Editorial comment
Current United States Preventative Services Task Force (USPSTF) guidelines endorse shared decision making (SDM) for PSA screening.1 However, current evidence shows marked variation and underutilization in SDM for prostate cancer screening, especially amongst more vulnerable patient populations.2 Although poorly studied, race and ethnicity, levels of education, income, and health literacy likely all play an important role in the adoption of SDM and, hence, account at least in part for the discrepancy between guideline recommendations and current practice. (Source: Urology)
Source: Urology - May 1, 2022 Category: Urology & Nephrology Authors: Rodrigo Rodrigues Pessoa, Simon P. Kim Source Type: research

Author reply
We want to thank Urology and the Editorial Response authors for 1 considering the importance of how the social determinants of health (SDH) affect shared decision making (SDM) for prostate cancer screening. Health literacy (HL) plays a particularly important role in prostate cancer screening, when considering the best interest of the patient and mitigating over-utilization of health care resources. It is well documented that racial barriers influence access to health care screening; surprisingly, our study illustrates that African-American men had higher rates of PSA testing. (Source: Urology)
Source: Urology - May 1, 2022 Category: Urology & Nephrology Authors: Scott C. Jamieson, Chase W. Mallory, Dhaval R. Jivanji, Alejandra Perez, Grettel Castro, No ël C. Barengo, Jorge Pereira, Alan M. Nieder Source Type: research

Editorial comment
Prostate cancer is a unique disease in which the treatment options impact the patient's quality of life. When determining prostate cancer management strategies providers and patients consider a number of factors including: life expectancy, disease specific factors and the treatment impact on functional outcomes and quality of life. Numerous studies have shown equivalent survival outcomes for both surgery and radiation therapy1; however, the quality-of-life outcomes vary and thus patient priorities often drive treatment decisions. (Source: Urology)
Source: Urology - May 1, 2022 Category: Urology & Nephrology Authors: Amy N. Luckenbaugh Source Type: research

Editorial comment
The authors of the study “Outcomes of the Supris Sling in an Urban Latina Population” performed a retrospective analysis examining 101 patients of Latina heritage who underwent midurethral sling placement utilizing the Supris sling. They found that this population of women had excellent success rates of stress urinary i ncontinence (SUI) treatment and low complication rates. This mirrors success and complication rates seen in larger, general populations and this study confirms that a midurethral sling is an effective and safe treatment option in this ethnic group. (Source: Urology)
Source: Urology - May 1, 2022 Category: Urology & Nephrology Authors: Raveen Syan Source Type: research

Editorial comment
Success rates of retropubic sling in Latina women compare with those published in the clinical trial literature. Urinary urgency and urgency incontinence symptoms may be more predominant in Latina women, and Gonzalez et al. emphasize need for further investigation of potential underlying structural, cultural, environmental, or lifestyle-related factors that may be at play. This amplifies generalizability of sling clinical trial results to an important demographic that is otherwise not well-represented in phase III trials for stress urinary incontinence. (Source: Urology)
Source: Urology - May 1, 2022 Category: Urology & Nephrology Authors: Yahir Santiago-Lastra Source Type: research

Editorial comment
In this study, Seiden and colleagues1 assessed the utility of genomic testing to risk stratify 63 Black men with prostate cancer eligible for active surveillance (AS) at King's County Hospital Center, which serves a predominantly under-represented minority population in Brooklyn. In 63% of the cohort, genomic testing was discordant with initial risk stratification, with 28 men being reclassified to a higher National Comprehensive Cancer Network (NCCN) risk category and this was independent of a pre-biopsy prostate specific antigen (PSA)>10 ng/ml, abnormal digital rectal examination (DRE) and a high Prostate Imaging-Reporti...
Source: Urology - May 1, 2022 Category: Urology & Nephrology Authors: Peter E. Lonergan Source Type: research

Author reply
The majority of men diagnosed with prostate cancer in the PSA-screening era are eligible for active surveillance and is often the initial therapy in men with low-risk prostate cancer. Active surveillance may reduce unnecessary treatments for patients without increasing risk of prostate cancer mortality.123 However, Black men represented only 7%-13% in these prospective cohort studies. Compared to White men, it has been previously shown that Black men have an increased prostate cancer incidence, higher baseline prostate-specific antigen value, more aggressive prostate cancer features, greater frequency of biochemical recurr...
Source: Urology - May 1, 2022 Category: Urology & Nephrology Authors: Stanley Weng, Benjamin Seiden, Andrew G. Winer Source Type: research

Editorial comment
This study clearly shows that self-identified Black men classified as being low risk with standard NCCN based risk criteria may harbor genomically aggressive disease. (Source: Urology)
Source: Urology - May 1, 2022 Category: Urology & Nephrology Authors: Shivanshu Awasthi, Kosj Yamoah Source Type: research

Editorial comment
The authors test the hypothesis that African American (AA) race confers a lower success rate on urethral reconstruction for stricture using a retrospective case series design. Detailed preoperative stricture information show that Caucasian (CA) and AA patients have similar stricture length and undergo equivalent surgical reconstructions (eg anastomotic versus substitution urethroplasty). The ability to answer questions about disparate outcomes depends on a sufficient number of events (eg complications or stricture recurrences) and the authors are hampered by their own success. (Source: Urology)
Source: Urology - May 1, 2022 Category: Urology & Nephrology Authors: Hunter Wessells Source Type: research

Author reply
We agree that the retrospective nature of the study introduces biases that prevent making definitive proclamations about race and its effect on urethroplasty success.  Unfortunately, one ofthese limitations includes the number of dilations or DVIUs that patients have received in the past. Often times patients are unsure how many endoscopic procedures they have undergone because it has been so numerous. This limitation would be useful to explore in future studie s as an additional factor that might be compounding quality and access of care. (Source: Urology)
Source: Urology - May 1, 2022 Category: Urology & Nephrology Authors: Kathryn N. Sawyer, Stacey S. Cofield, John P. Selph Source Type: research

Editorial comment
Using a measure of neighborhood “disadvantage” known as the Area Deprivation Index (ADI), Knorr et al report higher rates of post radical cystectomy morbidity/mortality among patients that live in the most socioeconomically disadvantaged areas. Several prior studies have evaluated the impact socioeconomic position (SEP) has on post-cystectomy outcomes. However, this study is unique in that the exposure tested extends beyond solitary measures of socioeconomic position (such as income or education) to a validated composite measure that also provides a more nuanced understanding of neighborhood dwelling absent in prior st...
Source: Urology - May 1, 2022 Category: Urology & Nephrology Authors: Leah Ibrahim Puri, Richard S. Matulewicz Source Type: research

Author reply
We acknowledge that use of the Area Deprivation Index (ADI) for post-operative risk assessment has limitations pertaining to the inability to capture individual level socioeconomic position (SEP) and other demographic variables that ultimately contribute to outcomes following radical cystectomy. We agree that historic discriminatory housing practices are responsible for a significant portion of modern-day inequity among those residing in disadvantaged neighborhoods across the United States but assert that this point is outside the scope of the present study. (Source: Urology)
Source: Urology - May 1, 2022 Category: Urology & Nephrology Authors: Jacob M. Knorr, Rebecca A. Campbell, Joshua Cockrum, Jarrod E. Dalton, Prithvi B. Murthy, Ryan K. Berglund, Jennifer Cullen, Christopher J. Weight, Nima Almassi, Robert Abouassaly, Jihad H. Kaouk, Georges-Pascal Haber, Byron H. Lee Source Type: research

Editorial comment
As Williams and Talwar comment, policy surrounding telemedicine is forthcoming and needed. During the initial emergence of COVID-19 the Center for Medicare and Medicaid Services (CMS) temporarily expanded insurance coverage to include telemedicine.1 Similarly, most private insurances followed the path of CMS and expanded their coverage as well. CMS is finalizing their policy to extend telemedicine coverage into 2023 as many private insurances are doing the same. 1 While coverage is being extended, it remains unclear if this coverage will be permanent, and whether or not telemedicine will continue to offer fair and equitabl...
Source: Urology - May 1, 2022 Category: Urology & Nephrology Authors: Juan Javier-DesLoges, Manoj Monga, Ithaar Derweesh Source Type: research

Author reply
Although the COVID-19 pandemic accelerated the implementation of telemedicine, it is likely here to stay even beyond the pandemic, given its ability to improve access to care by reducing logistic barriers for patients like transportation, time taken off from work, and access for rural populations.1 The rapid adoption of telemedicine resulted in a 12% increase in telemedicine usage among practicing urologists.2 Wider use of telemedicine has potential to ameliorate the worsening workforce shortages in underserved areas that do not have practicing urologists. (Source: Urology)
Source: Urology - May 1, 2022 Category: Urology & Nephrology Authors: Cheyenne Williams, Ruchika Talwar Source Type: research

Editorial comment
Racial disparities in the diagnosis and treatment of urological malignancies are well known. In SEER-Medicare, black patients were less likely to undergo initial surgical management for early-stage renal cell carcinoma with a greater rather than reduced disparity among healthy patients.1 For patients with muscle-invasive bladder cancer in the National Cancer Data Base, differences in access and treatment rather than tumor characteristics accounted for most of the racial disparity in overall survival. (Source: Urology)
Source: Urology - May 1, 2022 Category: Urology & Nephrology Authors: Hiten D. Patel, Gopal N. Gupta Source Type: research