Sex Does Not Affect Survival: A Propensity Score-Matched Comparison in a Homogenous Contemporary Radical Cystectomy Cohort.

OBJECTIVES To determine whether biological sex affects oncological outcome after extended pelvic lymph node dissection, radical cystectomy, and urinary diversion for muscle-invasive bladder cancer, and to identify risk factors impacting outcome. PATIENTS AND METHODS We performed a single-center, retrospective observational cohort study with prospective data collection with a propensity score matched population. A total of 1165 consecutive patients from 2000 to 2020, (317 women and 848 men) scheduled for open extended pelvic lymph node dissection, radical cystectomy, and urinary diversion for urothelial bladder cancer were included in the final analysis. Overall Survival (OS), Cancer-Specific-Survival (CSS), and Recurrence-Free-survival (RFS) were assessed with multivariable weighted Cox regression analysis as well as with propensity score matched Cox-Regression. RESULTS No significant difference was found between sexes regarding OS (HR 1.18, [0.93-1.49], P = .16), CSS (HR 0.87, [0.64-1.18], P = .38), or RFS (HR 0.80, [0.59-1.07], P = .13). These results were confirmed after propensity score matching: female sex was not associated with inferior OS (HR 1.20, [0.91-1.60], P = .19), CSS (HR 1.01, [0.75-1.35], P = .97) or RFS (HR 0.98, [0.75-1.27], P = .86). CONCLUSIONS We did not find a significant difference in cancer-related outcomes or overall survival after extended pelvic lymph node dissection, open radical cystectomy, and urinary diversion for urothelial cancer between males and females even after adjustment with propensity matching score for multiple factors including oncological parameters, smoking status, and renal function

Quantitative evaluation of encrustations in double-J ureteral stents with micro-computed tomography and semantic segmentation

Accurate evaluation of stent encrustation patterns, such as volume distribution, from different patient groups are valuable for clinical management and the development of better stents. This study quantitatively compares stent encrustation patterns from stone and kidney transplant patients. Twenty-seven double-J ureteral stents were collected from patients with stone disease or who underwent kidney transplantation. Encrustations on stent samples were quantified by means of micro−Computed Tomography and semantic segmentation using a Convolutional Neural Network model. Luminal encrustation volume per stent unit was derived to represent encrustation level, which did not differ between patient groups in the first six weeks. However, stone patients showed higher encrustation levels over prolonged indwelling times (p = 0.02). Along the stent shaft body, the stone group showed higher encrustation levels near the ureteropelvic junction compared to the ureterovesical junction (p = 0.013), whereas the transplant group showed no such difference. Possible explanations were discussed regarding vesicoureteral reflux. In both patient groups, stent pigtails were more susceptible to encrustations, and no difference between renal and bladder pigtail was identified. The segmentation method presented in this study is also applicable to other image analysis tasks in urology

Bone and Mineral Metabolism in Children with Nephropathic Cystinosis Compared with other CKD Entities

Context: Children with nephropathic cystinosis (NC) show persistent hypophosphatemia, due to Fanconi syndrome, as well as mineral and bone disorders related to chronic kidney disease (CKD); however, systematic analyses are lacking. Objective: To compare biochemical parameters of bone and mineral metabolism between children with NC and controls across all stages of CKD. Design: Cross-sectional multicenter study. Setting: Hospital clinics. Patients: Forty-nine children with NC, 80 CKD controls of the same age and CKD stage. Main outcome measures: Fibroblast growth factor 23 (FGF23), soluble Klotho, bone alkaline phosphatase (BAP), tartrate-resistant acid phosphatase 5b (TRAP5b), sclerostin, osteoprotegerin (OPG), biochemical parameters related to mineral metabolism, and skeletal comorbidity. Results: Despite Fanconi syndrome medication, NC patients showed an 11-fold increased risk of short stature, bone deformities, and/or requirement for skeletal surgery compared with CKD controls. This was associated with a higher frequency of risk factors such as hypophosphatemia, hypocalcemia, low parathyroid hormone (PTH), metabolic acidosis, and a specific CKD stage-dependent pattern of bone marker alterations. Pretransplant NC patients in mild to moderate CKD showed a delayed increase or lacked an increase in FGF23 and sclerostin, and increased BAP, TRAP5b, and OPG concentrations compared with CKD controls. Post-transplant, BAP and OPG returned to normal, TRAP5b further increased, whereas FGF23 and PTH were less elevated compared with CKD controls and associated with higher serum phosphate. Conclusions: Patients with NC show more severe skeletal comorbidity associated with distinct CKD stage-dependent alterations of bone metabolism than CKD controls, suggesting impaired mineralization and increased bone resorption, which is only partially normalized after renal transplantation