Yale Urology Research [Q1: January-March 2025]

The following is a comprehensive list of Yale Urology publications/presentations for the first quarter of calendar year 2025. The listing is in descending published date order and features primary faculty, trainee, and alumni work. Each item includes links to the full study or presentation and provides portions of the abstract/summary.

Cahill EM, Rabil MJ, Rotker K, Honig SC. Post-vasectomy semen analysis: what is the best protocol? Int J Impot Res. 2025 Mar 29. doi: 10.1038/s41443-025-01052-3. Epub ahead of print. PMID: 40155486.

Vasectomy is a safe, quick, and highly effective form of permanent sterilization. However, vasectomy does not render patients sterile immediately, and they must continue to use alternate forms of contraception until cleared by a post-vasectomy semen analysis (PVSA).

Li L, Cheng S, Xu Y, Deng S, Mu P, Yu X. Androgen Deprivation-Induced TET2 Activation Fuels Prostate Cancer Progression via Epigenetic Priming and Slow-Cycling Cancer Cells. bioRxiv [Preprint]. 2025 Mar 29:2025.03.26.645495. doi: 10.1101/2025.03.26.645495. PMID: 40196510; PMCID: PMC11974783.

Our study provides the first single-nucleotide resolution map of 5hmC dynamics in PCa, identifies a cell state driving epigenetic rewiring, and underscores the transformative potential of novel therapeutic strategies for advanced PCa.

Kinnaird A, Luger F, Cash H, Ghai S, Urdaneta-Salegui LF, Pavlovich CP, Brito J, Shore ND, Struck JP, Schostak M, Harland N, Rodriguez-Socarrás M, Brisbane WG, Lughezzani G, Toledano H, Ouertani MS, Macek P, Fung C, Tu W, Gusenleitner A, Günzel K, Incze PF, George AK, Pereira JG, Jansen R, Renzulli J 2nd, Klotz L; OPTIMUM Investigators. Microultrasonography-Guided vs MRI-Guided Biopsy for Prostate Cancer Diagnosis: The OPTIMUM Randomized Clinical Trial. JAMA. 2025 Mar 23:e253579. doi: 10.1001/jama.2025.3579. Epub ahead of print. PMID: 40121537; PMCID: PMC11931425.

The use of microultrasonography-guided biopsy was noninferior to MRI/conventional ultrasonography fusion-guided biopsy for the detection of Gleason Grade Group 2 or higher prostate cancer in biopsy-naive men. Microultrasonography may provide an alternative to MRI for image-guided prostate biopsy.

Khajir G, Webb LT, Lokeshwar SD, Diaz GM, Anderson T, Choksi AU, Zhao J, Leapman MS, Sprenkle PC, Renzulli JF. Diagnostic performance of high-resolution micro-ultrasound and conventional ultrasound in fusion biopsy for clinically significant prostate cancer detection. Urol Oncol. 2025 Mar 21:S1078-1439(25)00087-0. doi: 10.1016/j.urolonc.2025.03.006. Epub ahead of print. PMID: 40121104.

The aim of this study was to evaluate the diagnostic outcomes of MRI-ultrasound fusion targeted biopsy in detecting clinically significant prostate cancer (csPCa) using either microUS technology or conventional ultrasound.

McManus HD, Long JB, Westvold SJ, Leapman MS, Hurwitz ME, Mitchell AP, Pollack CE, Gross CP, Dinan MA. Off-Label Use of First-Line Immunotherapy for Metastatic Renal Cell Carcinoma. Clin Genitourin Cancer. 2025 Mar 15;23(3):102330. doi: 10.1016/j.clgc.2025.102330. Epub ahead of print. PMID: 40186898.

We retrospectively analyzed off-label and post-FDA-approval 1 L ICI receipt in a cohort of Medicare beneficiaries ≥66 years old diagnosed with mRCC from 2015 to 2019. Off-label and postapproval 1 L ICI were defined as before or on/after 4/16/2018 (1L ipilimumab/nivolumab approval).

Annapureddy D, [Tan WS]. IMPACT OF TUMOR STAGE IN PATIENTS WITH BCG-UNRESPONSIVE NMIBC WHO UNDERGO UPFRONT RADICAL CYSTECTOMY: A LARGE MULTI-INSTITUTIONAL STUDY. Urologic oncology. 03/2025;43(3):81. doi: 10.1016/j.urolonc.2024.12.204.

The purpose of this study was to compare oncologic outcomes in patients undergoing upfront RC for T1 or Ta BCG-unresponsive NMIBC with those with pure CIS in a large multi-center cohort.

Annapureddy D [Tan WS]. IMPROVED OUTCOMES IN BCG-UNRESPONSIVE BLADDER CANCER PATIENTS WITH NON-INVASIVE DISEASE UNDERGOING BLADDER SPARING THERAPY COMPARED TO T1 DISEASE: RESULTS FROM AN INTERNATIONAL COHORT. Urologic oncology. 03/2025;43(3):80-81. doi: 10.1016/j.urolonc.2024.12.203.

The purpose of this study was to compare oncologic outcomes in patients with T1 or Ta BCG-unresponsive NMIBC to those with pure carcinoma in situ (CIS) disease in a multi-center, international cohort.

Sterling J [Carbonella J, Golos A]. Repairing stress urinary incontinence and dehiscence after masculinizing genital gender affirmation surgery: A staged approach. Urology video journal. 03/2025;25:100292. doi: 10.1016/j.urolvj.2024.100292.

Here, we show de novo SUI following vaginectomy and metoidioplasty can be safely surgically corrected.

Xiaosong Meng [Sprenkle P]. CAPTAIN RANDOMIZED CONTROLLED TRIAL OF TULSA AGAINST RADICAL PROSTATECTOMY FOR INTERMEDIATE-RISK PROSTATE CANCER: DESIGN AND RECRUITMENT UPDATE. Urologic oncology. 03/2025;43(3):79. doi: 10.1016/j.urolonc.2024.12.200.

Here, we report the design of a RCT comparing TULSA (MRI-guided transurethral ultrasound ablation of the prostate) against RP.

Rancourt J. Pediatric Urology: Voiding Dysfunction and Neurogenic Bladder. Physician assistant clinics. 03/2025. doi: 10.1016/j.cpha.2025.01.009.

Pediatric LUTD accounts for many referrals to pediatric urology. A thorough assessment includes detailed history, voiding diary, and noninvasive in-office testing. Addressing constipation and underlying neuropsychiatric disorders is imperative to treatment. If nonpharmacologic interventions fail, treatment with anticholinergics, alpha blockers, and beta-adrenergic agonists may be useful.

Neurogenic bladder is another complex diagnosis seen in pediatric urology. Evaluation includes UDS and serial imaging. A primary goal of treatment is preservation of renal function.

Rahman S, Kong V, Jalfon M, Hesse D, Kim J, Wright JL, Adeniran A, Humphrey P, Martin DT, Ghali F. Evaluating Treatment Patterns and the Role of Neoadjuvant Chemotherapy in Plasmacytoid Urothelial Carcinoma: Insights from a Combined National and Institutional Series. Cancers (Basel). 2024 Sep 1;16(17):3050. doi: 10.3390/cancers16173050. PMID: 39272908; PMCID: PMC11394101.

Our objective was to characterize treatment patterns and outcomes of PUC in the NCDB and our recent institutional experience.

Raman S [Sprenkle P]. Abstract no. 192 AI-assisted prostate segmentation module for MRI-guided transurethral ultrasound (TULSA) treatment planning: Multi-reader multi-case study and initial real-world experience. Journal of vascular and interventional radiology. 03/2025;36(3):S88-S89. doi: 10.1016/j.jvir.2024.12.238.

We present the validation of a deep learning model for artificial intelligence (AI)–assisted whole prostate segmentation compared to manual segmentation with two goals: 1) non-inferior accuracy and 2) time savings.

Smani S, DuBois J, Zhao K, Sutherland R, Rahman SN, Humphrey P, Hesse D, Tan WS, Martin D, Lokeshwar SD, Ghali F. Advancements in the Diagnosis, Treatment, and Risk Stratification of Non-Muscle Invasive Bladder Cancer. Curr Oncol Rep. 2025 Mar;27(3):236-246. doi: 10.1007/s11912-025-01645-7. Epub 2025 Feb 20. PMID: 39976835.

This review examines the evolving landscape of non-muscle invasive bladder cancer (NMIBC) management, focusing on risk stratification, novel therapeutic strategies, and the integration of biomarkers into clinical care.

Olawoyin O, Press B, Choksi A, Sohoni N, Weiss R, Sterling J, Arlen AM. Factors Associated With Short Term Outcomes After Pyeloplasty in the Pediatric Population. Urology. 2025 Feb 17:S0090-4295(25)00178-5. doi: 10.1016/j.urology.2025.02.016. Epub ahead of print. PMID: 39970964.

To determine the patient and surgical factors that contribute to 30 days morbidity after pediatric pyeloplasty using a national database.

Bao N, Zhang J, Li Z, Wei S, Zhang J, Greenwald SE, Onofrey JA, Lu Y, Xu L. CT-Less Whole-Body Bone Segmentation of PET Images Using a Multimodal Deep Learning Network. IEEE J Biomed Health Inform. 2025 Feb;29(2):1151-1164. doi: 10.1109/JBHI.2024.3501386. Epub 2025 Feb 10. PMID: 40030243.

In this work, we propose a novel multimodal fusion network (MMF-Net) for WBBS of PET images, without the need for CT images. Specifically, the tracer activity ($\lambda$-MLAA), attenuation map ($\mu$-MLAA), and synthetic attenuation map ($\mu$-DL) images are introduced into the training data.

Rahman S [Hesse D, Jalfon M, Kong V, Ghali F]. Evaluating the therapeutic role of lymph node dissection in variant histology bladder cancer. Journal of clinical oncology. 02/2025;43(5_suppl):749-749. doi: 10.1200/jco.2025.43.5_suppl.749.

Our objective was to characterize the impact of LND on survival outcomes across variant subtype BC.

Ghali F [Rahman SN]. Modeling survival outcomes of KEYNOTE-564 with standard of care control arm treatment: A simulation study. Journal of clinical oncology. 02/2025;43(5_suppl):517-517. doi: 10.1200/jco.2025.43.5_suppl.517.

We sought to model the survival of KEYNOTE-564 control group patients had they received CPI/TKI per current standard of care (SOC) to more accurately assess this intervention.

Ghali F. Pilot study evaluating duplex sequencing of urinary DNA as a biomarker for recurrence in non-muscle invasive bladder cancer. Journal of clinical oncology. 02/2025;43(5_suppl):865-865. doi: 10.1200/jco.2025.43.5_suppl.865.

We present a pilot study applying duplex sequencing technique to uDNA in NMIBC for use as a biomarker of recurrence.

Chen F, Esmaili R, Khajir G, Zeevi T, Gross M, Leapman M, Sprenkle P, Justice AC, Arora S, Weinreb JC, Spektor M, Huber S, Humphrey PA, Levi A, Staib LH, Venkataraman R, Martin DT, Onofrey JA. Comparative Performance of Machine Learning Models in Reducing Unnecessary Targeted Prostate Biopsies. Eur Urol Oncol. 2025 Feb 8:S2588-9311(25)00026-4. doi: 10.1016/j.euo.2025.01.005. Epub ahead of print. PMID: 39924390.

Our aim was to evaluate the effectiveness of machine learning (ML) models in reducing unnecessary biopsies.

Annapureddy D, Taylor JI, Kamat AM, O'Donnell MA, Howard J, Tan WS, McElree IM, Davaro F, Yim K, Harrington S, Dyer E, Black AJ, Kanabur P, Roumiguié M, Lerner S, Black PC, Raman JD, Preston MA, Steinberg G, Huang W, Li R, Packiam VT, Woldu SL, Lotan Y. Impact of Tumor Stage on Oncologic Outcomes of High-grade Bacillus Calmette-Guérin Unresponsive Non-muscle-invasive Bladder Cancer Undergoing Bladder-sparing Therapies. Eur Urol Focus. 2025 Feb 7:S2405-4569(25)00001-X. doi: 10.1016/j.euf.2025.01.001. Epub ahead of print. PMID: 39922753.

The purpose of this study is to investigate the role of tumor stage in oncologic outcomes in BCG-unresponsive NMIBC undergoing bladder-sparing therapies.

Smani S, Sohoni N, Golos A, Palencia P, Olawoyin O, Lokeshwar SD. Evaluating local anesthetic strategies in ambulatory urologic surgery: insights from the Baby ORIOLES randomized clinical trial. Transl Androl Urol. 2025 Feb 28;14(2):202-204. doi: 10.21037/tau-2024-711. Epub 2025 Feb 25. PMID: 40114822; PMCID: PMC11921433.

Well-designed, large-scale clinical trials are essential to advancing this field and providing evidence-based strategies for optimal pain control while reducing reliance on opioids.

Honig S. Editorial Comment. J Urol. 2025 Jan 29:101097JU0000000000004426. doi: 10.1097/JU.0000000000004426. Epub ahead of print. PMID: 39878196.

This study notes that only 25.4% had PVSAs performed. Thus, one would expect a higher failure rate. Compliance with PVSA is critical to assessing failure rates. As expected, there was a higher failure rate in patients who did not perform a PVSA.

[Leapman M]. Personalized frailty risk assessment in long-term survivors of colorectal cancer. Journal of clinical oncology. 02/2025;43(4_suppl):65-65. doi: 10.1200/jco.2025.43.4_suppl.65.

This was a retrospective cohort study of individuals aged 66 and older in the SEER-Medicare linked database, diagnosed with stage I-III colon or rectal cancer between 2003-2012.

[Onofrey JA] Enhancing uncertainty estimation in semantic segmentation via monte-carlo frequency dropout. arXiv. 2025.

We evaluated traditional MC-Dropout and the MC-frequency Dropout in three segmentation tasks involving different imaging modalities: (i) prostate zones in biparametric MRI, (ii) liver tumors in contrast-enhanced CT, and (iii) lungs in chest X-ray scans.

[Onofrey JA] SRE-conv: Symmetric rotation equivariant convolution for biomedical image classification. arXiv. 2025.

While current work largely relies on data augmentation or explicit modules to capture orientation information, this comes at the expense of increased training costs or ineffective approximations of the desired equivariance. To overcome these challenges, we propose a novel and efficient implementation of the Symmetric Rotation-Equivariant (SRE) Convolution (SRE-Conv) kernel, designed to learn rotation-invariant features while simultaneously compressing the model size. The SRE-Conv kernel can easily be incorporated into any CNN backbone.

[Onofrey JA] Head motion degrades machine learning classification of alzheimer's disease from positron emission tomography. arXiv. 2025.

Head motion during data acquisition has indeed been shown to degrade image quality and induces tracer uptake quantification error. This study demonstrates that it also biases machine learning-based AD classification.

Brady SS [Rickey L]. Ethnic and racial social identity, socioeconomic position, and Women’s bladder health. Social science & medicine (1982). 01/2025:117694. doi: 10.1016/j.socscimed.2025.117694.

To inform policies and programs designed to prevent lower urinary tract symptoms (LUTS) and promote bladder health among different social groups, this research utilized RISE FOR HEALTH data to examine potential health inequities in LUTS and bladder health by different indices of socioeconomic position, as well as ethnic and racial social identity.

Passarelli R [Sterling J, Kim IY]. Translational urology. Chapter 48 - Multicenter considerations. 2025:245-248. doi: 10.1016/b978-0-323-90186-4.00029-8.

Despite the laborious start-up process, there are many advantages to a multicenter clinical trial over a single-center trial.

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