The History of Urological Care and Training at Thomas Jefferson University

The Department of Urology at Thomas Jefferson University and Thomas Jefferson University Hospital is generally acknowledged as the oldest formal Department of Urology in the US, formally designated as the Department of Genitourinary Surgery in 1904. The Department has been under the direction of 8 chairmen and has trained over 144 residents and 25 fellows with over 200 Jefferson Medical College graduates specializing in urology. Thomas Jefferson University was originally founded as Jefferson Medical College in 1824. Dr. George McClelland petitioned Jefferson College at Cannonsburg (now Washington and Jefferson College) to add a medical school to their institution. While technically part of Jefferson College in western Pennsylvania, Jefferson Medical College was to be located in Philadelphia under the direction of the medical faculty. By 1838, Jefferson Medical College gained its own charter and was no longer affiliated with Jefferson College. As a proprietary school, the faculty administrated and managed all the finances of the school. This included the sale of “tickets” to attend lectures. An infirmary to treat the poor was established in 1825. This dispensary to treat indigent patients under student observation was the first instituted by any medical school in the United States. Eventually, all medical schools in the United States adopted Jefferson’s example of combining lectures with practical patient experience. In 1969 Thomas Jefferson University was established that incorporated Jefferson Medical College, the College of Allied Health Sciences, the College of Graduate Studies and the Jefferson Medical College Hospital

Stent vs. Stent-less Ileal Conduits After Radical Cystectomies: Is There Difference In Early Postoperative Outcomes?

Placing ureteral stents at the ureteroileal anastomosis for radical cystectomy with ileal conduit (RCIC) diversion has long been common practice, which has recently been called into question. In this study, we aim to investigate the difference in 30-day outcomes between patients who did and did not receive ureteral stents after RCIC.https://jdc.jefferson.edu/urologyfposters/1003/thumbnail.jp

PARP-1 regulates DNA repair factor availability.

PARP-1 holds major functions on chromatin, DNA damage repair and transcriptional regulation, both of which are relevant in the context of cancer. Here, unbiased transcriptional profiling revealed the downstream transcriptional profile of PARP-1 enzymatic activity. Further investigation of the PARP-1-regulated transcriptome and secondary strategies for assessing PARP-1 activity in patient tissues revealed that PARP-1 activity was unexpectedly enriched as a function of disease progression and was associated with poor outcome independent of DNA double-strand breaks, suggesting that enhanced PARP-1 activity may promote aggressive phenotypes. Mechanistic investigation revealed that active PARP-1 served to enhance E2F1 transcription factor activity, and specifically promoted E2F1-mediated induction of DNA repair factors involved in homologous recombination (HR). Conversely, PARP-1 inhibition reduced HR factor availability and thus acted to induce or enhance BRCA-ness . These observations bring new understanding of PARP-1 function in cancer and have significant ramifications on predicting PARP-1 inhibitor function in the clinical setting

Current prostate cancer treatments: effect on quality of life.

Patients with prostate cancer (PCa) are presented with multiple therapeutic options. However, the evidence supporting a survival benefit with current PCa therapies is often limited and data directly comparing the available options are lacking. Although dramatic improvements have been made in the treatment methods available for PCa and there has been a decline in death rates for the disease, each active intervention has potential side effects and long-term complications that can adversely affect quality of life (QOL). The cancer diagnosis and management strategies can also negatively affect the QOL of patients and their families. The healthcare costs associated with cancer treatment are another factor to consider. When determining treatment options, patients and physicians should consider the efficacy of the therapy, as well as the safety, effect on QOL, and cost. As a part of a risk reduction strategy, effective screening programs, along with possible therapeutic agents, could have a positive effect on QOL and offer a preemptive benefit to patients at increased risk of PCa

Application of Alvimopan as a Component of Enhanced Recovery After Surgery (ERAS) Protocol for Patients Undergoing Radical Cystectomy and Diversion (C&D)

Introduction Radical cystectomy with urinary diversion (C&D) is performed for patients with muscle-invasive bladder cancer (MIBC) or refractory carcinoma in situ (CIS) C&D patients receive one of several types of diversion depending on their age, comorbidities, functional status, and extent of disease (Figure 1) Post-operative length of stay (LOS) can be prolonged (9-11 days) and 30 day readmission rates and mortality elevated (30% and 1.5%); return of bowel function usually the rate-limiting step to discharge Enhanced Recovery After Surgery (ERAS) protocols utilize pre-, intra-, and postoperative elements in order to improve return of bowel function and decrease LOS Alvimopan is a μ-opioid receptor antagonist commonly included in ERAS, and limits deleterious effects of narcotics on the GI system The goal of this analysis was to determine the effect of Alvimopan on post-operative LOS and 30 day readmission in patients undergoing C&Dhttps://jdc.jefferson.edu/patientsafetyposters/1131/thumbnail.jp

Pretest Genetic Education Video Versus Genetic Counseling for Men Considering Prostate Cancer Germline Testing: A Patient-Choice Study to Address Urgent Practice Needs.

PURPOSE: Germline testing (GT) for prostate cancer (PCA) is now central to treatment and hereditary cancer assessment. With rising demand for and shortage of genetic counseling (GC), tools to deliver pretest informed consent across practice settings are needed to improve access to GT and precision care. Here, we report on Evaluation and Management for Prostate Oncology, Wellness, and Risk (EMPOWER), a patient-choice study for pretest video-based genetic education (VBGE) versus GC to inform urgent practice needs. PATIENTS AND METHODS: Men with PCA or at risk for PCA (family history of PCA) were eligible and could choose pretest VBGE or GC. Outcomes included decisional conflict for GT, change in genetics knowledge, satisfaction, and intention to share results with family and/or providers. Descriptive statistics summarized results with counts and percentages for categorical variables and mean ± standard deviation for continuous variables. Data were compared with Fisher\u27s exact, chi-squared, or Wilcoxon two-sample tests. Mean change in genetics knowledge was compared with RESULTS: Data on the first 127 participants were analyzed. Characteristics were White (85.8%), bachelor\u27s degree (66.9%), and PCA diagnosis (90.6%). The majority chose VBGE (71%) versus GC (29%; CONCLUSION: A substantial proportion of men opted for pretest VBGE, with comparable patient-reported outcomes and uptake of GT. The results support the use of pretest video to address the critical GC shortage in the precision era

Implementation of Germline Testing for Prostate Cancer: Philadelphia Prostate Cancer Consensus Conference 2019

PURPOSE: Germline testing (GT) is a central feature of prostate cancer (PCA) treatment, management, and hereditary cancer assessment. Critical needs include optimized multigene testing strategies that incorporate evolving genetic data, consistency in GT indications and management, and alternate genetic evaluation models that address the rising demand for genetic services. METHODS: A multidisciplinary consensus conference that included experts, stakeholders, and national organization leaders was convened in response to current practice challenges and to develop a genetic implementation framework. Evidence review informed questions using the modified Delphi model. The final framework included criteria with strong (\u3e 75%) agreement (Recommend) or moderate (50% to 74%) agreement (Consider). RESULTS: Large germline panels and somatic testing were recommended for metastatic PCA. Reflex testing-initial testing of priority genes followed by expanded testing-was suggested for multiple scenarios. Metastatic disease or family history suggestive of hereditary PCA was recommended for GT. Additional family history and pathologic criteria garnered moderate consensus. Priority genes to test for metastatic disease treatment included BRCA2, BRCA1, and mismatch repair genes, with broader testing, such as ATM, for clinical trial eligibility. BRCA2 was recommended for active surveillance discussions. Screening starting at age 40 years or 10 years before the youngest PCA diagnosis in a family was recommended for BRCA2 carriers, with consideration in HOXB13, BRCA1, ATM, and mismatch repair carriers. Collaborative (point-of-care) evaluation models between health care and genetic providers was endorsed to address the genetic counseling shortage. The genetic evaluation framework included optimal pretest informed consent, post-test discussion, cascade testing, and technology-based approaches. CONCLUSION: This multidisciplinary, consensus-driven PCA genetic implementation framework provides novel guidance to clinicians and patients tailored to the precision era. Multiple research, education, and policy needs remain of importance