Standardized Reporting of Machine Learning Applications in Urology: The STREAM-URO Framework

The Standardized Reporting of Machine Learning Applications in Urology (STREAM-URO) framework was developed to provide a set of recommendations to help standardize how machine learning studies in urology are reported. This framework serves three purposes: (1) to promote high-quality studies and streamline the peer review process; (2) to enhance reproducibility, comparability, and interpretability of results; and (3) to improve engagement and literacy of machine learning within the urological community.

Diagnostic accuracy of SUVmax in predicting malignancy of supraclavicular lymph nodes from primary oesophageal cancer

PURPOSE

To determine the diagnostic accuracy and optimum cut-off value of SUVmax on PET to predict malignancy of supraclavicular lymph nodes (SCLNs) in patients with oesophageal carcinoma.

MATERIAL AND METHODS

All diagnosed cases of oesophageal cancer were retrospectively reviewed (2010-2016). Patients that had a confirmed diagnosis of oesophageal cancer with avid SCLNs on staging PET were included in the study. 33 SCLNs that subsequently underwent ultrasound guided biopsy for staging were analysed. The maximum uptake values (SUVmax) of the SCLNs and primary tumours were measured. A receiver operating characteristic (ROC) analysis was performed to determine the optimum cut off of SUVmax in predicting malignancy.

RESULTS

24/33 PET-detected SCLNs were malignant. ROC analysis identified the best nodal SUVmax cut-off to be 3.0. The diagnostic accuracy of PET was 76.0 % (sensitivity = 78.9 %, specificity = 66.6 %). For SCLNs with SUVmax > 3.0, PET showed a positive predictor value of 88.2 %; for SCLNs < 3.0, PET showed a negative predictor value of 50 %. The median SUVmax of pathologically negative and positive nodes were 2.8 (range 1.8-6.0) and 5.3 (range 1.9-13.4). The median primary tumour SUVmax was 13.8 (range 3.7-30.0). The SUVmax of metastatic lymph nodes were significant higher than those of benign lesions (p < 0.05).

CONCLUSION

Our study revealed an accuracy rate of 76 % for PET detected SCLNs in patients with oesophageal carcinoma. For SCLNs with SUVmax > 3.0, PET had a high PPV (88 %), which can minimize the need for further diagnostic tests.

Long-Term Outcomes of Renal Transplant in Patients With End-Stage Renal Failure Due to Systemic Lupus Erythematosus and Granulomatosis With Polyangiitis

OBJECTIVES

Systemic lupus erythematosus and granulomatosis with polyangiitis are systemic inflammatory conditions associated with renalfailure that can recur after renal transplant. Patients with these conditions are treated with chronic immunosuppression, potentially increasing risk of secondary malignancies. Here, we investigated long-term outcomes in renal transplant recipients with these conditions.

MATERIALS AND METHODS

Transplant recipients with end-stage kidney disease due to systemic lupus erythematosus and granulomatosis with polyangiitis seen between 1982 and 2016 at a national kidney transplant center were included. Primary outcome variables were long-term allograft survival and incidence of secondary malignancy. Secondary outcome measures were incidence of delayed graft function, primary disease recurrence, and serum creatinine at follow-up.

RESULTS

Ninety-eight transplant procedures (90 from deceased donors) in 92 consecutive patients (mean age 42.3 ± 14.4 y) were included: 55 with systemic lupus erythematosus and 37 with granulomatosis with polyangiitis. Follow-up duration was 110.53 ± 81.95 months (range, 1-393 mo). Overall renal allograft survival was 94.7% at 1 year, 85.4% at 5 years, and 75.4% at 10 years posttransplant. Patientswith systemic lupus erythematosus showed overall allograft survival of 91.6% at 1 year, 84.3% at 5 years, and 74.4% at 10 years. There was 1 allograft failure due to recurrence of primary disease in this group. Patients with granulomatosis with polyangiitis showed overall allograft survival of 100% at 1 year, 92.4% at 5 years, and 92.4% at 10 years. There were 21 mortalities, with 5 (23.8%) due to secondary malignancy. In total, 46 malignancies were diagnosed in 31 patients.

CONCLUSIONS

We found excellent long-term renal allograft survival rates in patients with systemic lupus erythematosus and granulomatosis with polyangiitis, with secondary malignancy rates similar to those shown in recipients without autoimmune diseases. These findings provide clinicians with long-term data on transplant recipients with end-stage renal failure due to systemic inflammatory conditions.

The value of multimodality imaging in the investigation of a PSA recurrence after radical prostatectomy in the Irish hospital setting

INTRODUCTION

The diagnostic evaluation of a PSA recurrence after RP in the Irish hospital setting involves multimodality imaging with MRI, CT, and bone scanning, despite the low diagnostic yield from imaging at low PSA levels. We aim to investigate the value of multimodality imaging in PC patients after RP with a PSA recurrence.

METHODS

Forty-eight patients with a PSA recurrence after RP who underwent multimodality imaging were evaluated. Demographic data, postoperative PSA levels, and imaging studies performed at those levels were evaluated.

RESULTS

Eight (21%) MRIs, 6 (33%) CTs, and 4 (9%) bone scans had PCa-specific findings. Three (12%) patients had a positive MRI with a PSA <1.0 ng/ml, while 5 (56%) were positive at PSA ≥1.1 ng/ml (p = 0.05). Zero patient had a positive CT TAP at a PSA level <1.0 ng/ml, while 5 (56%) were positive at levels ≥1.1 ng/ml (p = 0.03). Zero patient had a positive bone at PSA levels <1.0 ng/ml, while 4 (27%) were positive at levels ≥1.1 ng/ml (p = 0.01).

CONCLUSION

The diagnostic yield from multimodality imaging, and isotope bone scanning in particular, in PSA levels <1.0 ng/ml, is low. There is a statistically significant increase in the frequency of positive findings on CT and bone scanning at PSA levels ≥1.1 ng/ml. MRI alone is of investigative value at PSA <1.0 ng/ml. The indication for CT, MRI, or isotope bone scanning should be carefully correlated with the clinical question and how it will affect further management.

Conversion rates of abstracts to publications from the Irish Society of Urology Annual Meeting (2005–2011) – Questioning the scientific value of national urological meetings for smaller European nations

Background:

Large annual scientific meetings such as the American Urological Association (AUA) and the European Association of Urology (EUA) have abstract conversion rates into publication of 37%−48%. There are no data on the conversion rates from national meetings of smaller European countries. Our objective was to present the conversion rates and manuscript characteristics of the Irish Society of Urology (ISU) annual meeting over a seven-year period (2005–2011), and to demonstrate the value, viability and sustainability of such a meeting as a model for other small national research programmes.

Methods:

All abstracts presented at the ISU annual meeting between 2005 and 2011 were identified. The subsequent publication rate following the meetings was established for the corresponding studies based on a Medline scan. A range of characteristics associated with subsequent publication were analysed using the logistic regression of the dichotomous variable of publications vs. non-publication of each factor.

Results:

Overall, 46% of the 322 abstracts presented at the ISU meeting were followed by publication into Medline-indexed journals with a mean impact factor of 2.6. A total of 74% abstracts were published within two years. Oral presentations were more likely to be published than posters ( p < 0.0001), and prospective clinical research was more likely to be published in a journal with a higher impact factor than retrospective analyses ( p = 0.033); the mean time to publication was 16.7 months.

Conclusions:

Almost half the abstracts presented at the ISU were subsequently published in peer-reviewed journals, the majority within two years. This compares favourably with larger urological meetings, and provides an incentive to other smaller countries within Europe to continue with national research programmes.

Is citation index a good indicator of landmark papers in urology?

Objective:

Knowledge of landmark papers in urology is essential both for the practise of evidence-based medicine and for trainees requiring a syllabus for the FRCS Urology examination. Citation index (CI) is seen as a direct measure of the quality of a scientific paper. The aim of this study was to compare papers with the highest CI in each urologic sub-speciality with the landmark papers in urology.

Methods:

Seventy-nine of the highest impact factor journals in urology, medicine and urologic sub-specialities were identified from the Journal of Citation Reports: Science edition 2012. Urology papers with the highest CI were identified from these journals using the database of the Science CI (1965–2012). Forty-four landmark papers in urology were then identified from textbooks, recommended reading lists for the FRCS Urology examination, and publications on landmark urology papers. High CI papers were then compared to landmark papers.

Results:

The top 10 cited papers in each urologic sub-speciality were identified. A total of 31.8% ( n = 14) landmark papers were among the top 10 cited papers. Urinary tract infection had the highest proportion of landmark papers in the top 10 cited articles. Kidney cancer papers had the highest mean CI while urinary tract trauma had the lowest.

Conclusion:

This study shows that CI alone is a poor indicator of landmark papers in urology. This paper gives a comprehensive overview both of landmark papers in urology and those with the highest CI, and may be used as an adjunct to the FRCS Urology syllabus.

Ureteral diverticulum: a review of the current literature

INTRODUCTION

Ureteral diverticulum is a rare urological condition with only 45 cases described in the literature. These previously reported cases vary in their presentation, diagnosis and management and there is no consensus in the literature on the best diagnostic tool available. We describe our experience on diagnosing and managing this condition in two patients and provide a descriptive review of the current literature on ureteral diverticulum.

MATERIALS AND METHODS

A Medline search was performed to identify all reported cases of ureteral diverticulum. Key words used were: ureteral diverticulum; abortive bifid ureter; congenital diverticulum; acquired diverticulum. We also reviewed the records of two patients who presented consecutively to our institution with a ureteral diverticulum. The clinical and radiological characteristics of this entity were then evaluated.

RESULTS

Forty-one manuscripts were identified, encompassing single case reports and case series, the largest of which contained seven patients. Two additional cases were diagnosed in our institution; a true congenital diverticulum and an abortive bifid ureter which is synonymous with a true ureteral diverticulum. Both were uncomplicated cases and were managed conservatively. Retrograde pyelography was used for definitive diagnosis of this lesion.

CONCLUSION

Ureteral diverticulum may present as an incidental finding or with a secondary complication. Conservative management is advocated in the literature for non-complicated cases. Retrograde pyelography is our diagnostic tool of choice.

Disseminated leiomyosarcoma in a child with acquired immune deficiency syndrome

A child with disseminated leiomyosarcoma and acquired immune deficiency syndrome (AIDS) is reported. She was originally believed to have peptic ulcer disease by radiographic and endoscopic evaluation but was found subsequently to have hypergastrinemia, hypochlorhydria, and a smooth muscle tumor. Leiomyosarcoma in children and its evolution in AIDS are discussed.

Severe gastrointestinal involvement in children with the acquired immunodeficiency syndrome

Five children with the acquired immunodeficiency syndrome (AIDS) and unusual gastrointestinal disease are described. Two children presented with malnutrition, abdominal distention, and diarrhea. One was found to have moderately severe villus atrophy on jejunal biopsy and was initially thought to have celiac disease. Jejunal biopsy from the second child revealed infiltration of the mucosa with acid-fast bacilli-laden macrophages. A third child suffered recurrent abdominal pain, progressive weight loss, diarrhea, and severe gastrointestinal hemorrhage secondary to infection with cytomegalovirus. Pseudomembranous necrotizing jejunitis associated with overgrowth of Klebsiella pneumoniae in the duodenal fluid occurred in one patient. The fifth child presented in the newborn period with Serratia marcescens cholecystitis. Gastrointestinal disease in children with AIDS may be due to idiopathic villus atrophy and bacterial or opportunistic infection.