Urine Biopsy as Dynamic Biomarker to Enhance Clinical Staging of Bladder Cancer in Radical Cystectomy Candidates.

PURPOSE: There is significant interest in identifying complete responders to neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) to potentially avoid removal of a pathologically benign bladder. However, clinical restaging after NAC is highly inaccurate. The objective of this study was to develop a next-generation sequencing-based molecular assay using urine to enhance clinical staging of patients with bladder cancer. METHODS: Urine samples from 20 and 44 patients with bladder cancer undergoing RC were prospectively collected for retrospective analysis for molecular correlate analysis from two clinical trials, respectively. The first cohort was used to benchmark the assay, and the second was used to determine the performance characteristics of the test as it correlates to responder status as measured by pathologic examination. RESULTS: First, to benchmark the assay, known mutations identified in the tissue (MT) of patients from the Accelerated Methotrexate, Vinblastine, Doxorubicin, Cisplatin trial (ClinicalTrials.gov identifier: NCT01611662, n = 16) and a cohort from University of California-San Francisco (n = 4) were cross referenced against mutation profiles from urine (MU). We then determined the correlation between MU persistence and residual disease in pre-RC urine samples from a second prospective clinical trial (The pT0 trial; ClinicalTrials.gov identifier: NCT02968732). Residual MU status correlated strongly with residual disease status (pT0 trial; n = 44; P = .0092) when MU from urine supernatant and urine pellet were assessed separately and analyzed in tandem. The sensitivity, specificity, PPV, and NPV were 91%, 50%, 86%, and 63% respectively, with an overall accuracy of 82% for this second cohort. CONCLUSION: MU are representative of MT and thus can be used to enhance clinical staging of urothelial carcinoma. Urine biopsy may be used as a reliable tool that can be further developed to identify complete response to NAC in anticipation of safe RC avoidance.

Functional Penile Length After Penile Plication: "Empha-sizing" What Matters.

OBJECTIVE: To reassess penile length changes after penile plication (PP), we defined a novel measurement of functional penile length (FPL) and compared preoperative and postoperative measurements. PP reduces penile curvature in Peyronie's Disease (PD) patients, but is traditionally thought to reduce overall penile length. However, the literature on PD lacks a standardization for penile length measurement techniques, leading to high inter-study variability. METHODS: A prospectively maintained database of PD patients who underwent PP from 2018-2021 was queried. FPL was obtained by measuring the erect penis from the base of the pubis to the tip of the glans, as a straight line disregarding any curvature. Intraoperative assessment of FPL was performed before incision and immediately after surgical correction. RESULTS: Of 28 patients included, the average age was 59, average SHIM was 17, and average PDQ was 9. Curvature was unidirectional in 16 patients (57%) and bidirectional in 12 (43%). Dorsal curvature was most common (71%). The average curve severity was 37 ± 8.6 degrees. Mean FPL pre-operatively was 11.1 ± 1.4 cm and 12.5 ± 1.3 cm post-operatively. This represented an average 12.8% ± 6.6% increase in FPL following plication. All 28 patients reported subjective improvement in their curvature. CONCLUSION: Functional penile length is a useful primary surgical outcome when describing post-operative expectations for penile plication. We report an increase in FPL achieved for PD treated with PP despite conventionally being considered a shortening procedure. This can be an invaluable tool for preoperative counseling and setting expectations for penile length.

Quantifying Glans Width Changes in Response to Preoperative Androgen Stimulation in Patients Undergoing Hypospadias Repair.

PURPOSE: Testosterone (T) administration prior to hypospadias surgery to increase glans size remains controversial. Understanding T's effect on glans width (GW) is essential to understanding its potential impact on surgical outcomes. We hypothesized that preoperative T in prepubertal boys significantly increases GW at the time of hypospadias surgery. MATERIALS AND METHODS: Our single institutional database was queried to identify patients who underwent hypospadias surgery from 2016 to 2020, in which data for T administration and GW were available. Descriptive, nonparametric and categorical statistics were performed as indicated. RESULTS: A total of 579 patients were eligible for analysis. Median age at surgery was 0.9 years (IQR 0.6-1.6). A total of 247/579 patients (42.7%) received T. The median GW at surgery was 15 mm (IQR 13-17). When comparing patients who had T administered to those who did not, we found a significant difference in GW at surgery (16 mm vs 14 mm, p <0.001). The median change in GW from the office to surgery was 4 mm for those receiving T vs 0 mm for those not receiving T (p <0.001). We identified a greater change in GW from preoperative to intraoperative measurements in patients who received 2 doses of T vs 1 dose (4 mm vs 2 mm, p <0.001). A histogram plot revealed the distribution of GW change at surgery. CONCLUSIONS: In our prospectively collected cohort of patients undergoing hypospadias surgery, we were able to quantitate the change in GW from preoperative T. Two doses of T resulted in a significant increase in GW vs 1 dose.

Multidisciplinary management of adult cloacal exstrophy complications: A challenging case of nephrolithiasis and abdominal wall extrusion of a catheterizable ileal pouch.

Cloacal exstrophy is a rare congenital syndrome which comprises multiple genitourinary, gastrointestinal and musculoskeletal anomalies. The long-term effects following childhood cloacal exstrophy management is poorly characterized in living adults. In this report, a 42-year-old female born with cloacal exstrophy presented after numerous prior surgical reconstructions with abdominal extrusion of a catheterizable ileal pouch and bilateral staghorn calculi. We review the steps in surgical management of this uncommon scenario with a goal of improving the patient's quality of life.