Introduction: Indigenous Peoples have higher morbidity rates and lower life expectancies than non-Indigenous Canadians. We aimed to identify disparities between Indigenous and non-Indigenous men regarding prostate cancer (PCa) screening, diagnoses, management, and outcomes. Methods: We studied an observational cohort of men diagnosed with PCa between June 2014 and October 2022. Men were prospectively enrolled in the province-wide Alberta Prostate Cancer Research Initiative. The primary outcomes were tumor characteristics (stage, grade, PSA) at diagnosis. Secondary outcomes were PSA testing rates, time from diagnosis to treatment, treatment modality, metastasis-free, cancer-specific, and overall survivals. Results:We examined 1 444 974 men for whom aggregate PSA testing data were available. Men in Indigenous communities were less likely to have PSA testing performed than men outside of Indigenous communities (32 vs. 46 PSA tests per 100 men [aged 50-70] within one year, p<0.001). Among 6049 men diagnosed with PCa, Indigenous men had higher-risk disease characteristics: a higher proportion of Indigenous men had PSA 10 ng/ml (48% vs. 30%, p<0.01), TNM stage T2 (75% vs. 47%, p<0.01), and Gleason grade group ≥2 (79% vs. 64%, p<0.01) compared to non-Indigenous men. With a median followup of 40 (IQR 25-65) months, Indigenous men were at higher risk of developing PCa metastases (HR 2.2, 95% CI 1.2-3.9, p=0.01) than non-Indigenous men. Conclusions: Despite receiving care in a universal healthcare system, Indigenous men were less likely to receive PSA testing and more likely to be diagnosed with aggressive tumors and develop prostate cancer metastases than non-Indigenous men.

The CUA is mourning the loss of Dr. Eric Freedman, who passed away in September while hiking in Yosemite National Park. He is survived by his wife Nancy, and his children Sarah and Josh, as well as his extended family.Dr. Freedman completed his urology residency at Dalhousie University and practiced urology in Victoria, BC, and later Fredonia, NY. Most recently and for close to 18 years, he served the California communities of Sonora and Folsom as a urologist at Advanced Urology.A CUA member since 1993, in 1995-96, Dr. Freedman served as the CUA Local Organizing Committee Chair. He was also the first Secretary/Treasurer of the Pediatric Urologists of Canada (PUC) and created the PUC logo.Dr. Freedman made a lasting impression on all those who knew him and he will be deeply missed.CUAJ honors its members and friends who have passed away. We invite colleagues of the deceased to submit brief remembrances.

Introduction: Concerns have been raised regarding the effectiveness and durability of transverse ventral corporotomies to reliably correct chordee. Herein, we assessed the outcomes of this technique to correct ventral curvature (VC) in severe penoscrotal hypospadias. Methods: We selected 62 patients who underwent both stages of primary staged inner prepuce graft repair with a minimum six-month followup from a prospectively collected hypospadias database (2008-2021, n=881). Proximal TIP/Byars flaps cases and redos were excluded. VC was corrected by dividing the urethral plate in all cases and performing three transverse ventral corporotomies ± dorsal plication (80%). Residual VC was checked in all cases during the second stage. All procedures were performed by a single surgeon. Preoperative testosterone stimulation (PTS) was administered for glans width <14 mm (three intramuscular injections, three weeks apart). Age at each stage of repair, meatal location, degree of VC assessed before/ after degloving with an artificial erection measured by photograph with an electronic app, anesthetic block (caudal/dorsal penile block), and complications (urethrocutaneous fistula [UCF], glans dehiscence [GD], recurrent VC, and graft contraction) were collected. Outcomes of interest were postoperative recurrent VC and overall complication rate. Recurrent VC was assessed by reflex erection during examination and/or parents reporting. Results: Median patient age at first and second stage was 21 and 30 months, respectively; mean followup was 42 months. Eighty-four percent of patients had penoscrotal 45 (72%), scrotal 9 (15%), and perineal hypospadias 12 (13%). Overall, 35/62 (57%) patients had VC between 30-70° and 27 (43%) had >70° after degloving; 57/62(92%) boys received PHS (three shots). Grafts took well in most cases, with only four (6%) contractions. Of these, two needed re-grafting and two were stretched (vit. E). The median interval between stages was eight months. Overall, complications occurred in 15/62(24%) boys: nine UCFs, five GDs, and one recurrent VC due to skin tethering. All successful cases had the neomeatus located at the tip of the glans. Parents of three boys with GD decided for no further surgery, leaving the meatus at the corona. In total, the re-operation rate was 19% (12/62). Conclusions: An overall re-operation rate of 19% was observed in patients who underwent staged preputial graft repair with three transverse corporotomies to treat scrotal/perineal hypospadias. This rate is significantly lower than what has been previously reported using staged Byars flaps procedures or single-stage operations. After a mean followup of almost four years, recurrent VC was seen in only one child (1.6%) due to skin tethering. Despite being the longest followup described with this technique thus far, we recognize that recurrent VC may not present until adolescence, therefore, following these patients until adulthood is imperative.

Introduction: Holmium laser enucleation of the prostate (HoLEP) is a longstanding surgical treatment for benign prostatic hyperplasia (BPH). The thulium fiber laser is the newest laser currently available and possibly offers better hemostatic properties; however, there is a paucity of data on outcomes in BPH treatment. This prospective study aimed to compare the safety profile, as well as the intraoperative and clinical outcomes between HoLEP with Moses technology (m-HoLEP) and thulium fiber laser enucleation of the prostate (TFLEP). Methods: Twenty patients were included in this prospective study after obtaining institutional review board approval. Two experienced surgeons were involved in this study: one performed 10 m-HoLEP procedures, while the other performed 10 TFLEP procedures. Demographic information of patients was collected, as well as intraoperative variables and complications. Statistical analyses were performed on SPSS Statistics Version 27. Results: TFLEP and m-HoLEP patients were similar in age (72.3 vs 75.4 years, respectively, p=0.45) and prostate size (131.3 vs 123.3 cc, respectively, p=0.67). There was no difference in American Society of Anesthesiologists (ASA) score (p=0.50) and anticoagulant usage (p=0.54) between both groups. The duration of morcellation was similar in both groups (p=0.44). Hemoglobin reduction was similar in m-HoLEP compared to TFLEP (18.0 vs 17.3 g/L, respectively, p=0.67). Length of hospitalization was comparable in both study arms (p=0.16). There was no difference in mean duration (p=0.23) or rate (p=0.54) of enucleation between both laser modalities. Complications, such as urosepsis, re-admission, and transfusion, did not vary between m-HoLEP and TFLEP groups. Conclusions: Although preliminary, the results of this study demonstrate similar perioperative and clinical outcomes for TFLEP and m-HoLEP. This study is ongoing, with a total recruitment of 50 per arm planned and an anticipated followup period of one year.

Introduction:In line with Canadian provincial directives due to the COVID-19 pandemic, certain urological procedures that are normally performed as inpatient procedures were performed as same-day procedures to reduce the usage of healthcare resources. At our center during the pandemic, we began performing laser enucleation of the prostate (LEP), robotic-assisted radical prostatectomy (RARP), and percutaneous nephrolithotomy (PCNL) as outpatient surgeries. Recent literature has suggested that these procedures are safe and feasible as same-day surgeries. Our goal was to determine if there was a difference in patient outcomes in LEP, RARP, and PCNL patients operated as same-day surgery vs. inpatient. Methods: Patients operated for LEP, RARP, or PCNL were studied between May 2020 to March 2022. Among LEP patients, 104 were identified as planned same-day procedures (PSD-LEP) and 65 were planned inpatient procedures (PIP-LEP). Among RARP patients, 46 were identified as planned same-day procedures (PSD-RARP) and 148 were planned inpatient procedures (PIP-RARP). AmongPCNL patients, 38 were identified as planned same-day procedures (PSD-PCNL) and 12 were planned inpatient procedures (PIP-PCNL). PSD patients were compared to PIP patients for all patient groups with primary outcomes being SD failure, 30-day complications, and readmission rates. Results: General patient characteristics, such as age, American Society of Anesthesiologist classification, and Revised Cardiac Risk Index (RCRI) were similar between PSD and PIP in both patient populations. Of the PSD-LEP patients, 77.9% were successfully discharged the day of the surgery. The overall postoperative complication, 30-day ED visits, and readmission rates were 8.7%, 3.8%, and 1.0 %, respectively, for PSD-LEP patients vs. 23 % (p=0.017), 9.2% (p=0.27), and 4.6% (p=0.32), respectively, for PIP-LEP patients. Of the PSD-RARP patients, 73.9% were successfully discharged the day of the surgery. The overall postoperative complication, 30-day ED visits, and readmission rates were 15.2%, 17.4%, and 4.3%, respectively, for PSD-RARP patients vs. 6.1% (p =0.097), 4.1% (p <0.05), and 1.4% (p=0.51), respectively, for PIP-RARP patients. Of the PSD-PCNL patients, 71.1% were successfully discharged the day of the surgery. The overall postoperative complication, 30-day ED visits, and readmission rates were 21.1%, 7.9%, and 2.6 % respectively, for PSD-PCNL patients vs. 16.7% (p=1.0), 8.3% (p=1.0), 8.3% (p=1.0), respectively, for PIP-PCNL patients. Conclusions: Same-day discharge for LEP, RARP, and PCNL is safe and feasible in select patients with an acceptable and comparable complication rate.