone-free rates (SFR) and overall complication rates were our primary outcomes, and secondary outcomes were re-intervention rates and individual complication rates, such as urinary tract infection (UTI).Methods: We conducted a systematic review with meta-analysis in adherence to PRISMA guidelines.Following Prospero protocol registration (CRD42024511335), we searched MEDLINE, EMBASE, Cochrane CENTRAL, and Web of Science from inception to February 15, 2024.The search was supplemented by snowballing techniques and a Google Scholar search for grey literature.Our search included adult and pediatric populations, and a separate subgroup analysis was conducted for each population.Results: Eleven studies were included yielding 2383 patients (US=1021, FS=1362), with eight studies (n=1737 patients) completing the adult subgroup, and three studies (n=646 patients) completing the pediatric subgroup.Patients treated with US had a 63% increased likelihood of achieving SFR status (OR=1.63;95% CI [1.23,2.16];P=0.0007,I 2 = 29%).Subgroup analysis demonstrated this difference to be only present in the adult subgroup.Complication rates were 64% less likely for adult patients exposed to US conditions (OR=0.36,95% CI [0.16,0.82],P=0.01,I 2 = 0%); however, no such difference was observed in pediatric samples.There was no difference in re-intervention rates and postoperative UTI in both ESWL approaches.Conclusions: Our analysis demonstrated that ultrasound guidance achieved superior ESWL outcomes in terms of SFR rates and complications compared to fluoroscopy-guided ESWL.However, this difference was only observed in the adult subgroup, which raises the question of age being a factor or whether there are other contributing factors.Our results should be interpreted with caution as the number of randomized controlled trials (RCTs) was limited, and heterogeneity existed between the studies.More research is needed, especially in pediatric populations, to further elucidate and confirm the benefits of US guidance in ESWL.

ccurate and readable patient information materials play a crucial role in healthcare. They serve as vital tools for bridging communication gaps, ensuring information about diagnoses, treatment options, and care plans is accessible and comprehensible. We are all aware of the diversity of medical/ scientific literacy of our patients, but this can be difficult to assess and appreciate in the moment during our (often) hectic clinic interactions. 1 By presenting medical information in a clear, straightforward manner, enduring material, like our Canadian Urological Association (CUA) patient information brochures, empower patients and their families to make informed decisions about their healthcare. This empowerment is particularly important in complex cases, where stakes are high and choices may have significant implications for quality of life. Furthermore, well-designed patient information brochures can enhance patient satisfaction, improve adherence to treatment plans, and ultimately contribute to better outcomes.

Gender inequality has been prevalent in the history of medicine, specifically within surgical specialties. Though there have been advances, urology has remained overwhelmingly male-dominant, with slow growth in female recruitment. This survey study evaluated whether gender-related differences in the perception of urology are present among future applicants that could account for gender disparity seen in recruitment. An anonymized, online survey was distributed to medical students enrolled at the Max Rady College of Medicine during the 2022-2023 semester. Attracting and deterring survey statements were created using current literature to guide topics of interest. Participants rated each statement using a five-point Likert scale with optional supplemental qualitative responses. Likert ratings were compared using a Mann-U-Whitney calculation between self-identifying male and female participants. We received 90 responses over six weeks, achieving a response rate of 23%. Female students, compared to their male peers, were deterred by factors such as working in a male-dominated specialty (p<0.001) and working with primarily male patients (p<0.001). There were no significant gender-related differences for statements pertaining to interest in surgery, work-life balance, or exposure to urology. In this survey study, the biggest deterrents reported by female medical students to entering urology were working in a male-dominated profession and seeing primarily male patients. There were no significant gender-related differences for questions relating to interest in surgery, work-life balance, and exposure to urology.