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To examine the overall and stage-specific age-adjusted incidence, 5-year survival and mortality rates of bladder cancer (BCa) in the United States, between 1973 and 2009. A total of 148,315 BCa patients were identified in the Surveillance, Epidemiology and End Results database, between years 1973 and 2009. Incidence, mortality, and 5-year cancer-specific survival rates were calculated. Temporal trends were quantified using the estimated annual percentage change (EAPC) and linear regression models. All analyses were stratified according to disease stage, and further examined according to sex, race, and age groups. Incidence rate of BCa increased from 21.0 to 25.5/100,000 person-years between 1973 and 2009. Stage-specific analyses revealed an increase incidence for localized stage: 15.4–20.2 (EAPC: +0.5%, p<0.001) and distant stage: 0.5–0.8 (EAPC: +0.7%, p=0.001). Stage-specific 5-year survival rates increased for all stages, except for distant disease. No significant changes in mortality were recorded among localized (EAPC: −0.2%, p=0.1) and regional stage (EAPC: −0.1%, p=0.5). An increase in mortality rates was observed among distant stage (EAPC: +1.0%, p=0.005). Significant variations in incidence and mortality were recorded when estimates were stratified according to sex, race, and age groups. Albeit statistically significant, virtually all changes in incidence and mortality were minor, and hardly of any clinical importance. Little or no change in BCa cancer control outcomes has been achieved during the study period.

Objective Compare different imaging scenarios in the diagnosis of uncomplicated renal colic due to urolithiasis (URCU). Materials and methods A total of 206 prospectively included patients had been admitted with suspected URCU and had undergone abdominal plain film (APF), US and unenhanced CT after clinical STONE score evaluation. CT was the reference standard. We assessed sensitivity (Se), specificity (Spe) and Youden index for colic pain diagnosis, percentage of patients managed by urologic treatment with stone identified, percentage of alternative diagnoses (AD) and exposure to radiation, according to single imaging approaches, strategies driven by patient characteristics and conditional imaging strategies after APF and US. Results One hundred (48.5%) patients had a final diagnosis of URCU and 19 underwent urologic treatment. The conditional strategy, i.e. CT in patients who had no stone identified at US, had a perfect sensitivity and specificity. This enabled diagnosis of all stones requiring urology management while decreasing the number of CT exams by 22%. The strategy whereby CT was used when there was neither direct or indirect APF + US finding of colic pain nor alternative diagnoses in patients with a STONE score ≥ 10 had a sensitivity of 0.95 and a specificity of 0.99, identified 84% of stones managed by urologic treatment and decreased the number of CT examinations by 76%. Conclusion In patients with clinical findings consistent with URCU, the use of ultrasound as first-line imaging modality, with CT restricted to patients with negative US and a STONE score ≥ 10, led to a sensitivity and specificity of above 95%, identified 84% of stones requiring urological management and reduced the number of CT scans needed by fourfold. Key Points • For diagnosis, the use of APF + US as first-line imaging, with CT restricted to patients with both a normal APF + US and a STONE score ≥ 10, provides both a sensitivity and specificity superior or equal to 95% and reduces the number of CT scans necessary by fourfold. • For management, the use of APF + US as first-line imaging, with CT restricted to patients with both a normal APF + US and a STONE score ≥ 10, maintains a 84% stone identification rate in urology-treated patients.

Background and aimIncisional hernia (IH) after Kidney Transplantation (KT) is a challenging complication due to both technical reasons and patients’ complexity. Data regarding outcomes of hernia repair in KT recipients are uncertain, since the biggest part of previous papers focused on risk factors for incisional hernia occurrence and not on its outcomes. Aim of the study was to focus on risk factors for incisional hernia recurrence after surgical repair in KT recipients.MethodsData regarding all consecutive patients undergoing kidney transplantations from January 2011 until September 2020 in Montpellier University Hospital were retrospectively collected from a single institutional database.ResultsAfter a median follow-up of 48 months (IQR25-75 31–59), data from 1546 consecutive KT were collected. 83 patients underwent 99 incisional hernia surgeries after KT, with 14 patients that had one recurrence (14.4%) and 2 patients that experienced two recurrences (2.4%). Total recurrence rate was 16.8%. At univariate analysis, the only factor associated with an incisional hernia recurrence was having undergone to at least one previous abdominal surgery other than KT (p value 0.002). Overall morbidity was 15% (n = 15), with most of complications classified as mild (59%). No mortality related to incisional hernia repair occurred.ConclusionIHs after KT represent an important condition. Its surgical management is challenging due to its anatomical complexity and patient’s status. This is the largest sample size in the literature of patients treated for IH after KT and it shows that a previous surgery other than the KT is a risk factor for hernia recurrence after surgical repair, without regarding surgical technique or other comorbidity and therapeutical factors.

PurposeThe objective of this study was to compare living-donor kidney transplantation (LDKT) performed either sequentially, in one operating room, leading to extended cold ischemia time (CIT) or simultaneously, in two different operating room, with shorter CIT.MethodsWe retrospectively included all living-donor nephrectomies and kidney transplantations, performed from March 2010 to March 2014, in three French university centers. In the first one (C1), LDKTs were performed in sequential manner (Sequential group) and in C2 and C3, LDKTs were performed in simultaneous manner (Simultaneous group).ResultsA total of 324 LDKT were performed: 176 LDKT in Sequential group and 148 LDKT in Simultaneous group. Patients characteristics were equivalent between groups, except nephrectomy side, ABO mismatch rate and previous kidney transplantation rate. CIT, rewarming time, transfusion and delayed graft function (DGF) were significantly higher in Sequential group. Overall survival and graft survival of kidney transplant recipients were similar in the Sequential and Simultaneous groups. 5-year eGFR was similar between groups. In univariate analysis, number of graft arteries, recipient BMI, previous kidney transplantation status and CIT were significant predictors of DGF. Only previous kidney transplantation status was an independent predictive factor of DGF in the multivariate analysis.ConclusionsSequential surgical organization results in the same functional results as simultaneous surgical organization. DGF was higher for LDKT performed sequentially but at 5-year overall survival, graft survival and eGFR were similar between these two types of transplant organizations.

Background Partial (PN) or radical nephrectomy (RN) represents the standard of care for patients with small renal masses. Active surveillance (AS) also may be considered. We examined the rates of PN, RN, and AS within a contemporary population-based cohort. Methods Using the surveillance, epidemiology and end results database, we identified 26,468 patients diagnosed with T1aN0M0 renal cell carcinoma, between years 1988 and 2008. Determinants of PN and AS were assessed using logistic regression analyses within surgically managed patients and within the entire cohort, respectively. Results Overall, 8,966 (34%), 14,705 (56%), and 2,797 (11%) patients underwent PN, RN, and AS, respectively. The rate of PN increased (4.7% in 1988 to 40.4% in 2008, P  < 0.001), whereas the rate of RN decreased over time (92.9% in 1988 to 41.4% in 2008, P  < 0.001). The rate of AS increased over time (2.4% in 1988 to 18.2% in 2008, P  < 0.001). In multivariable analyses, the determinants for PN consisted of more contemporary year of diagnosis, younger patient age, male gender, Caucasian race, married status, and decreasing tumor size (all P  ≤ 0.003). The determinants of AS consisted of more contemporary year of diagnosis, more advanced age, male gender, decreasing tumor size, and unmarried marital status (all P  ≤ 0.001). Regional differences for management of localized RCC were detected. Conclusions It is encouraging that PN rates have increased in an eightfold fashion. Moreover, a fivefold increase was recorded for AS. These figures show a paradigm shift in the management of small renal masses.

Purpose To test whether the rates of in-hospital mortality, complications, and transfusions are higher in patients treated with cytoreductive nephrectomy (CNT) for metastatic renal cell carcinoma (mRCC) relative to patients treated with nephrectomy (NT) for non-mRCC. Methods We assessed 17,688 patients treated with a NT between years 1999 and 2008, within the Florida Inpatient Database. Chi-square and Student t -tests were used to compare the statistical significance of differences in proportions and means, respectively. Univariable and multivariable logistic regression analyses tested the relationship between surgery type (CNT vs. NT) and three end points: in-hospital mortality, complications, and transfusions. Results Overall, 6.0% of patients underwent CNT. The rates of in-hospital mortality, complications, and transfusions were 2.4, 26.5, and 24.3% in CNT patients versus 0.9, 18.9, and 11.1% in NT patients. At multivariable analyses, CNT patients demonstrated a 2.0-, 1.3-, and 2.4-fold higher risk of in-hospital mortality, complications, and transfusions (all P  < 0.001). Similarly, more advanced age, comorbidity, and the cumulative number of secondary surgical procedures were independent predictors of a higher risk of in-hospital mortality, complications, and transfusions (all P  < 0.001). Conclusions The rate of in-hospital mortality, complications, and transfusions is higher in patients treated with CNT relative to NT. Older age, higher comorbidity, and the necessity of secondary surgical procedures further increases the risk of all aforementioned end points. Physicians should consider these observations during the planning of a CNT, and patients should be informed accordingly.

Purpose: The association between marital status and tumor stage and grade, as well as overall mortality (OM) and cancer-specific mortality (CSM) received little attention in patients with squamous cell carcinoma of the penis (SCCP). Methods: We relied on the surveillance, epidemiology, and end results (SEER) 17 database to identify patients diagnosed with primary SCCP. Logistic and Cox regression models, respectively, addressed the effect of marital status on the rate of locally advanced disease and its effect on OM and CSM. Covariates consisted of age, race, socioeconomic status, year of surgery, and SEER registries. Results: Between 1988 and 2006, 1,884 patients with SCCP were identified. At surgery, 1,192 (63.3 %) were married and 966 (51.3 %) had locally advanced disease. In multivariable logistic regression models predicting locally advanced disease at surgery, unmarried men had a 1.5-fold higher (p < 0.001) risk than others. In multivariable Cox models predicting CSM, marital status had no effect [hazard ratio (HR) = 1.3, p = 0.1]. Finally, in multivariable Cox models predicting OM, unmarried men had a 1.3-fold higher (p = 0.001) risk than others. Conclusion: Unmarried men tend to present with less favorable disease stage at SCCP. Moreover, unmarried men tend to live less long than their married counterparts. However, marital status has no effect on CSM.

Objective: The detrimental effect of unmarried marital status on stage and survival has been confirmed in several malignancies. We set to test whether this applied to patients diagnosed with prostate cancer (PCa) treated with radical prostatectomy (RP). Methods: We identified 163,697 non-metastatic PCa patients treated with RP, within 17 Surveillance, Epidemiology, and End Results registries. Logistic regression analyses focused on the rate of locally advanced stage /pNl) at RP. Cox regression analyses tested the relationship between marital status and cancer-specific (CSM), as well as all-cause mortality (ACM). Results: Respectively, 9.1 and 7.8% of individuals were separated/divorced/widowed (SDW) and never married. SDW men had more advanced stage at surgery (odds ratio: 1.1; p < 0.001), higher CSM and ACM (both hazard ratio [HR]: 1.3; p < 0.001) than married men. Similarly, never married marital status portended to a higher ACM rate (HR: 1.2, p = 0.001). These findings were consistent when analyses were stratified according to organ confined vs. locally advanced stages. Conclusions: Being SDW significantly increased the risk of more advanced stage at RP. Following surgery, SDW men portended to a higher CSM and ACM rate than married men. Consequently, these individuals may benefit from a more focused health care throughout the natural history of their disease.

Chronic inflammation may play a role in prostate cancer carcinogenesis. In that context, our objective was to investigate the role of nonsteroidal anti‐inflammatory drugs (NSAIDs) in prostate cancer risk based on the EPICAP data. EPICAP is a population‐based case–control study carried out in 2012–2013 (département of Hérault, France) that enrolled 819 men aged less than 75 years old newly diagnosed for prostate cancer and 879 controls frequency matched to the cases on age. Face to face interviews gathered information on several potential risk factors including NSAIDs use. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated using unconditional logistic regression models. All‐NSAIDs use was inversely associated with prostate cancer: OR 0.77, 95% CI 0.61–0.98, especially in men using NSAIDs that preferentially inhibit COX‐2 activity (OR 0.48, 95% CI 0.28–0.79). Nonaspirin NSAIDs users had a decreased risk of prostate cancer (OR 0.72, 95% CI 0.53–0.99), particularly among men with an aggressive prostate cancer (OR 0.49, 95% CI 0.27–0.89) and in men with a personal history of prostatitis (OR 0.21, 95% CI 0.07–0.59). Our results are in favor of a decreased risk of prostate cancer in men using NSAIDs, particularly for men using preferential anti‐COX‐2 activity. The protective effect of NSAIDs seems to be more pronounced in aggressive prostate cancer and in men with a personal history of prostatitis, but this needs further investigations to be confirmed. Our results showed a decreased risk of prostate cancer in men using NSAIDs, especially with frequent, current, and chronic use. This effect is particularly observed in men using nonaspirin NSAIDs, and especially with preferential anti‐COX‐2 activity. Protective effect of NSAIDs seemed to be more pronounced in aggressive prostate cancer and in situation of chronic inflammation mediated by a personal history of prostatitis.

Purpose The existing literature suggests that the postoperative mortality (POM) rate in radical cystectomy (RC) patients does not exceed 3%. We sought to develop and externally validate a reference table that quantifies POM after RC. Methods We identified 12,274 patients treated with RC, between 1998 and 2007, within the Nationwide Inpatient Sample database. A total of 6188 (50.4%) randomly selected patients was used as the development cohort. Logistic regression analysis for prediction of POM adjusted for: age, sex, race, Charlson comorbidity index (CCI), urinary diversion type, year of surgery, annual hospital caseload, location/teaching status of hospital, region and bed size of hospital. The reference table was developed by using stepwise variable removal to identify the most accurate and parsimonious model. The model was externally validated in 6086 (49.6%) patients. Results POM occurred in 2.4% of patients. POM proportion increased with increasing age (≤59: 0.6% vs. 60–69: 1.6% vs. 70–79: 3.1% vs. ≥80: 4.6%, P  < 0.001), and higher CCI (CCI 0: 1.7% vs. CCI 1: 3.0% vs. CCI 2: 4.2% vs. CCI 3: 4.3% vs. CCI ≥ 4: 12.1%, P  < 0.001). In multivariable analyses, only age and CCI remained as independent predictors of POM, after stepwise variable removal. The discrimination accuracy of the reference table in predicting POM was 70%. Conclusions Age and CCI represent the foremost determinants of POM after RC. The developed reference table is capable of predicting POM after RC, in an individualized fashion. The accuracy of the model is good (70%), and it is highly generalizable.