Have You Read? May 2021

By: Daniel A. Shoskes, MD | Posted on: 01 May 2021

MacDonald SM and Raman JD: Widely Variable Parental Leave Practices for Urology Residency Programs in the United States. Urology 2021; doi: 10.1106/j.urology.2020.12.049.

Parental leave during residency can be a conflict between what is medically necessary and psychologically beneficial against minimum ABU work requirements. In this study, the authors asked a cohort of urology program directors about their current policies. A 22-question survey designed to assess parental leave policies was distributed to 144 ACGME accredited urology residency program directors in the United States.

A total of 65 program directors completed the survey for a response rate of 43%. The median age of program directors was 49 and 78% were male. Only 12% reported no formal maternity leave policy, while 21% reported no formal paternity leave policy. Maternity leave duration varied greatly with 6 (49%) and 12 weeks (27%) as the most common duration, while paternity leave was most commonly reported as 2 (39%), 6 (18%) and 12 weeks (19%) in length. Most parental leave policies were available via an institutional website (81%), with only 39% available on a public website. While most leave policies covered compensation, few addressed call expectations or procedural safety precautions.

The authors conclude that parental leave policies across urology training programs in the United States are variable and may not cover critical components of pregnancy or leave. An opportunity exists to create a comprehensive, standardized parental leave policy.

Powles T, Rosenberg JE, Sonpavde GP et al: Enfortumab Vedotin in Previously Treated Advanced Urothelial Carcinoma. NEJM 2021; doi: 10.1056/NEJMoa2035807.

The options for patients with metastatic urothelial carcinoma who fail platinum-based therapies continue to expand. In this study, the authors conducted a global, open-label, phase 3 trial of enfortumab vedotin for the treatment of patients with locally advanced or metastatic urothelial carcinoma who had previously received platinum-containing chemotherapy and had had disease progression during or after treatment with a PD-1 or PD-L1 inhibitor. Patients were randomly assigned in a 1:1 ratio to receive enfortumab vedotin or investigator-chosen chemotherapy (standard docetaxel, paclitaxel, or vinflunine), administered on day 1 of a 21-day cycle.

A total of 608 patients underwent randomization; 301 were assigned to receive enfortumab vedotin and 307 to receive chemotherapy. A total of 301 deaths have occurred (134 in the enfortumab vedotin group and 167 in the chemotherapy group). At the prespecified interim analysis, the median followup was 11.1 months. Overall survival was longer in the enfortumab vedotin group than in the chemotherapy group (median overall survival, 12.88 vs. 8.97 months; hazard ratio for death, 0.70; 95% CI, 0.56–0.89; p = 0.001). Progression-free survival was also longer in the enfortumab vedotin group than in the chemotherapy group (median progression-free survival, 5.55 vs. 3.71 months; hazard ratio for progression or death, 0.62; 95% CI 0.51–0.75; p<0.001). The incidence of treatment-related adverse events was similar in the two groups.

The authors conclude that Enfortumab vedotin significantly prolonged survival as compared with standard chemotherapy in patients with locally advanced or metastatic urothelial carcinoma who had previously received platinum-based treatment and a PD-1 or PD-L1 inhibitor.

Das A, Cohen JE, Ko OS et al: Surgeon Scorecards Improve Muscle Sampling on Transurethral Resection of Bladder Tumor and Recurrence Outcomes in Patients with Nonmuscle Invasive Bladder Cancer J Urol 2021; 205: 693-700.

TURBT can be a challenging procedure and millimeters can mean the difference between adequate sampling of muscle and bladder perforation. Can giving surgeons a scorecard of their success in sampling muscle improve outcomes? The authors did a retrospective review of transurethral resections of bladder tumor from January 2006 to February 2018. The presence of detrusor muscle in the pathology report was noted. Individual surgeon scorecards were created and distributed. Rates of detrusor muscle sampling were compared prior to and 12 months after distribution. Chart review was done to compare 3-year recurrence and progression outcomes before and after distribution of scorecards. The rate of detrusor muscle sampling increased from 36% to 54% (p=0.001) in the 12 months after scorecard distribution. Pathological reporting of muscle also improved for all samples (73%, 2,530/3,488 to 90%, 334/373, p <0.001), Ta (75%, 1,127/1,500 to 94%, 155/165, p <0.001) and T1 (93%, 362/390 to 100%, 58/58, p=0.04). On multivariate Cox regression analysis, the surgeon scorecard was associated with decreased 3-year risk of recurrence (hazard ratio 0.63, 95% CI 0.40–0.99).

The authors conclude that creation and distribution of individual surgeon scorecards improved detrusor muscle sampling on transurethral resection and was associated with decreased risk of disease recurrence. Quality evaluation of transurethral resection of bladder tumor may contribute to improved outcomes of patients with nonmuscle invasive bladder cancer.

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