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Centers of Excellence: From the Editor

Centers of Excellence: From the Editor

Comparison of Diagnostic Accuracies of Commonly Used Trial of Void Parameters

Importance: Understanding the diagnostic accuracy of postoperative trial of void (TOV) parameters is important for decision making related to postoperative catheterization.

Objective: The aim of the study was to compare the diagnostic accuracies of common postoperative TOV parameters.

Design: The study population comprised a prospective cohort undergoing outpatient urogynecologic procedures at a tertiary referral center from September 2018 to June 2021. Participants recorded their postvoid residual volume (PVR), voided volume, and subjective force of stream (sFOS) for all postoperative voids until meeting criteria to stop. The primary outcome was the sensitivity of TOV parameters in predicting postoperative urinary retention, defined as PVR ≥1/2 voided volume on the first 2 postoperative voids. Sample size was set at 183 to detect a 20% difference (α = 0.05, β = 0.2, up to 20% with missing data) in sensitivity between TOV parameters. Diagnostic accuracies were compared with McNemar’s test for paired proportions, with Youden’s index calculated to determine optimal thresholds.

Results: The 160 participants had a mean age of 52.1 ± 11.4 years and a mean body mass index of 28.9 ± 5.8 kg/m2 (calculated as weight in kilograms divided by height in meters squared).Mean preoperative PVR was 25.8 ± 29.9 mL. Most participants had surgery that included a midurethral sling (137/160, 85.6%). Thirty-four (34/160, 21.3%) participants met criteria for postoperative urinary retention. The optimal recovery room TOV thresholds to predict postoperative urinary retention were PVR ≥87 mL (sensitivity 96.8%, specificity 60.0%), voided volume ≤ 150 mL (sensitivity 83.9%, specificity 72.3%), and sFOS ≤60% (sensitivity 100%, specificity 50.8%). Voided volume ≤ 150 mL had greater diagnostic accuracy than PVR ≥100 mL (156.2 vs 151.8).

Conclusions: In this cohort, PVR ≥87 mL, voided volume ≤ 150 mL, and sFOS ≤60% had optimal diagnostic accuracy for postoperative urinary retention.

Julia K. Shinnick, MD,* Christina A. Raker, ScD,† Elizabeth J. Geller, MD,‡ Charles R. Rardin, MD,* and Anne C. Cooper, MD, MA§

*Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Teaching Affiliate of the Warren Alpert Medical School of Brown University, Providence, RI; †Division of Research, Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Teaching Affiliate of the Warren Alpert Medical School of Brown University, Providence, RI; ‡Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and §Division of Urogynecology, Department of Obstetrics & Gynecology, Dartmouth Geisel School of Medicine, Dartmouth, NH.

Source: Shinnick, et al. Comparison of Diagnostic Accuracies of Commonly Used Trial of Void Parameters. Urogynecology 2024;00:00–00 DOI: 10.1097/SPV.0000000000001539.

Advancing mHSPC Care: Bridging Research and Practice - A Letter from UroToday's mHSPC Center of Excellence Editor-in-Chief, Neeraj Agarwal, MD, FASCO

Welcome to UroToday’s Center of Excellence on metastatic hormone-sensitive prostate cancer (mHSPC). I am honored to serve as its new editor. This multimedia Center helps audiences in the United States and worldwide stay abreast of clinical trials, real-world studies, biomarker data, regulatory approvals, and expert perspectives on this challenging, dynamic disease and treatment landscape. As therapies for patients with mHSPC evolve, real-world practice has lagged behind. Indeed, five years after the regulatory approvals of novel androgen receptor pathway inhibitors (ARPIs) for treating mHSPC, data suggest that less than half of patients are receiving them in the metastatic hormone-sensitive setting. In this editorial, I cover key data and approvals in mHSPC, what we know about real-world treatment patterns, and how we can narrow gaps between data and practice.


In the United States, the National Cancer Institute estimates that at least 8% of all prostate cancer cases are metastatic when first diagnosed (ie, de novo or synchronous mHSPC),1 and this proportion is higher in regions where prostate-specific antigen (PSA) screening is not routine and thus patients are more likely to be diagnosed only after they become symptomatic.2-4

Welcome Letter from the Advanced Prostate Cancer Center of Excellence Editor

For more than 20 years, UroToday has been THE premier online educational resource for genitourinary oncology – clinicians educating clinicians. During this time, advanced prostate cancer has been completely transformed, pa≥ particularly in the last 10+ years. Since then, we have seen (briefly) the following in advanced prostate cancer:

  • Docetaxel for mCRPC progression
  • Cabazitaxel following docetaxel for mCRPC progression
  • Radium-223 for mCRPC
  • Docetaxel + ADT for mHSPC
  • Abiraterone + prednisone for mHSPC
  • ARPIs + ADT for mHSPC
  • ARPIs + ADT for M0 CRPC
  • Enzalutamide +/- ADT for non-metastatic HSPC
  • PARP inhibitors for mCRPC
  • Radioligand therapy for mCRPC

Emerging Frontiers in Advanced Bladder Cancer: Paradigm Shifts in Diagnosis and Treatment

Thank you for visiting UroToday’s Center of Excellence for Advanced Bladder Cancer (aUC). I am delighted to serve as its new editor. This Center of Excellence curates evergreen content on emerging diagnostic and treatment information in a rapidly changing field.

Embracing Trimodal Therapy as a Viable Alternative to Radical Cystectomy

For years, the standard treatment for muscle-invasive bladder cancer (MIBC) was radical cystectomy (RC), preceded by neoadjuvant cisplatin-based chemotherapy (NAC), if tolerable. Currently, the National Comprehensive Cancer Center (NCCN) has two category 1 recommendations for patients with cT2-T4aN0 MIBC: NAC followed by cystectomy, and trimodal therapy (TMT).1

Health Policy in Urological Diseases

The recent cyberattack on Change Healthcare has been called the most pervasive and damaging of its type in U.S. history.1 Change is a third-party healthcare technology company that, by its own account, touches 1 in every 3 patient records and processes 15 billion transactions annually.2 After the attack, Change shut down its systems to prevent further breaches, which left tens of thousands of healthcare providers unable to electronically fill prescriptions, verify insurance eligibility, obtain prior authorizations, or submit reimbursement claims.

Addressing Knowledge Gaps and Clinical Challenges of PSMA PET in Prostate Cancer

More than three years after the first FDA approval of a PSMA radiotracer for detecting prostate cancer (PCa), we are seeing an evolution and maturation of use in the clinic. The availability of PSMA PET with different tracers enables us to detect lesions that conventional imaging misses, identify disease recurrence at very low (<0.5 ng/mL) PSA levels, and distinguish between benign and malignant tissue.1-3 In some countries and regions, PSMA PET is now standard practice for initial PCa staging, treatment planning, and monitoring treatment response. However, questions persist about how to manage patients in the PSMA PET era, particularly because registrational trials of current therapies predated the widespread availability of PSMA PET and therefore used only conventional imaging (i.e., CT, bone scan). Here, I discuss current knowledge gaps pertaining to the use of PSMA PET in various scenarios and how we can best steward this resource.

Addressing Gender Disparities in Urology and Genitourinary Cancer Research

Gender disparities –the underrepresentation of women and other gender minorities—have historically and continually plagued many fields of medicine and scientific research. The fields of urology, genitourinary (GU) oncology, and prostate cancer research have especially been male-dominated.1,2

Advances in Therapeutic Strategies for Advanced Renal Cell Carcinoma: A Comprehensive Review

Advanced renal cell carcinoma (RCC) accounts for about 2% of cancer deaths globally, and its incidence is increasing in the United States and worldwide.1 Clear cell RCC (ccRCC) comprises about 75% of RCCs and is the most aggressive subtype, although survival rates are substantially improving with the advent of targeted systemic therapies and immune checkpoint inhibitors. In this editorial, I update readers on current therapeutic approaches for patients with advanced RCC, including clear cell and other histotypes. I also review the role of (neo)adjuvant treatment and biomarkers in advanced RCC management.

Empowering Bladder Cancer Care: A Formal Partnership between IBCG and UroToday in the Era of Expanding Therapies

“Nothing in life is to be feared; it is only to be understood.” – Marie Curie

As we embark on 2024, we continue to see an explosion of research and clinical trials in bladder cancer. Every FDA approval is the fruit of thousands of hours of dedicated work by investigators, patients, research, and clinical teams. However, regulatory approval is only the first step in linking patients with new therapies. Without effective dissemination of knowledge and guidance, many patients will not receive evidence-based treatments and indeed may not even know their treatment options.

In Bladder Cancer, Listen to Patients and Prioritize Quality of Initial Management

Bladder cancer can be seen as a chronic condition—patients with nonmetastatic disease can live years, even decades, after diagnosis, and they often die of unrelated causes.1 This chronicity intensifies the impacts of initial management: Clinical decisions made in the first weeks or months of the patient’s journey exert a domino effect that spans the entire disease trajectory. Early detection and appropriate initial management significantly improve patient outcomes and quality of life, while delayed detection and excessive or inappropriate treatment lead to needless suffering and financial toxicity.

Introduction to the Trimodality Therapy - Bladder Cancer Center of Excellence

Muscle-invasive bladder cancer (MIBC) represents 1/3 of the approximately 81,000 newly diagnosed bladder cancer cases in the US each year.1 Cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) has been the traditional and most widely used management approach to MIBC.

Welcome to the Pelvic Health Center of Excellence

Diane Newman welcomes viewers to the Pelvic health Center of Excellence on UroToday.com The leading location for state of the art lectures, original articles, research, current treatments and emerging clinical care in pelvic health and pelvic floor dysfunction. Diane encourages viewers to utilize this center as a resource for current research, clinical expertise and to stay up to date with current treatments and interventions.

Social Determinants of Health and Healthcare Disparities Within Urology

Welcome to UroToday’s new Center of Excellence on Disparities: Social Determinants of Health. I am honored to serve as its Editor and excited to share new research and expert conversations with you. The World Health Organization and the United States Centers for Disease Control and Prevention define social determinants of health (SDOH) not as individual variables, but as the environments in which people are born, grow, learn, work, play, and age.1,2 Specific characteristics of these environments can either increase or reduce disparities in health, healthcare access, and quality of life among individuals, regions, and nations. This Center focuses on SDOH and healthcare disparities within urology, particularly genitourinary (GU) oncology. However, it is important to emphasize that SDOH affects all persons and all healthcare fields in a multitude of ways, and therefore, many topics covered by this Center will appeal to a broad audience. In this editorial, I outline the current status of GU research on SDOH and disparities, how experts are redefining SDOH and downstream effects in order to improve research and policy, and why it is crucial to engage medically underserved communities in these efforts.

An Introduction to the UroToday “Prostate Cancer Translational Research” Center of Excellence

Over the past several decades, significant strides have been made in the development of new treatments for prostate cancer.  Twenty years ago, the only option for patients with metastatic castration-resistant prostate cancer (mCRPC) was to continue androgen deprivation therapy (ADT), despite diminishing efficacy; today, there are over a dozen treatment options and combinations for patients with advanced prostate cancer. These new treatments and the advent of PSA screening have reduced prostate cancer mortality rates by over 50% since 1993; however, an estimated 34,700 patients in the U.S. and 375,000 globally are still dying from prostate cancer each year. 1, 2 Our work is not yet done.

Welcome to the Gender Disparities in Urologic Oncology Center of Excellence

It’s a great pleasure to welcome you to the UroToday Center of Excellence focusing on sex- and gender-based disparities among urologists and their patients. Some may wonder why a site like UroToday is taking on this focus – hopefully, as you digest the data that this center will provide, it will become clear that the bias and disparities existing in our society critically affect our professional interactions and career satisfaction, the delivery of urologic care, and outcomes for our patients.

Introducing UroToday’s Health Policy Center of Excellence

We are very excited to welcome you to UroToday’s new Health Policy Center of Excellence. Although the practice of medicine has always been profoundly shaped by the sociopolitical landscape, the COVID-19 pandemic was a stark reminder of how healthcare and policy rely heavily on each other to ensure a functioning and healthy society. Urology may be a small field, but even two decades ago, the estimated cost burden of urological diseases in Americans exceeded $11 billion.1 Despite this, the voice of the urologist is often missing from legislation and healthcare initiatives.

Nomenclature Matters: What Should the Future Be for Gleason Grade Group 1?

The term “cancer” dates to the time of Hippocrates, when the crab (karkinos)-like cutaneous manifestations of advanced tumors heralded incurable disease, pain, decline, and death. Today the term denotes an incredibly diverse spectrum of conditions, all characterized by abnormal cell division and growth—and nearly all by the capacity for metastasis—but varying very widely in aggressiveness and kinetics of progression. In the era of microscopy and histopathology, each cancer now has its formal criteria for diagnosis, and clinicians recognize the variable meaning of each. To the public, however, the connotation of the diagnosis “You have cancer” has changed only to an extent in the modern age.

In the case of prostate cancer, prostate specific antigen (PSA)-based early detection and the years-to-decades lead time associated with screening has radically changed the clinical meaning of the diagnosis. Countless research articles and reviews on prostate cancer begin by citing the fact that it is the most common non-cutaneous cancer diagnosed among men in the US and in many other countries.

An Update on Key Areas of Progress In Bladder Cancer

Urothelial carcinoma remains one of the most common malignancies, with about 81,000 new diagnoses and approximately 17,000 associated deaths in 2022 alone.1 Survival numbers are dependent on early diagnosis and drop with delayed diagnosis and/or advanced stages of disease.1 Both muscle-invasive bladder cancer (MIBC) and non-muscle invasive bladder cancer (NMIBC) are associated with substantial morbidity and reduced quality of life.2,3

Recent Findings from Clinical Trials, Observational Studies, and Molecular and Genomic Research in Upper Tract Urothelial Carcinoma

Thank you for visiting UroToday’s Center of Excellence on upper tract urothelial carcinoma (UTUC). We examine expert content in a variety of formats to help practicing clinicians stay up to date. This letter highlights some of the most exciting recent findings from clinical trials, observational studies, and molecular and genomic research.