Budgetary Impact of Including the Urinary Genomic Marker Cxbladder Detect in the Evaluation of Microhematuria Patients.

INTRODUCTION: Current AUA guidelines mandate a risk-stratified approach for the evaluation of microhematuria. Urine genomic tests with high negative predictive value could further reduce unnecessary diagnostic testing and morbidity, but the economic impact is unknown. This study modeled the financial impact of Cxbladder Detect on microhematuria evaluations. METHODS: A decision tree analysis was constructed by Coreva Scientific comparing 1-year costs of the standard microhematuria evaluation using the AUA guidelines vs an algorithm incorporating Cxbladder Detect. Cxbladder Detect-positive patients had cystoscopy and imaging, whereas patients with negative tests were reevaluated in 6 months. Patients with positive diagnostic testing underwent cystoscopy, and positive cystoscopies led to transurethral resection of bladder tumor. Test performance was based on published literature, and costs were based on Medicare allowable fees. RESULTS: Using the decision tree model, the average savings of using Cxbladder Detect was $559 compared with the standard of care, with an average reduction of 0.38 procedures per patient. Probabilistic analysis showed statistical significance with a median reduction in the total cost of $498 per patient (95% CrI [-1356, -2]) and a significant median reduction in diagnostic procedures per patient of 0.36 (95% CrI [-0.52, -0.16]) without impact on the number of cancers diagnosed. CONCLUSIONS: This model-based study demonstrates the potential economic value of using a Cxbladder-driven protocol for microhematuria evaluations.

Digital Identity in Academic Urology: Assessment of Female Pelvic Medicine and Reconstructive Surgery, and Opportunity for Improvement.

INTRODUCTION: We describe the digital identity of academic urologists in FPMRS (Female Pelvic Medicine and Reconstructive Surgery) by assessing their visible online information. METHODS: A Google™ search of SUFU (Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction) board members, past presidents and fellowship directors was completed. Hits on the first page of results were categorized as institutional page, group/society page, ratings site, interview/multimedia, journal article or book, social media, professional profile or another person. Sites were subclassified as physician controllable content or not controllable. Descriptive statistics, comparisons among SUFU roles and site type associations were calculated. RESULTS: First page results contained a median (Q1-Q3) of 11 (10-11) hits with 2 (2-3) institutional pages and 1 (1-2) group/society. Ratings sites were frequent returns, with 4 hits (3-5) in 98% of searches (60). Only 1 (1-1) social media, 1 (1-2) professional profile and 1 (1-2) interview/multimedia hits occurred. Overall 6 (5-7) sites were physician controllable content with all but 1 physician having at least 1 such result. Institutional (correlation coefficient -0.38, p = 0.001) or group/society (-0.34, p = 0.023) pages were associated with fewer ratings sites. Group/society pages were 3.41 times more prevalent (mean 11.7% vs 3.44%, p = 0.009) among SUFU board members, while past presidents had 3.03 (6.8% vs 2.3%, p = 0.046) times more journal articles or books and fellowship directors had 1.43 (25.6% vs 18.6%, p = 0.021) times more institutional pages. CONCLUSIONS: For active SUFU members ratings sites comprise a substantial portion of their search results. More online engagement or social media use could increase the visibility of physician controllable content in their digital identities.

Preliminary assessment of safety and efficacy in proof-of-concept, randomized clinical trial of tanezumab for chronic prostatitis/chronic pelvic pain syndrome.

OBJECTIVE: To assess the efficacy and safety of tanezumab, a humanized monoclonal antibody directed against the pain-mediating neurotrophin, nerve growth factor, to treat pain and other symptoms of chronic prostatitis/chronic pelvic pain syndrome in a Phase IIa, proof-of-concept clinical trial powered to provide 2-sided 90% confidence interval around the primary endpoint. METHODS: Patients received a single intravenous dose of tanezumab (20 mg) or placebo. The primary efficacy endpoint was the change from baseline to week 6 in average daily numerical rating scale pain score. The secondary endpoints included the change from baseline to week 6 in the National Institutes of Health Chronic Prostatitis Symptom Index and urinary symptoms. Safety was also assessed. RESULTS: Overall, 62 patients were randomized (30 to tanezumab and 32 to placebo). At week 6, tanezumab marginally improved the average daily pain (least-squares mean difference from placebo -0.47, 90% confidence interval -1.150-0.209) and urgency episode frequency (least-squares mean difference from placebo -1.37, 90% confidence interval -3.146-0.401). No difference was seen in the National Institutes of Health chronic prostatitis symptom index total score or micturition frequency at week 6. The most common adverse events were paresthesia and arthralgia. The odds of having a ≥ 30% reduction in pain were 1.75-fold greater (90% confidence interval 0.65-4.69) for patients receiving tanezumab versus placebo. CONCLUSION: Tanezumab might improve symptoms for some patients with chronic prostatitis/chronic pelvic pain syndrome. Although proof of concept was not demonstrated in the present study, additional studies with larger populations and stricter inclusion criteria according to patient phenotype might identify populations in which antinerve growth factor treatment will provide clinical benefit.