Validez diagnóstica del sistema vesical imaging-reporting and data system (VI-RADS): estudio con datos de la vida real / Diagnostic validity of the vesical imaging-reporting and data system (VI-RADS): A real-world study

Objetivo: Recientemente se ha generalizado el uso del sistema vesical imaging-reporting and data (VI-RADS). Nos propusimos validar el rendimiento diagnóstico del VI-RADS para diferenciar el cáncer vesical músculo-iinvasivo (CVMI) del cáncer vesical no músculo-invasivo (CVNMI) en un contexto de práctica clínica real. Métodos Entre diciembre de 2019 y febrero de 2022 se revisaron los pacientes con sospecha de cáncer vesical primario. Se incluyeron los pacientes con un protocolo de RM multiparamétrica adecuado para VI-RADS antes de cualquier tratamiento invasivo. La estadificación local de los pacientes se realizó mediante resección transuretral, segunda resección o cistectomía radical como tratamiento de referencia. Dos expertos en radiología genitourinaria cegados a los datos clínicos e histopatológicos evaluaron las imágenes de RM multiparamétrica de forma independiente y retrospectiva. Se analizó el rendimiento diagnóstico de ambos radiólogos y la concordancia entre lectores. Resultados De los 96 pacientes, 20 (20,8%) tenían CVMI y 76 (79,2%) tenían CVNMI. La exactitud diagnóstica del CVMI fue alta para los dos radiólogos. El primer radiólogo tenía un área bajo la curva (ABC) de 0,83 y 0,84, una sensibilidad de 85% y 80% y una especificidad de 80,3% y 88,2% para VI-RADS≥3 y≥4, respectivamente. El segundo radiólogo tenía un área bajo la curva (ABC) de 0,79 y 0,77, una sensibilidad del 85% y el 65% y una especificidad del 73,7% y el 89,5% para VI-RADS≥3 y≥4, respectivamente. La concordancia de la puntuación VI-RADS global entre los dos radiólogos fue moderada (K=0,45). Conclusión El sistema VI-RADS tiene un alto poder diagnóstico para diferenciar el CVMI de CVNMI antes de la resección transuretral. La concordancia entre los radiólogos es moderada. (AU)

Objective: Preoperative Vesical Imaging-Reporting and Data System (VI-RADS) becomes widespread. We aimed to validate the diagnostic performance of VI-RADS in differentiating muscle-invasive (MIBC) from non-muscle-invasive bladder cancer (NMIBC) in a real-world setting. Methods Between December 2019 and February 2022 suspected primary bladder cancer patients were reviewed. Those with proper multiparametric MRI (mpMRI) protocol for VI-RADS before any invasive treatment were included. Patients were locally staged according to transurethral resection, second resection, or radical cystectomy as the reference standard. Two experienced genitourinary radiologists who were blinded to clinical and histopathological data evaluated the mpMRI images independently and retrospectively. The diagnostic performance of both radiologists and the interreader agreement were analyzed. Results Among 96 patients, 20 (20.8%) had MIBC, and 76 (79.2%) had NMIBC. Both radiologists had great diagnostic performance in diagnosing MIBC. The first radiologist had an area under curve (AUC) of 0.83 and 0.84, the sensitivity of 85% and 80%, and the specificity of 80.3% and 88.2% for VI-RADS≥3 and≥4, respectively. The second radiologist had an area under curve (AUC) of 0.79 and 0.77, the sensitivity of 85% and 65%, and the specificity of 73.7% and 89.5% for VI-RADS≥3 and≥4, respectively. The overall VI-RADS score agreement between the two radiologists was moderate (K=0.45). Conclusion VI-RADS is diagnostically powerful in differentiating MIBC from NMBIC prior to transurethral resection. The agreement between radiologists is moderate. (AU)

Diagnostic validity of the vesical imaging-reporting and data system (VI-RADS): a real-world study.

OBJECTIVES: Preoperative Vesical Imaging-Reporting and Data System (VI-RADS) becomes widespread. We aimed to validate the diagnostic performance of VI-RADS in differentiating muscle-invasive (MIBC) from non-muscle-invasive bladder cancer (NMIBC) in a real-world setting. METHODS: Between December 2019 and February 2022 suspected primary bladder cancer patients were reviewed. Those with proper multiparametric MRI (mpMRI) protocol for VI-RADS before any invasive treatment were included. Patients were locally staged according to transurethral resection, second resection, or radical cystectomy as the reference standard. Two experienced genitourinary radiologists who were blinded to clinical and histopathological data evaluated the mpMRI images independently and retrospectively. The diagnostic performance of both radiologists and the interreader agreement were analyzed. RESULTS: Among 96 patients, 20 (20.8%) had MIBC, and 76 (79.2%) had NMIBC. Both radiologists had great diagnostic performance in diagnosing MIBC. The first radiologist had an area under curve (AUC) of 0.83 and 0.84, the sensitivity of 85% and 80%, and the specificity of 80.3% and 88.2% for VI-RADS ≥3 and ≥4, respectively. The second radiologist had an area under curve (AUC) of 0.79 and 0.77, the sensitivity of 85% and 65%, and the specificity of 73.7% and 89.5% for VI-RADS ≥3 and ≥4, respectively. The overall VI-RADS score agreement between the two radiologists was moderate (κ = 0.45). CONCLUSION: VI-RADS is diagnostically powerful in differentiating MIBC from NMBIC prior to transurethral resection. The agreement between radiologists is moderate.

La probabilidad de detección de tumor residual en la segunda resección transuretral del cáncer de vejiga urotelial PT1 según los factores de riesgo / The probability of residual tumor detection in the second transurethral resection of PT1 urothelial bladder cancer according to the risk factors

Objetivo Analizar los factores predictivos de tumores residuales en la segunda resección tras la resección transuretral inicial del tumor de vejiga en pacientes con tumores pT1 y desarrollar un método sencillo para predecir la probabilidad de detección del tumor residual. Material y métodos En nuestro estudio retrospectivo se incluyeron pacientes con cáncer de vejiga pT1 que se sometieron a una segunda resección entre 2 y 6 semanas después de la primera resección transuretral del tumor de vejiga. Se registraron los datos demográficos de los pacientes y las características del tumor en la primera y segunda resección. Resultados En nuestro análisis se incluyeron 144 pacientes con un seguimiento de 53 meses. En el análisis de regresión logística univariante, el grado del tumor, el carcinoma in situ concomitante, el aspecto macroscópico del tumor (sólido frente a papilar) y la presencia de una histología diferente, fueron factores de riesgo significativos para el tumor residual. En el análisis multivariante, solo el grado del tumor fue un factor predictivo independiente del tumor residual en la segunda resección transuretral (OR: 5,62; IC del 95%: 1,228-25,708; p=0,026). Según nuestros resultados, los pacientes con el riesgo más alto tienen una probabilidad de detección de tumor residual del 90,9% en la segunda resección, y en los pacientes con el riesgo más bajo es del 25,4%. Conclusiones El grado del tumor, el aspecto macroscópico del tumor (sólido frente a papilar) y el carcinoma in situ concomitante fueron predictores significativos de tumores residuales en la segunda resección de pacientes con cáncer de vejiga no músculo invasivo pT1 primario. Descubrimos que se podía calcular la probabilidad de un tumor residual para así determinar estrategias adaptadas al riesgo en función de estas probabilidades (AU)

Objective To analyze the predictive factors for residual tumors in the second resection after the initial transurethral resection of bladder tumor (TUR-BT) in patients with pT1 tumors and to develop a simple method to predict the probability of residual tumor detection. Material and methods Patients with pT1 bladder cancer who underwent a second resection within 2 to 6 weeks after the initial transurethral resection of bladder tumor were included in our retrospective study. The patients’ demographics and the tumor characteristics of the initial and second resections were recorded. Results A total of 144 patients were included in our analysis with a 53-month follow-up. In the univariate logistic regression analysis, tumor grade, concomitant carcinoma in situ, macroscopic appearance of the tumor (solid vs papillary), and presence of a variant histology, were significant risk factors for residual tumor. In the multivariate analysis, tumor grade was the only independent predictor of residual tumor at second transurethral resection (OR: 5.62, 95% CI: 1.228–25.708, p=0.026). According to our findings, the patients with the highest risk have a 90.9% residual tumor detection probability at the second resection, and the patients with the lowest risk have 25.4% Conclusions Tumor grade, macroscopic appearance of the tumor (solid vs papillary), and concomitant carcinoma in situ, were important predictors of residual tumors at second resection of primary pT1 non-muscle invasive bladder cancer patients. We were able to calculate the probability of residual tumor which helped us determine risk adapted strategies according to these probabilities (AU)

Are the current nomograms sufficient to predict shockwave lithotripsy outcomes?

INTRODUCTION AND OBJECTIVES: To investigate factors affecting SWL outcomes, validate three current nomograms (Kim JK, Triple D and S3HoCKwave) and compare the predictive ability of the nomograms for SWL outcomes in upper urinary tract stones. PATIENTS AND METHODS: Medical records of patients with renal and proximal ureteral stones treated with SWL between March 2013 and October 2020 were retrospectively reviewed. Factors affecting SWL success were analyzed with multivariate logistic regression analysis and the three predictive scoring systems compared with the area under the curve (AUC). RESULTS: A total of 580 patients were included in our study. The overall stone free rate was 61% and 144/580 patients (24.8%) were stone free after one session. In multivariate logistic regression analysis, stone location at upper calyx (OR:2.988; 95%Cl: 1.350-6.612; p = 0.007), middle calyx (OR:3.036; 95%Cl: 1.472-6.258; p = 0.003), and lower calyx (OR:2.131; 95%Cl: 1.182-3.839; p = 0.012), as well as number of stones (OR:1.663; 95%Cl: 1.140-2.425; p = 0.008), maximum diameter of stone (OR:1.156; 95%Cl: 1.098-1.217; p < 0.001) and maximum Hounsfield Unit (OR:1.001; 95%Cl: 1.001-1.002; p < 0.001) were independent risk factors of SWL failure. The AUCs of the Kim JK, Triple D and S2HoCKwave scores for predicting SWL success were 0.678, 0.548, and 0.626 respectively. CONCLUSIONS: Stone location, number, maximal diameter, and maximum HU were independent predictive factors for SWL outcome in the treatment of upper urinary tract stones. Current nomograms, "Kim JK nomogram", "Triple D score" and "S3HoCKwave score" can predict treatment success after SWL, but all of them have poor discrimination according to AUC analysis.

The probability of residual tumor detection in the second transurethral resection of pT1 urothelial bladder cancer according to the risk factors.

OBJECTIVE: To analyze the predictive factors for residual tumors in the second resection after the initial transurethral resection of bladder tumor (TUR-BT) in patients with pT1 tumors and to develop a simple method to predict the probability of residual tumor detection. MATERIAL AND METHODS: Patients with pT1 bladder cancer who underwent a second resection within two to six weeks after the initial TUR-BT were included in our retrospective study. The patients' demographics and the tumor characteristics of the initial and second resections were recorded. RESULTS: A total of 144 patients were included in our analysis with a 53-month follow-up. In the univariate logistic regression analysis, tumor grade, concomitant carcinoma in situ (CIS), macroscopic appearance of the tumor (solid vs papillary), and presence of a variant histology, were significant risk factors for residual tumor. In the multivariate analysis, tumor grade was the only independent predictor of residual tumor at second TUR (OR: 5.62, 95% CI: 1.228-25.708, p = 0.026). According to our findings, the patients with the highest risk have a 90.9% residual tumor detection probability at the second resection, and the patients with the lowest risk have 25.4%. CONCLUSIONS: Tumor grade, macroscopic appearance of the tumor (solid vs papillary), and concomitant CIS, were important predictors of residual tumors at second resection of primary pT1 NMIBC patients. We were able to calculate the probability of residual tumor which helped us determine risk adapted strategies according to these probabilities.

Oncologic outcomes and predictive factors for progression in pT3a renal cell carcinoma

Objectives: We aimed to evaluate oncologic outcomes of pT3a renal cell carcinoma (RCC) patients that treated with radical or partial nephrectomy and identify clinical or pathological factors that predict local recurrence or metastasis. Methods: In this single center, retrospective study, we evaluated medical records of 856 patients who underwent radical or partial nephrectomy for RCC. Patients who had pT3aN0M0 RCC in final pathology and at least 6 months of follow-up included in the study. Patients’ demographic characteristics, laboratory parameters, tumor characteristics and oncological outcomes were recorded. Cancer specific and overall survivals were our primary outcomes. Multivariate analysis was performed to identify factors affecting oncologic outcomes. Results: A total of 86 pT3aN0M0 RCC patients were included final analysis of our study. During the mean 60.75 months follow up, 3 patients (3.5%) had experienced local recurrence and 19 patients (22.1%) had experienced metastasis. Total of 24 patients (27.9%) had died during the follow up. In this population 10-year OS was 70.8%, 10-year PFS was 61.3% and 10-year CSS was 78.4%. In multivariate analysis, chronic renal failure (CRF) was an independent worse prognostic factor for overall survival (p=0.03). Besides this sarcomatoid differentiation was an independent prognostic factor for PFS, CSS and OS (p=<0.001). Conclusions: Our study investigated the predictive factors for worse oncologic outcomes in pT3aN0M0 RCC patients. Although many factors have predictive value in univariate analysis, only sarcomatoid differentiation have independent predictive value for worse CSS, PFS and OS. Besides sarcomatoid differentiation, CRF is an independent prognostic factor for poor OS (AU)

Changes in antimicrobial resistance and demographics of UTIs in pediatric patients in a single institution over a 6-year period.

PURPOSE: To determine changes in antimicrobial resistance and demographics of UTIs in pediatric patients in a single institution over a 6-year period. MATERIALS AND METHODS: The current study examined outpatient urinary isolates from patients aged <18 years. A retrospective cross-sectional analysis of bacteria isolated from children with UTI was performed between 2009 and 2014. The most common bacterial pathogens were determined in the following four age groups: <2 years; 2-5 years; 6-12 years; and 13-17 years. The study analyzed the prevalence and antibiotic resistance patterns for the six most common uropathogens: Escherichia coli, Proteus, Klebsiella, Enterobacter, Pseudomonas and Enterococcus (Summary table). The antibiotic resistance pattern for UTI during 2009-2014 was also examined. RESULTS: A total of 6515 urinary cultures was examined. The majority of these isolates were from female patients (66.8%). E. coli was the most common uropathogen overall, but the prevalence of E. coli was higher among females (79.5%) than males (54.9%). The biggest percentage of isolates in males was from children aged <2 years (46.1%). Conversely, the majority of isolates in females were from children aged >6 years (46.8%). Results of antimicrobial resistance for E. coli were the highest for ampicillin (70%) and lowest for meropenem (0.19%). Comparing the hospital network data from 2009 to 2014, E. coli resistance increased for ampicillin (from 47.1% to 89%), trimethoprim-sulfamethoxazole (TMP-SMX) (from 44.8% to 56%) and nitrofurantoin (from 5.3% to 15.1%). In contrast, cephalosporins have maintained low antibiotic resistance. CONCLUSION: UTI in females was nearly twice as common than in males. E. coli remained the most common pediatric uropathogen. Although widely used in other tract infections, ampicillin was a poor empiric choice for pediatric UTIs. Cephalosporins were appropriate alternatives given their low resistance rates. A successful empirical treatment protocol should be based on local epidemiology and susceptibility rates.