Editor’s Choice

You have accessJournal of UrologyEditor's Choice1 May 2024Editor's Choice D. Robert Siemens D. Robert SiemensD. Robert Siemens https://orcid.org/0000-0002-3203-6468 View All Author Informationhttps://doi.org/10.1097/JU.0000000000003913AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Gabapentin for Scrotal Surgery Periprocedure pain control has become pivotal to quality improvement in our practices over the years, with novel strategies meant to increase patient satisfaction at the same time as reducing opioid use.1 Though nonsteroidal anti-inflammatories have a role in multimodal pain management for scrotal surgery, the role of gabapentin is untested. Meta-analyses have demonstrated inconsistent effects of gabapentin on pain and opioid avoidance, with some significant risk.2 However, postoperative pain after scrotal surgery may have a neuropathic component, so these agents may represent an effective, albeit off-label, solution. Punjani et al test this in a randomized, double-blind, placebo-controlled trial to evaluate its efficacy and safety.3 The findings from 70 patients show that gabapentin significantly reduced postoperative pain, although without impacting opioid usage, patient satisfaction, or increasing adverse events. The authors conclude that perioperative gabapentin could be a viable component in the multimodal pain management strategy after scrotal surgery, offering a significant reduction in pain with minimal risk. Neoadjuvant Chemohormonal Therapy in Locally Advanced Prostate Cancer The optimal management of very-high-risk, locally advanced prostate cancer remains controversial. Neoadjuvant trials with hormonal therapy (NHT) prior to surgery have hinted at some benefits, but with inconsistent gains in survival outcomes. Pan et al advance our understanding, completing a trial testing the efficacy of docetaxel-based neoadjuvant chemohormonal therapy (NCHT) prior to radical prostatectomy in patients with locally advanced prostate cancer, comparing it to NHT alone.4 Conducted as a randomized trial with 141 high-risk patients, the authors aimed to determine if NCHT offers pathological benefits and improves 3-year biochemical progression-free survival (bPFS). The results revealed that patients receiving NCHT had significant improvements in 3-year bPFS rates compared to the NHT group, with a longer median time to bPFS, although no significant differences were noted in pathological downstaging or minimal residual disease rates. The authors conclude that NCHT offers substantial bPFS benefits over NHT in high-risk, locally advanced disease, advocating for larger scale studies and longer follow-up for further validation. The study is important and will add to the conversation on neoadjuvant treatment strategies when other currently recruiting trials read out, including those that are biomarker driven and involve other novel therapies. Conversion of Partial to Radical Nephrectomy Partial nephrectomy (PN) has eclipsed radical nephrectomy (RN) for the treatment of smaller, localized renal masses and, especially when performed with advanced technological support, has been associated with favorable oncological outcomes with the added benefit of preserving renal function for even more surgically complex cases.5 Yet the potential for conversion from PN to RN during surgery is a risk that requires further exploration, especially given its importance in preoperative patient counseling and surgical planning. Wang et al deepen our understanding of the factors that might predispose patients to this conversion risk, evaluating 650 patients scheduled for robotic PN from MUSIC-KIDNEY (the Michigan Urological Surgery Improvement Collaborative‒Kidney mass: Identifying and Defining Necessary Evaluation and therapY).6 The authors found that only 4.2% were converted to RN, with no reported conversions to open surgery. A significant finding was that preoperative plans had already acknowledged the possibility of conversion in most of these cases. Intraoperative decisions to convert were predominantly based on tumor complexity or oncological concerns rather than bleeding, which only accounted for 19% of conversions. The authors' findings can help with preoperative counseling, detailing the low overall risk of conversion in the real-world setting, with most decisions to convert being supported by oncological concerns and highlighting the importance of judicious surgical decision-making. The Effect of Delayed Voiding in the Workplace There is suggestive evidence that the prevalence of lower urinary tract symptoms (LUTS) varies across occupations. Some studies report that women in certain occupations have increased rates of LUTS that can lead to behavioral modification and even associate with negative workplace outcomes. Rao et al, in this issue of The Journal, investigate the impact of nursing workloads on LUTS, particularly focusing on delayed voiding behavior as a critical occupational health issue.7 Analyzing data from an impressive survey of 13,191 women working as nurses in 20 tertiary hospitals in China, the research examines how voiding behaviors are linked to workloads and contribute to the development of LUTS. The findings reveal that over half of the participants suffer from LUTS, and subjective workload significantly influences LUTS through delayed voiding behaviors. The importance of this study lies in its large sample size and the implications it holds for occupational health policies and the promotion of bladder health in workplaces such as nursing. REFERENCES 1. . Practical use of self-adjusted nitrous oxide during transrectal prostate biopsy: a double-blind randomized controlled trial. J Urol. 2024; 211(2):214-222. Link, Google Scholar 2. . Gabapentinoids in urology: a review of their current role. J Urol. 2023; 209(1):12-13. Link, Google Scholar 3. . Gabapentin for postoperative pain control and opioid reduction in scrotal surgery: a randomized controlled clinical trial. J Urol. 2024; 211(5):658-666. Link, Google Scholar 4. . A prospective randomized trial of neoadjuvant chemohormonal therapy vs hormonal therapy in locally advanced prostate cancer treated by radical prostatectomy. J Urol. 2024; 211(5):648-655. Google Scholar 5. . Does utilizing IRIS, a segmented three-dimensional model, increase surgical precision during robotic partial nephrectomy?. J Urol. 2023; 210(1):171-178. Link, Google Scholar 6. ; Michigan Urological Surgery Improvement Collaborative. Conversion to radical nephrectomy from robotic partial nephrectomy is most commonly due to anatomic and oncologic complexity. J Urol. 2024; 211(5):669-676. Link, Google Scholar 7. . Nursing workloads and lower urinary tract symptoms among Chinese female nurses: the mediating role of delayed voiding behaviors. J Urol. 2024; 211(5):699-706. Link, Google Scholar © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5May 2024Page: 643-644 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information D. Robert Siemens More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...