United States

Background
Transurethral ultrasound ablation (TULSA-PRO), developed by Profound Medical Inc., is an emerging treatment for localized prostate cancer focused on slowing disease progression while preserving quality of life. The procedure uses directional ultrasound under real-time MRI guidance to thermally ablate targeted prostatic tissue. FDA-cleared in 2019, TULSA-PRO has treated over 3,000 patients to date. This study evaluates early outcomes from a single-center experience at Saint Louis University Hospital (SLUH).
Methods
Twenty-six patients with biopsy-confirmed prostate adenocarcinoma were treated with TULSA-PRO at SLUH between May 2023 and July 2025. Biopsy methods included transrectal ultrasound-guided, MRI fusion, transperineal, and outside hospital biopsies. Patients were categorized by NCCN risk level. Ablation targeted either the whole gland or one side (hemi-gland), based on tumor location and clinical factors. MRI guided both applicator placement and thermal coverage.
Follow-up was conducted at two weeks and then every three months. Data collected included catheter duration, urinary function, complications, and symptom scores (AUASS, IPSS, IIEF, SHIM). Postoperative imaging was obtained in select patients.
Results
The average age at treatment was 69.4 years, and the mean prostate size was 42 cc. Gleason scores were 3+4 in 13 patients, 4+3 in 9, and 3+3 in 4. MRI-visible lesions were present in 10 patients. Ablation times ranged from 26–135 minutes (mean 70.7 min). Hospital stay was 1 day for 21 patients and same-day discharge for 5.
Twelve patients had catheter removal within two weeks, the rest between 13-42 days. Three patients developed urinary tract infections. All patients regained continence within 12 weeks. Scrotal or testicular swelling occurred in 3 cases and resolved conservatively. Erectile dysfunction was reported in 6 patients. Mean pre- and post-op AUASS were 10.4 and 10, respectively. Mean postoperative PSA was 0.221. Early follow-up imaging shows no recurrence in some patients at 12 months.
Conclusion
TULSA-PRO is a safe and well tolerated treatment for localized prostate cancer with low complication rates and preserved continence. Most cases of erectile dysfunction were mild and manageable. Early oncologic outcomes such as PSA reduction and follow-up imaging are encouraging. TULSA-PRO offers a promising option for patients seeking effective cancer control with quality-of-life preservation.

AMA Research Challenge 2025 

Early Outcomes Following Transurethral Ultrasound Ablation of the Prostate for Prostate Cancer

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Join the AMA Research Challenge poster symposium and semifinals to explore top research posters and score posters in the semifinals (an AMA member exclusive opportunity).

poster

Doxorubicin is an effective chemotherapeutic agent, but its long-term cardiotoxicity contributes substantially to morbidity and mortality, with ~9% of patients developing cardiomyopathy in the years following treatment. Prior studies show that intermittent fasting exacerbates doxorubicin-induced cardiotoxicity by promoting nuclear translocation of transcription factor EB (TFEB), which drives cardiac muscle atrophy and fibrosis. Because high-fat diets (HFD) have been shown to suppress TFEB activity, we hypothesized that HFD could mitigate doxorubicin-induced cardiotoxicity. Male C57BL/6N mice were fed standard chow until 8 weeks of age, were subsequently randomized to standard chow or HFD, and then treated with doxorubicin (5mg/kg intraperitoneally) or saline (n=5/group). On echocardiogram and stress testing, compared with chow-fed mice, HFD-fed mice preserved lean mass, exercise capacity, and cardiac function, with reduced fibrosis and improved ejection fraction, left ventricular mass, and fractional shortening. Mechanistically, doxorubicin increased mRNA abundance of the main lysosomal hydrolytic enzyme, lysosomal acid lipase (LAL), a key regulator of lipophagy. LAL knockout mice showed increased mortality, cardiac atrophy, fibrosis, and enhanced TFEB nuclear translocation. These findings suggest that lipid availability sustains LAL activity, suppresses TFEB, and protects against excess cardiac catabolism. Conclusively, HFD preserved cardiac structure and function during doxorubicin therapy, highlighting a potential translational dietary strategy to reduce cardiotoxicity in human cancer patients.

Exploiting Lysosomal Lipolysis to Prevent Doxorubicin Cardiotoxicity

Background 
Inguinal hernias account for nearly 800,000 surgical repairs annually. While generally associated with good outcomes, elective inguinal hernia repair (IHR) has postoperative complications in over 10% of cases. Identifying modifiable risk factors remains important. As an important risk factor, obesity has previously been shown to have a negative impact on surgical outcomes. However, limited research has analyzed the effects of obesity specifically on robot-assisted IHRs. This study aims to determine whether Body Mass Index (BMI) is associated with a combined outcome of postoperative complications within 30 days of robotic IHR.
Methods
This retrospective cohort study analyzed 290 patients who underwent robotic IHR at a single center. BMI was primary independent variable, and the outcome was any complication within 30 days of surgery, comprising wound-related complications (surgical site infection, hematoma, or seroma) and other adverse events (urinary retention, severe pain, reoperation). Univariate analysis was used to evaluate associations between covariates and the primary outcome. A multivariable logistic regression model was constructed with the statistically significant covariates in the univariate analysis. 
Results
Of the 290 patients analyzed, 23 (7.9%) experienced a postoperative complication within 30 days according to the criteria. Based on the multivariate logistic regression, higher BMI was independently associated with increased odds of complication (OR 1.10, 95% CI 1.01-1.20, p = 0.0214). Use of anticoagulants (OR 7.15, 95% CI 1.30-32.70, p = 0.0135) and ASA class ≥3 (OR 2.68, 95% CI 1.02-6.76, p = 0.0386) were also significantly associated with postoperative complication. The model demonstrated acceptable discrimination (AUC 0.723) and good fit (Hosmer-Lemeshow p = 0.47). Additional univariate analyses were performed for surgical site occurrences (SSOs) and emergency department (ED) visits. For SSOs, ASA class ≥3 was significantly associated with increased odds (OR 7.60, 95% CI 1.81-38.0, p = 0.0066). For ED visits, male sex was associated with decreased odds compared to female sex (OR 0.21, 95% CI 0.05-1.12, p = 0.048), and concomitant procedures were associated with increased odds (OR 5.53, 95% CI 1.19-28.8, p = 0.028).
Conclusion
Higher BMI, ASA Class (≤2 vs. ≥3), and use of anticoagulants were each independently associated with an increased odds for postoperative complication within 30 days of robotic IHR. This suggests that patient-specific risk factors should be considered during perioperative planning, and selected patients may benefit from preoperative weight-loss prehabilitation programs. Future work should focus on refining risk stratification and assessing potential interventions for at risk populations.

BMI and 30-Day Complications After Robotic Inguinal Hernia Repair: A Multivariate Analysis

Abstract Title
Comparative Analysis of PRDX Expression in Bladder Urothelial Carcinoma and Decoding Its Prognostic Value

Background
Bladder urothelial carcinoma (BLCA) is one of the most common types of urologic malignancies that disproportionately affects older males and is projected to double by 2040. Oxidative stress is a common hallmark of cancer, resulting from an imbalance between the overproduction of reactive oxygen species (ROS) and dysfunctional antioxidant defenses. Peroxiredoxin (PRDX1-6) are a family of antioxidant enzymes with each possessing unique biological roles. However, their contributions in cancer progression, immune modulation, and prognostic qualities in patients with BLCA remain unclear. This study investigates the association between PRDXs expression and their impact on genomic instability, tumor immune microenvironment, and tumor characteristics in BLCA.

Methods
Clinical information and RNA sequencing data of the PRDX genes were acquired from The Cancer Genome Atlas (TCGA). Samples were grouped by PRDX expression levels using their z-score relative to all samples (n = 411). An analysis was conducted to assess the relationship between PRDXs expression levels to genomic instability metrics (aneuploidy score, mutation score, TMB, MSI), tumor immune microenvironment (immune score, stromal score, estimate score), and expression of innate immune and checkpoint genes. Kaplan–Meier survival analysis and ROC curves were also generated to evaluate their prognostic relevance. 

Results
Overexpression of PRDX1, PRDX4, and PRDX5 were significantly associated with genomic instability. While the overexpression of PRDX2, PRDX4, and PRDX6 were significantly associated with tumor immune microenvironment. The heatmap analysis for innate immune genes showed that PRDX4 and PRDX6 exhibited a hot immune phenotype with high expression of immune checkpoint genes (PDCD1LG2), whereas PRDX2 and PRDX3 exhibited colder immune profiles with downregulation of immune checkpoints. Notably, the overexpression of PRDX6 was associated with poor prognosis and more advanced tumor characteristics. In contrast, the overexpression of PRDX1 was also linked to reduced overall survival and a colder immune phenotype, suggesting potential immune evasion. 

Conclusion
PRDX6 was linked to poor prognosis as evidenced by its reduced survival outcome and hot immune phenotype, suggesting a role in driving tumor progression. PRDX4 emerged as a gene of interest due to its impact on genomic instability and tumor immune microenvironment. In contrast, PRDX2 overexpression were associated with more advanced tumor stage and size, but not a significant impact on overall survival suggesting a role in tumor growth dynamics rather survival. Our findings may have important clinical implications for utilizing PRDXs as a potential prognostic biomarker to stratify BLCA patients and as a target to enhance immunotherapy response in BLCA. Future studies should validate findings and explore the role of PRDXs as useful biomarkers when combined with other biomarkers to improve BLCA prognosis. 




Comparative Analysis of PRDX Expression in Bladder Urothelial Carcinoma and Decoding its Prognostic Value

The COVID-19 pandemic has revealed significant secondary complications affecting musculoskeletal (MSK) health, especially in patients with pre-existing conditions. This review synthesizes data from clinical and experimental studies on key MSK biomarkers, including cartilage oligomeric matrix protein (COMP), hyaluronic acid (HA), osteocalcin, alkaline phosphatase (ALP), procollagen type I N-terminal peptide (PINP), osteopontin (OPN), matrix metalloproteinases (MMP-3 and MMP-9), myostatin, IGF-1, follistatin, and creatine kinase. COVID-19 is associated with decreased COMP and osteocalcin levels, indicating cartilage degradation and impaired bone formation, alongside elevated HA, ALP, PINP, OPN, and MMPs, reflecting increased joint inflammation, bone remodeling, and tissue breakdown. Changes in myostatin, IGF-1, follistatin, and creatine kinase levels have been showen to be linked with COVID-19 related sarcopenia. These biomarker alterations provide insight into the underlying mechanisms of MSK damage in COVID-19 patients and highlight the potential for using these markers in early diagnosis and management of post-COVID musculoskeletal disorders. Further longitudinal research is essential to develop targeted therapies aimed at mitigating long-term MSK complications in affected individuals.

Understanding Musculoskeletal Complications in COVID-19 Through Biomarkers

•In 2025, it is estimated that there will be 84,870 new cases of bladder
cancer and an estimated 17,420 people will die of this disease.
•Bladder cancer is associated with significant renal-related mortality.
•Patients with muscle invasive bladder cancer (MIBC) scheduled for radical
cystectomy (RC) have reported baseline CKD prevalence rates of
approximately 37%. Studies have shown higher CKD stages post-RC
increases all cause mortality.
•This can be attributed to chemotherapy-associated nephrotoxicity, acute
kidney injury (AKI), chronic kidney disease (CKD) with possible dialysis
dependence.
•Older adults are particularly vulnerable due to age-related declines in renal
function, comorbidities, and higher prevalence rates.
•In our study we plan to evaluate the burden and trends of renal function
decline in bladder cancer patients using national database.
•Using the CDC WONDER Database, this study aimed to evaluate renal-
related events as a cause of death in bladder cancer patients, with a focus
on demographic trends and the preferred place of death (PPOD) in the
United States.

The Impact of Declining Renal Function on Bladder Cancer in the U.S. (1999-2023): A Regression Analysis Using the CDC WONDER Database

Abstract Title:
Successful Split Transplantation of a Horseshoe Kidney to Two Patients

Introduction:
Horseshoe kidneys are a rare congenital anomaly resulting from fusion of the kidneys during development. Their unique anatomy including fusion at the lower poles, variable vasculature, and collecting system anomalies, have made them challenging to use in renal transplantation. However, with a shortage of donor kidneys, horseshoe kidneys are increasingly being considered viable for transplantation. En bloc transplantation involves transplanting the entire horseshoe kidney into one recipient, while split transplantation divides the kidney at the isthmus for transplantation into two recipients and may require nonstandard surgical techniques. 

Case Description:
Backtable examination of a low-KDPI deceased donor kidney revealed a horseshoe kidney with 5 arteries, 4 veins and 2 ureters. The urinary collecting system was assessed with BK ultrasound to ensure no communication across the isthmus of the kidney. The two renal moieties were sharply separated. To reduce the risk of major bleeding following reperfusion a sliding-clip renorrhaphy was performed to compress the cut edge of the graft using Hemo-Lock clips and fine monocryl suture. Standard reconstruction techniques were used to simplify the vascular anastomoses required, resulting in 1 large Carrel patch per graft with preservation of all arterial inflow. One graft required two separate venous anastomoses. Implantation was performed into a 33 year-old Type 1 diabetic male and a 75 year-old hypertensive male with prolonged anticipated time to transplant. Post-reperfusion bleeding was mild, controlled with direct suture ligation of sizable bleeding vessels and application of a TachoSil fibrin sealant “cap” over the cut edge of the graft. Both grafts had immediate function and the recipients were discharged without complication. One recipient was re-admitted on POD 6 with a moderate, non-compressive hematoma which resolved without intervention or transfusion. Eight months after transplant both patients are doing well with excellent graft function.

Discussion: 
Split horseshoe kidney transplantation presents several challenges including complex vascular reconstructions, management of the urinary collecting system, and control of post-reperfusion hemorrhage. The choice between en bloc transplantation and kidney splitting should be made with preoperative imaging and intraoperative anatomical assessment. Implantation of a split kidney is feasible and safe with careful judgment and utilization of uncommon surgical techniques to manage the above factors. As organ shortages continue to increase, horseshoe kidneys remain a valuable and underutilized resource for transplantation.


Successful Split Transplantation of a Horseshoe Kidney to Two Patients

Background 
Currently, there is a lack of standardized pharmacological protocols for managing primary headaches in the emergency department (ED). With nearly five million ED visits in the United States each year for headache complaints and a growing concern of increased patient census levels in the ED, efficient treatment strategies that foster timely, safe patient care are needed. This study aimed to examine how the type of pharmacological treatment was associated with length of stay for patients presenting to the ED for care of primary headaches. 

Methods 
This was a retrospective chart review of patients seen at the ED of an academic hospital between January 1, 2022, and December 31, 2022, with a chief complaint of primary headache. Patients with a secondary cause of headache (infection, trauma, or recent procedure involving the head), patients admitted to the hospital, and those under eighteen years of age were excluded. The primary predictor, pharmacological treatment, was classified into medication type (analgesics, antiemetics, anti-inflammatories, etc.), with patients able to receive treatment with any combination of medication type. The primary outcome was length of stay (LOS) from timing of first medication administration to discharge (minutes). Differences in medication types and LOS were determined using linear regression, controlling for patient sex and age, and whether medications were administered with fluids (yes/no). 

Results 
A total of 299 patients (74.2% female, average age of 40.4 years +/- 14.6 years) were included in the analysis. Most patients (66.3%, n=189) received three different medication types, 14.4% (n=41) received one type of medication, and 9.5% (n=27) received two types. No patients were prescribed opioids. The median LOS from medication administration to discharge was 122 (IQR 85-169) minutes. Compared to analgesics alone, patients prescribed a combination of analgesics/antiemetics/antiinflammatories had an increase of 65 minutes (β=65.1, 95% CI: 32.7-97.4) for LOS, and a combination of analgesics/antiemetics had an increase in 37 minutes (β=37.7, 95% CI:16.5-59.1). Regardless of medication class prescribed, IV fluids increased the time from first medication administration to discharge by 52 minutes (95% CI: 36-68 minutes, p<0.001). Of note, no opioids were administered. 

Conclusion 
In patients presenting to the ED with primary headaches, treatment with multiple pharmacological agents did not result in quicker recovery or faster time to discharge compared with analgesics alone. Further, the use of IV fluids increased LOS. Future research evaluating treatment protocols using patient-reported recovery rates would help create comprehensive, patient-centered guidelines to optimize headache management further. 


What a Headache: Pharmacologic Management and Its Association with Emergency Department Throughput in Primary Headache Presentations

Evaluating the Effect of Educational Interventions on Opioid Prescribing Practices for Hysterectomies

Nicholas Ernst1, Andrew Moore1, Laura Jackson, PhD1, MS, Annabelle D’Agostino, MPH1, Yasmin Abedin, MPH, MD2, Lori Spoozak, MD2

1University of Kansas School of Medicine, University of Kansas Medical Center, Kansas City, KS
2Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS

Background
Post-operative opioid prescribing contributes significantly to the opioid epidemic, with hysterectomy being one of the most common gynecologic surgeries linked to excess prescribing. Despite national guidelines, prescribing practices at discharge remain inconsistent, posing risks for opioid misuse, dependence, and diversion. Prior strategies, such as Enhanced Recovery After Surgery (ERAS) protocols, have shown success in reducing inpatient opioid use through multimodal pain management, but their impact on outpatient prescribing remains limited without additional measures. This study evaluated the impact of a multi-faceted quality improvement intervention consisting of a provider education series, a Restricted Opioid Prescribing Protocol (ROPP), and an opioid calculator, hypothesizing it would significantly reduce opioid prescribing at discharge and improve standardization among providers.
Methods
(IRB: STUDY00160958) This retrospective cohort study included patients who underwent hysterectomy during three defined time periods: Pre-ERAS (Feb–Aug 2020), Post-ERAS (May–Nov 2023), and Post-QI (July 2024–Jan 2025) at a single academic medical center. Patients were stratified by surgical approach: total abdominal hysterectomy (TAH), robot-assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy (TLH), and vaginal hysterectomy (VH). The primary outcome was mean morphine milligram equivalents (MME) prescribed at discharge. Secondary outcomes included prescribing variability, refill requests, and post-operative complications. Independent t-tests were used to compare groups, with p<0.05 considered statistically significant.
Results
A total of 668 patients were included. Opioid prescribing decreased significantly across all surgical types following ERAS implementation and further declined after the QI initiative. From Pre-ERAS to Post-ERAS, mean MME significantly decreased in TAH (183.13 to 141.52, p<0.05), RALH (178.82 to 101.69, p<0.01), TLH (178.50 to 109.72, p<0.01), and VH (136.72 to 99.11, p<0.05). From Post-ERAS to Post-QI, additional significant reductions were observed in TAH (141.52 to 68.08, p<0.01), RALH (101.69 to 73.26, p<0.01), TLH (109.72 to 73.56, p<0.01), and VH (99.11 to 82.50, p<0.05). Standard deviations decreased, reflecting reduced variability. Importantly, opioid reductions were not associated with increases in refill requests, emergency department visits, or readmissions, indicating adequate pain control was maintained.
Conclusion
This study demonstrates that our quality improvement initiative incorporating structured education, ROPP, and an opioid calculator into an existing ERAS protocol significantly decreased both the amount and variability of opioid prescribing following hysterectomy. The intervention proved effective across hysterectomy types. Future analyses will evaluate sustained impact over time, differences by prescriber training level, and effect on inpatient opioid use. Findings support wider implementation of standardized prescribing interventions as part of opioid stewardship efforts.

Evaluating the Effect of Educational Interventions on Opioid Prescribing Practices for Hysterectomies

Empathy is a critical component of healthcare. In the pediatric realm, empathy plays an important role in understanding how both the patient and their parents are feeling, and then sharing those feelings with them to better create an environment of healing and mutual understanding. The presence or lack of physician empathy has implications in patient outcomes, the patient-physician relationship, and overall patient happiness. The aim of this literature review is to synthesize and summarize findings from a variety of studies on physician empathy in the pediatric setting with the goal of enhancing patient care. Google scholar and PubMed were used to find relevant studies that were published in the last five years, using keywords like “pediatric” “empathy” “communication” and “physician empathy.” In the literature review, a variety of study types were included, such as surveys, meta-analyses, and qualitative studies. One of the key findings was that most research has been done with the caregivers of pediatric patients versus pediatric patients themselves. This is a gap that should be filled in the future, as one study showed that kids understand more than physicians assume and want to be involved in their care. Some advances have been made in improving communication, for example a study found that empathy, partnership, and respect all increased with family centered rounds. Other studies have found that communication training can increase perceived physician empathy and mindfulness. When taken as a whole, these studies show that communication training and an emphasis on including caregivers in decisions improve perceived physician empathy. Future research should include studies specifically on improving communication and empathy with pediatric patients themselves versus their caregivers, as presently most research done is with caregivers. Improving empathy with these steps can improve the quality of care and outcomes, as well as increasing patient and family satisfaction. 


Fostering Physician Empathy in the Pediatric Setting

Rising grocery prices and a growing interest in homesteading have driven a surge in poultry-related sales in the United States, ranging from keeping backyard chickens to buying eggs from local backyard chicken farmers. In North Carolina (NC), little is known about the backyard poultry community, yet extensive networks of poultry owners, primarily raising chickens, exist across the state. Several studies have explored the antimicrobial resistance (AMR) profile of the backyard poultry environment and the interaction between families and their chickens. However, with the expansion of flocks and diverse backyard operation styles, more information is needed about these interactions at the human-animal interface.
This pilot study aimed to characterize the husbandry practices of a sample of central NC backyard poultry owners and investigate the prevalence and AMR profiles of Salmonella spp., Escherichia coli (E. coli), and Campylobacter spp. isolated from their flocks’ environments. Increasing resistance to antibiotics like penicillin and macrolides poses challenges in treating human and animal infections. A two-fold approach was used: interviews with participants, and bacterial cultures from fecal, soil, and environmental samples. A semi-structured questionnaire facilitated discussions about poultry practices, flock interactions, and medication use. Adult participants were recruited through online poultry groups. From January to June 2024, focus groups and individual interviews were conducted with 18 participants from five NC counties. Thematic analysis revealed that most owners raised poultry for egg production and companionship. Biosecurity practices and medication usage varied. Most participants reported good poultry health and primarily used social media and online communities for information-sharing.
A total of 99 samples were collected across 15 farms, including nasopharyngeal swabs, fecal matter, environmental swabs, water bowl swabs, soil samples, and bedding samples. After a double-culture enrichment procedure, analysis by Kirby-Bauer disc diffusion showed that 41% (41/99) of samples tested positive for E. coli, and 46% (46/99) tested positive for Campylobacter. Of the E. coli isolates, 61% (25/41) contained extended-spectrum beta-lactamases (ESBL), which confer resistance to beta-lactam antibiotics, and 31.7% (13/41) exhibited the TEM gene encoding ESBL. Additionally, 91.3% (42/46) of Campylobacter strains were resistant to erythromycin, a macrolide antibiotic. This resistance contributes to the spread of harder-to-treat infections in both poultry and humans. These findings provide insight into backyard poultry husbandry practices and human-animal interactions. Future research, involving more participants and continuous environmental sampling, could help inform public health interventions aimed at improving husbandry practices and biosecurity.

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Exploiting Lysosomal Lipolysis to Prevent Doxorubicin Cardiotoxicity

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