Prostate Cancer: Under-representation of African American Men in Research Studies Used in the Latest NCCN Guidelines.

OBJECTIVE: To evaluate racial data in studies used in current NCCN prostate cancer guidelines. These guidelines represent the latest information that informs clinical practice. Prostate cancer disproportionately affects mortality in Black patients compared to White patients at a 2.1-fold higher death rate. However, this racial disparity is not accounted for when including patients in research. METHODS: The studies referenced in the latest NCCN guidelines were evaluated for inclusion of racial demographics, and whether they properly account for the higher mortality rate of prostate cancer seen in Black patients. We then analyzed topics within prostate cancer. RESULTS: After application of exclusion criteria, 547 of 878 studies were included for analysis; of those, only 32.4% included demographic data. Overall, Black patients accounted for 472,476 (12.8%) of total patients, while 3,023,007 (81.7%) patients were White. These findings were consistent with specific areas including risk stratification (12% vs 75%), imaging and staging (11% vs 80%), treatment (16% vs 81%), recurrence (15% vs 73%), castration-sensitive prostate cancer (9% vs 84%), castration-resistant prostate cancer (8% vs 73%), and metastatic bone disease (7% vs 84%). CONCLUSION: Our analysis showed consistently that although the guidelines utilize the best research, such studies often do not report racial demographics or have patient populations that do not reflect racial differences in mortality of prostate cancer. Our study questions the generalization of these studies to Black patients. Future research should emphasize inclusion of racial demographics and recruit appropriately representative study cohorts.

Evolving case of emphysematous pyelonephritis in a second renal allograft.

Emphysematous pyelonephritis is an acute necrotizing infection with gas in the kidney that portends a poor prognosis. Patients present with sepsis, requiring fluid resuscitation, glucose control, and broad-spectrum antibiotics. Surgical intervention ranges from relief of urinary obstruction (nephrostomy tube or stent), percutaneous drainage or nephrectomy. We present a 51-year-old second kidney transplant recipient diabetic male, suffering from sepsis of unknown etiology which was subsequently revealed to be due to emphysematous pyelonephritis. Percutaneous drainage was performed initially followed by renal transplant nephrectomy after no improvement of his clinical status. Herein, we describe the clinical course and escalation in management.

Virtual Urology Education in the Epicenter of COVID-19: Development and Outcomes of the Educational Multi-Institutional Program for Instructing REsidents (EMPIRE) Lecture Series.

INTRODUCTION: Sustaining resident education efforts during the height of the COVID-19 pandemic required innovative, virtual didactic programs. This article reviews the authors' collaborative experience with launching the Educational Multi-institutional Program for Instructing REsidents (EMPIRE) lecture series in the New York Section of the American Urological Association. METHODS: From April 13, 2020 to May 29, 2020, there were 68 EMPIRE lectures delivered via Zoom videoconferencing that were based on a variety of topics highlighted in the AUA Core Curriculum. Tracking tools from Zoom, Google Analytics from the New York Section website and YouTube Analytics were used to assess participant access of didactic materials. Additionally, a survey regarding the content and impact of the series was distributed and advertised to those who had attended the lecture series. RESULTS: The average number of participants was 159±68 per lecture (range 77 to 334) and the recordings received 9,086 total video views (range 42 to 443 views per video) at the time of survey completion. The survey received 170 total responses. The majority of speakers (77%) and participants (58%) were from the New York Section. Half of the participants were residents (50%) and others were attending urologists (35%), fellows (5%), medical students (9%), and advanced practice providers (1%). Survey respondents reported consistently high ratings of the EMPIRE series. Overall, 99% of respondents said that they would recommend the EMPIRE series to a colleague and 98% requested that the series continue after COVID-19 abates. CONCLUSIONS: The EMPIRE didactic series was well received, with the majority of participants positively endorsing its value. Further initiatives pertaining to virtual education for urology trainees should continue to be explored.

Fournier's Gangrene: A Review and Outcome Comparison from 2009 to 2016.

Objective: The outcome of Fournier's gangrene (FG) may be affected by comorbidities, demographics, and choice of treatment modality. We sought to evaluate our institution's management protocol of FG measured by mortality rate (MR) and length of hospital stay (LHS) in a retrospective cohort study. Approach: A database of 20 FG cases at our institution throughout the 2009-2016 study period was assembled by a retrospective review of medical records. A Fournier's Gangrene Severity Index Score (FGSIS) was calculated for each case. Data were analyzed for statistical significance using logistic regression. Results: The most common presentation of FG at our institution was a hyperglycemic diabetic male in his fifth decade of life with a second risk factor such as recent surgery or active malignancy. The average FGSIS was 9 overall and 14 for the mortalities. An increased FGSIS was predictive of having an increased MR or hospital stay above the median (>25 days) (p = 0.0194). The average LHS was 32 days overall, 22 days for patients treated with hyperbaric oxygen therapy and 40 days for patients treated with tangential hydrosurgery. Overall MR was 15%. Innovation: This is the second known study to characterize usage of tangential hydrosurgery in the management of FG. Conclusion: Treatment outcomes at our institution are comparable to those reported in recent literature, a significant decline from the historical MR of 50-60%.