Quality and Readability of Online Health Information on Common Urologic Cancers: Assessing Barriers to Health Literacy in Urologic Oncology.

INTRODUCTION: A growing number of Americans search online for health information related to urologic oncologic care each year. The American Medical Association recommends that medical information be written at a maximum sixth-grade level in order to be comprehensible by the majority of patients. As such, it is important to assess the quality and readability of online patient education material that patients are being exposed to. METHODS: A Google search was performed using the terms "testicular cancer," "prostate cancer," "kidney cancer," and "bladder cancer," and the top 30 results for each were reviewed. Websites were categorized based on their source. Readability was assessed using the Flesch-Kincaid Grade Level, the Gunning Frequency of Gobbledygook, and the Simple Measure of Gobbledygook indices. Quality was assessed using the DISCERN Quality Index (1-5 scale). RESULTS: A total of 91 websites were included in our analysis. On average, online health information pertaining to urologic cancers is written at a 10th- to 11th-grade reading level, which is significantly higher than that of an average American adult and that recommended by the American Medical Association (P < .01). The overall quality of websites was 3.4 ± 0.7, representing moderate to high quality. There was no significant difference in readability based on cancer type or information source. CONCLUSIONS: Despite being of moderate to high quality, online patient education materials related to common urologic cancers are often written at a grade level that exceeds the reading level of an average American adult. This presents as a barrier to online health literacy and calls into question the utility of these resources.

Silica Urinary Stones: A Case Report and A Brief Review of Literature.

Silicate stones are extraordinarily rare in human beings, but when present, they are often associated with ingestion of Magnesium Trisilicate, an antacid medication. However, there have been few case reports of patients who developed silicate stones, without ingestion of Magnesium Trisilicate. Hereby, we present the case of a 67-year-old man who developed acute kidney injury due to obstructive uropathy, detected during his scheduled chemotherapy for his relapsing multiple myeloma. Abdominal ultrasound and CT scan imaging demonstrated multiple non-mobile calcifications in the bladder neck/prostate bed. Stone analysis showed a material resembling silica. This case with silicate urinary tract stone highlights this extra-rare urinary stone in a patient without any identified source of silicate.  DOI: 10.52547/ijkd.7044.

The Distribution of Metastatic Renal Cell Carcinoma by Presenting Tumor Stage in the Modern Era.

INTRODUCTION: There is a stage migration for detection of kidney cancer, thus we aim to evaluate the distribution of metastatic renal cell carcinoma by presenting clinical T stage over time. MATERIALS AND METHODS: The National Cancer Database was evaluated for patients with metastatic kidney cancer from 2010 to 2016. The primary outcome was the temporal trend of presenting clinical T stage over time. The secondary outcome was overall survival. Kaplan-Meier and Cox regression analyses were performed. RESULTS: The incidence of metastatic kidney cancer has increased, from 3426 new cases in 2010 to 4510 in 2016. While diagnosis of metastasis has increased for all tumor stages over time, there has been a more rapid increase in metastasis of localized renal masses (cT1-T2) as compared to locally advanced disease (cT3-T4). In 2010, 46% of the new metastatic cases diagnosed were cT3-T4, while in 2016 this proportion decreased to 38.2%. Conversely, metastatic cases with cT1-T2 tumors increased from 54% in 2010 to 61.9% in 2016. Cox regression noted an increased risk of death correlating with higher clinical T stage. On Kaplan Meier analysis, the 2-year survival was 29.3%, 30.3%, 28.3%, and 16.0% for cT1, cT2, cT3, and cT4, respectively (logrank P < .001). CONCLUSION: Metastatic kidney cancer is increasingly diagnosed at a lower presenting cT stage. Survival outcomes worsen with increasing cT stage in the setting of metastasis.

Pharmacotherapy review: Emerging treatment modalities in transthyretin cardiac amyloidosis.

PURPOSE: This review aims to summarize the evidence and pharmacological characteristics of treatment options for transthyretin amyloid cardiomyopathy (ATTR-CM). Additionally, this review highlights the role of clinical pharmacists in helping to secure newly introduced therapies. SUMMARY: ATTR-CM, a disease characterized by misfolded protein that is deposited in the myocardium and disrupts cardiac functioning, has historically been underdiagnosed due to the need for invasive biopsy and an illusion of rarity. Once diagnosed, limited treatment modalities for ATTR-CM have led providers to rely on nonpharmacological remedies or off-label use of medications with limited evidence of benefit. However, recent noninvasive diagnostic advancements and heightened disease state awareness have revealed increased prevalence of ATTR-CM. This has led to the introduction of several first-in-class pharmaceuticals with actions targeted at inhibiting the various phases of amyloidosis: TTR stabilizers include diflunisal and Food and Drug Administration (FDA)-approved tafamidis; TTR silencers include patisiran and inotersen; fibril disrupters include doxycycline with tauroursodeoxycholic acid; and alternative agents include green tea extract and curcumin. CONCLUSION: ATTR-CM treatments have emerged and, despite current limited data, are continuing to evolve. Tafamidis, the only agent approved by FDA for ATTR-CM, shows promise to improve survival and quality of life in patients with ATTR-CM. Pharmacists can play a key role in assisting with agent selection for this disease state, as well as providing knowledge about current and future clinical trials evaluating the safety and efficacy of the available treatment modalities.

A Case of Heterotopic Ossification in Papillary Renal Cell Carcinoma Type 2.

Renal cell carcinoma (RCC) is associated with a variety of different histopathologic subtypes in which each subtype may be further subclassified. These entities carry with them unique prognoses and necessitate treatment with specific immunotherapy agents should advanced disease be uncovered. Meanwhile, aberrant physiologic processes may lead to unique histologic findings within these subtypes, further complicating management and prognostication. Heterotopic ossification within RCC is one of these rare occurrences and was once thought to have favorable prognostic implications. We report a case of a young female with papillary type 2 RCC with heterotopic ossification.

Giant kidney worms in a patient with renal cell carcinoma.

Dioctophyma renale (D. renale), or giant kidney worms, are the largest nematodes that infect mammals. Approximately 20 cases of human infection have been reported. We present a case of a 71-year-old man with a recent history of unintentional weight loss and painless haematuria, passing elongated erythematous tissue via his urethra. CT revealed a left renal mass with pulmonary nodules and hepatic lesions. On microscopy, the erythematous tissue passed was identified as D. renale. On subsequent renal biopsy, pathology was consistent with renal cell carcinoma. This is the first reported case of concomitant D. renale infection and renal cell carcinoma, and the second reported case of D. renale infection of the left kidney alone.

Forgotten ureteral stents: who's at risk?

The sequelae from forgotten stents carry significant morbidity and costs. In this study, we attempt to identify potential risk factors that may make patients less likely to follow up for stent removal so that more effective prevention efforts may be directed at these persons. A single-institution retrospective analysis of 187 consecutive patients who had stents placed between January 2010 and December 2010 was performed. Chart review was conducted to see if patients had undergone stent removal beyond the intended maximal stent life (MSL). Patients who were lost to follow-up were contacted to determine if stents were overdue. Logistic regression was performed to determine risk factors. Of the 187 patients who had stents placed, 147 had the stent removed before MSL and 28 had stents removed after the MSL. Twelve patients could not be contacted and were excluded from the analysis. Within our cohort of 175 patients, 48% were males, 73% were minorities (33% Latino, 30% Black, 8% Asian, and 2% Native American), 39% did not speak English, 79% were unemployed, 73% were uninsured, and 35% were married. Among the patients with forgotten stents, 68% were male, 64% were minorities (32% Latino, 29% Black, 4% Native American, and 0% Asian), 82% were unemployed, 39% did not speak English, 93% were uninsured, and 43% were married. Multivariate regression analysis demonstrated that uninsured patients (odds ratio [OR], 6.3; 95% confidence interval [CI], 1.4-28.2; P value 0.01) and males (OR, 2.8; CI, 1.2-6.8; P=0.02) had statistically significant associations with forgotten stents. Men were 2.8 times more likely to have forgotten stents than females. Patients without health insurance were six times more likely to have forgotten stents than patients with insurance. As efforts are made to prevent forgotten stents, increased attention should be given to these higher-risk patient populations.

Brief smoking cessation intervention: a prospective trial in the urology setting.

PURPOSE: Urologists have an important role in the treatment of tobacco related diseases, such as kidney and bladder cancer. Despite this role, urologists receive little training in promoting tobacco cessation. We prospectively evaluated a brief smoking cessation intervention offered by a urologist at an outpatient clinic. MATERIALS AND METHODS: Between 2009 and 2011 adult smokers from a single institution urology clinic were enrolled in a prospective, brief intervention trial or in usual care as controls. All patients were assessed by the validated Fagerström test for nicotine dependence and the readiness to quit questionnaire. Trial patients received a 5-minute brief smoking cessation intervention. The primary outcome was abstinence at 1 year and the secondary outcome was the number of attempts to quit. Multivariate logistic regression was used to identify factors associated with the quit rate and quit attempts. RESULTS: A total of 179 patients were enrolled in the study, including 100 in the brief smoking cessation intervention, 41 in the brief smoking cessation intervention plus nicotine replacement therapy and 38 usual care controls. Of the participants 81.0% were 40 years old or older with a mean ± SD 11.26 ± 7.23 pack-year smoking history. Mean readiness to quit and tobacco dependence scores were similar in the 2 arms (p = 0.25 and 0.92, respectively). The 1-year quit rate in the brief smoking cessation intervention group was 12.1% vs 2.6% in the usual care group (OR 4.44, p = 0.163) Adding nicotine replacement therapy increased the quit rate to 19.5% (vs usual care OR 9.91, p = 0.039). Patients who received the brief smoking cessation intervention were significantly more likely to attempt to quit (OR 2.31, p = 0.038). Increased readiness scores were associated with an increased quit rate and increased quit attempts. CONCLUSIONS: Urologists can successfully implement a brief smoking cessation intervention program. Our study highlights the role of the urologist in providing smoking cessation assistance and the significant impact of brief, simple advice about quitting smoking on the smoker quit rate.

Ethnicity and smoking status are associated with awareness of smoking related genitourinary diseases.

PURPOSE: Cigarette smoking is a recognized risk factor for kidney cancer, bladder cancer and erectile dysfunction. However, little is known regarding patient knowledge of these associations. We evaluated awareness of smoking as a risk factor for genitourinary disease and identified variables associated with awareness. MATERIALS AND METHODS: We performed a cross-sectional study in a convenience sample of 535 patients who presented to a urology clinic at a major public hospital between 2009 and 2011. Patient demographics and knowledge were captured in a self-reported questionnaire evaluating awareness of smoking as a risk factor for bladder, kidney and lung cancer, and erectile dysfunction. Factors associated with the awareness of smoking and genitourinary disease were identified by multivariable logistic regression. RESULTS: Urology patients generally had low overall awareness of smoking related genitourinary disease. Only 33.5%, 25.2% and 24.2% of patients identified smoking as a risk factor for kidney cancer, bladder cancer and erectile dysfunction, respectively, compared to 94.0% who identified it as a risk factor for lung cancer. Patients from ethnic minorities and current smokers consistently showed a more pronounced lack of awareness of the link between smoking and these diseases. Generally Hispanic and black patients were 2 to 3 times more likely than white patients to be unaware of the association of smoking with the diseases (p = 0.0019 to 0.059). Smokers were twice as likely as nonsmokers to be unaware of the link of smoking with kidney and bladder cancer (p = 0.025 and 0.0509, respectively). CONCLUSIONS: Our study highlights the need for increased awareness of smoking related genitourinary diseases, especially among minority patients and smokers. This study draws attention to an opportunity for urologists to provide smoking cessation assistance and education for this patient population.