Similar Journals
|
Urology
Journal Prestige (SJR): 1.111  Citation Impact (citeScore): 2 Number of Followers: 35  Hybrid journal (It can contain Open Access articles)ISSN (Print) 0090-4295 - ISSN (Online) 1527-9995 Published by Elsevier  [3206 journals]
|
- The pathophysiology and therapy of erectile dysfunction in a newly
discovered treatise by Wolfgang Reichart (1486–circa 1547)- Abstract: Publication date: Available online 13 February 2020Source: UrologyAuthor(s): Frank Ursin, Giovanni Rubeis, Florian Steger
- Abstract: Publication date: Available online 13 February 2020Source: UrologyAuthor(s): Frank Ursin, Giovanni Rubeis, Florian Steger
- A novel anterior bladder tube for traumatic bladder neck contracture in
females: initial results- Abstract: Publication date: Available online 13 February 2020Source: UrologyAuthor(s): Rishi Nayyar, Siddarth Jain, Kulbhushan Sharma, Sahil Pethe, Prashant KumarAbstractObjectiveTo describe a novel tabularized bladder flap technique for repair of post-traumatic obliterate bladder neck and urethral stricture in women. Traumatic genitourinary injury in females is rare, and generally associated with pelvic fracture. Obliterate bladder neck is frequent in such cases. The options for obliterate strictures are limited with Tanagho‘s repair as one option. Limitations of Tanagho's repair include bladder neck being shifted antero-superiorly posing voiding issues, posteriorly directed suture-line risking fistula formation with vagina and rotational tug of bladder putting tension at suture line. Here we present our initial results with our novel technique.Methods3 young females with bladder neck obliteration with or without associated uro-genital fistula were operated. A novel U-shaped anterior bladder wall flap was used to fashion a urethral tube and bladder neck. Native bladder neck fibres remained at bladder neck itself after reconstruction without limitation of length of urethral tube and continence outcome. Urogenital fistula was also repaired with omental interposition.Results3.5, 3 and 3.5 cm tubes were fashioned in the three cases respectively. No peri-operative complications were reported. Catheter was removed at 3 weeks. All cases had normal voiding and continence at follow up of 15, 7 and 3 months respectively.ConclusionsOur novel flap technique has provided good early results and aims to overcome the limitations of Tanagho's repair.
- Abstract: Publication date: Available online 13 February 2020Source: UrologyAuthor(s): Rishi Nayyar, Siddarth Jain, Kulbhushan Sharma, Sahil Pethe, Prashant KumarAbstractObjectiveTo describe a novel tabularized bladder flap technique for repair of post-traumatic obliterate bladder neck and urethral stricture in women. Traumatic genitourinary injury in females is rare, and generally associated with pelvic fracture. Obliterate bladder neck is frequent in such cases. The options for obliterate strictures are limited with Tanagho‘s repair as one option. Limitations of Tanagho's repair include bladder neck being shifted antero-superiorly posing voiding issues, posteriorly directed suture-line risking fistula formation with vagina and rotational tug of bladder putting tension at suture line. Here we present our initial results with our novel technique.Methods3 young females with bladder neck obliteration with or without associated uro-genital fistula were operated. A novel U-shaped anterior bladder wall flap was used to fashion a urethral tube and bladder neck. Native bladder neck fibres remained at bladder neck itself after reconstruction without limitation of length of urethral tube and continence outcome. Urogenital fistula was also repaired with omental interposition.Results3.5, 3 and 3.5 cm tubes were fashioned in the three cases respectively. No peri-operative complications were reported. Catheter was removed at 3 weeks. All cases had normal voiding and continence at follow up of 15, 7 and 3 months respectively.ConclusionsOur novel flap technique has provided good early results and aims to overcome the limitations of Tanagho's repair.
- Evaluation, treatment, and insurance coverage for couples with male factor
infertility in the US: A cross-sectional analysis of survey data- Abstract: Publication date: Available online 11 February 2020Source: UrologyAuthor(s): Clara Helene Glazer, Jake Anderson-Bialis, Deborah Anderson-Bialis, Michael L. EisenbergAbstractObjectiveTo characterize the evaluation, treatment, and insurance coverage among couples with male factor infertility in the US.Materials and MethodsA cohort of 969 couples undergoing fertility treatment with a diagnosis of male factor infertility were identified from an online survey. The proportion of men that were seen/not seen by a male were compared. Insurance coverage related to male factor was also assessed.ResultsOverall, 98.0% of the men reported at least one abnormal semen parameter. Of these, 72.0% were referred to a male fertility specialist with the majority being referred by the gynecologist of their female partner. As part of the male evaluation, 72.2% had blood hormone testing. Of the 248 men who were not recommended to see a male fertility specialist, 96.0% had an abnormal semen analysis including 7.6% who had azoospermia. Referral to a male fertility specialist was largely driven by severity of male factor infertility rather than socioeconomic status. Insurance coverage related to male factor infertility was poor with low coverage for sperm extractions (72.9% reported 0-25% coverage) and sperm freezing (83.7 reported 0-25% coverage).ConclusionAlthough this cohort includes couples with abnormal semen parameters, 28% of the men were not evaluated by a male fertility specialist. In addition, insurance coverage for services related to male factor were low. These findings may be of concern as insufficient evaluation and coverage of the infertile man could lead to missed opportunities for identifying reversible causes of infertility/medical comorbidities and places an unfair burden on the female partner.
- Abstract: Publication date: Available online 11 February 2020Source: UrologyAuthor(s): Clara Helene Glazer, Jake Anderson-Bialis, Deborah Anderson-Bialis, Michael L. EisenbergAbstractObjectiveTo characterize the evaluation, treatment, and insurance coverage among couples with male factor infertility in the US.Materials and MethodsA cohort of 969 couples undergoing fertility treatment with a diagnosis of male factor infertility were identified from an online survey. The proportion of men that were seen/not seen by a male were compared. Insurance coverage related to male factor was also assessed.ResultsOverall, 98.0% of the men reported at least one abnormal semen parameter. Of these, 72.0% were referred to a male fertility specialist with the majority being referred by the gynecologist of their female partner. As part of the male evaluation, 72.2% had blood hormone testing. Of the 248 men who were not recommended to see a male fertility specialist, 96.0% had an abnormal semen analysis including 7.6% who had azoospermia. Referral to a male fertility specialist was largely driven by severity of male factor infertility rather than socioeconomic status. Insurance coverage related to male factor infertility was poor with low coverage for sperm extractions (72.9% reported 0-25% coverage) and sperm freezing (83.7 reported 0-25% coverage).ConclusionAlthough this cohort includes couples with abnormal semen parameters, 28% of the men were not evaluated by a male fertility specialist. In addition, insurance coverage for services related to male factor were low. These findings may be of concern as insufficient evaluation and coverage of the infertile man could lead to missed opportunities for identifying reversible causes of infertility/medical comorbidities and places an unfair burden on the female partner.
- Seminoma In A Young Phenotypic Female With Turner Syndrome 45,XO/46,XY
Mosaicism: A Case Report With Review Of The Literature- Abstract: Publication date: Available online 10 February 2020Source: UrologyAuthor(s): Joseph M. Armstrong, Neha R. Malhotra, Glen A. LauAbstractTurner syndrome is a chromosomal disorder that occurs in an estimated 1 in 2500 female live births. It is estimated that 6-12% of all Turner syndrome patients will be a mosaic with Y-chromosomal elements putting them at risk for gonadoblastoma and subsequent dysgerminoma. While 30-50% of this population demonstrate gonadoblastoma, we only found 23 reported cases of dysgerminoma in the literature, and no reported cases of seminoma. We present the first case of seminoma in a phenotypic Turner 15-year-old female after prophylactic gonadectomy.
- Abstract: Publication date: Available online 10 February 2020Source: UrologyAuthor(s): Joseph M. Armstrong, Neha R. Malhotra, Glen A. LauAbstractTurner syndrome is a chromosomal disorder that occurs in an estimated 1 in 2500 female live births. It is estimated that 6-12% of all Turner syndrome patients will be a mosaic with Y-chromosomal elements putting them at risk for gonadoblastoma and subsequent dysgerminoma. While 30-50% of this population demonstrate gonadoblastoma, we only found 23 reported cases of dysgerminoma in the literature, and no reported cases of seminoma. We present the first case of seminoma in a phenotypic Turner 15-year-old female after prophylactic gonadectomy.
- The Influence of Indentation Deformity on Outcomes with Intralesional
Collagenase Clostridium histolyticum Monotherapy for Peyronie's Disease- Abstract: Publication date: Available online 10 February 2020Source: UrologyAuthor(s): Matthew J Ziegelmann, Daniel Heslop, Matthew Houlihan, Petar Bajic, Sevann Helo, Landon Trost, Tobias KohlerObjectiveTo identify patient-specific factors associated with patient-reported improvements in functional outcomes after intralesional Collagenase Clostridium histolyticum for Peyronie's Disease (PD).MethodsWe retrospectively explored our prospectively-maintained CCH registry. We sought to identify patient-specific factors that prevented the need for surgical straightening and/or improved ability to engage in penetrative intercourse.Results86 patients underwent CCH monotherapy and had objective follow-up data available. Mean PD symptom duration was 25 months (SD 44) and baseline curvature was 65o (SD 24). Prominent indentation/hourglass deformities (defined as girth discrepancy> 10%) were present in 40 patients (47%). Mean objective curve improvement was 19o (SD 20), and 60% achieved improvement ≥ 15o. Greater baseline curvature was associated with greater absolute improvements in curvature, although there was no association between baseline curvature and relative (%) improvement. 3/40 patients (8%) with indentation achieved girth improvement. Patients with baseline indentation/hourglass were less likely to report that CCH prevented the need for surgery (35% vs 64%, p=0.018). Patients with curve improvement < 15o were also less likely to report that CCH prevented the need for surgery (25% vs 63%, p=0.0086) or improved penetration (54% vs 89%, p=0.018).There were no differences in outcomes based on age, BMI, symptom duration, and presence of biplanar curvature.ConclusionsBaseline indentation/hourglass deformity and curve improvement < 15o are associated with less favorable functional improvements such as preventing the need for surgery and improving penetration.
- Abstract: Publication date: Available online 10 February 2020Source: UrologyAuthor(s): Matthew J Ziegelmann, Daniel Heslop, Matthew Houlihan, Petar Bajic, Sevann Helo, Landon Trost, Tobias KohlerObjectiveTo identify patient-specific factors associated with patient-reported improvements in functional outcomes after intralesional Collagenase Clostridium histolyticum for Peyronie's Disease (PD).MethodsWe retrospectively explored our prospectively-maintained CCH registry. We sought to identify patient-specific factors that prevented the need for surgical straightening and/or improved ability to engage in penetrative intercourse.Results86 patients underwent CCH monotherapy and had objective follow-up data available. Mean PD symptom duration was 25 months (SD 44) and baseline curvature was 65o (SD 24). Prominent indentation/hourglass deformities (defined as girth discrepancy> 10%) were present in 40 patients (47%). Mean objective curve improvement was 19o (SD 20), and 60% achieved improvement ≥ 15o. Greater baseline curvature was associated with greater absolute improvements in curvature, although there was no association between baseline curvature and relative (%) improvement. 3/40 patients (8%) with indentation achieved girth improvement. Patients with baseline indentation/hourglass were less likely to report that CCH prevented the need for surgery (35% vs 64%, p=0.018). Patients with curve improvement < 15o were also less likely to report that CCH prevented the need for surgery (25% vs 63%, p=0.0086) or improved penetration (54% vs 89%, p=0.018).There were no differences in outcomes based on age, BMI, symptom duration, and presence of biplanar curvature.ConclusionsBaseline indentation/hourglass deformity and curve improvement < 15o are associated with less favorable functional improvements such as preventing the need for surgery and improving penetration.
- Pressure Regulating Balloon Herniation: A Correctable Cause of Artificial
Urinary Sphincter Malfunction- Abstract: Publication date: Available online 10 February 2020Source: UrologyAuthor(s): Roger K. Khouri, Adam S. Baumgarten, Nicolas M. Ortiz, Ellen E. Ward, Ryan C. Baker, Maia E. VanDyke, Yooni A. Yi, Steven J. Hudak, Allen F. MoreyObjectivesTo report our experience with isolated PRB replacement for AUS malfunction in the setting of PRB herniation.MethodsA retrospective review of our large single-surgeon male AUS database was completed. We analyzed men with herniated PRBs palpable in the groin within an otherwise intact system. Patients with evidence of AUS fluid loss were excluded. PRBs were replaced in a submuscular location through a lower abdominal incision. Continence was defined as requiring ≤1 pad per day. Cystoscopic improvement of sphincter coaptation was confirmed intraoperatively.ResultsOf the 725 patients who underwent AUS surgery between 2011-2019, we identified 23 (3.2%) with PRB herniation and persistent or bothersome SUI who underwent isolated PRB replacement (median age 72 years, IQR 66-80). Four of the 23 patients were excluded from the analysis for subsequent explant unrelated to PRB replacement. At a mean follow up of 21.7 months (range 2-99 months), 94.7% of patients (18/19) noted significant improvement in their SUI, and 78.9% of patients (15/19) achieved continence. Median time between AUS placement and PRB revision was 13 months (IQR 6-34 months).ConclusionsPRB replacement appears to be a safe and effective salvage therapy for AUS patients with PRB herniation and persistent incontinence without mechanical failure. Intraoperative cystoscopic confirmation of enhanced sphincter coaptation appears to be a reliable predictor of treatment success.
- Abstract: Publication date: Available online 10 February 2020Source: UrologyAuthor(s): Roger K. Khouri, Adam S. Baumgarten, Nicolas M. Ortiz, Ellen E. Ward, Ryan C. Baker, Maia E. VanDyke, Yooni A. Yi, Steven J. Hudak, Allen F. MoreyObjectivesTo report our experience with isolated PRB replacement for AUS malfunction in the setting of PRB herniation.MethodsA retrospective review of our large single-surgeon male AUS database was completed. We analyzed men with herniated PRBs palpable in the groin within an otherwise intact system. Patients with evidence of AUS fluid loss were excluded. PRBs were replaced in a submuscular location through a lower abdominal incision. Continence was defined as requiring ≤1 pad per day. Cystoscopic improvement of sphincter coaptation was confirmed intraoperatively.ResultsOf the 725 patients who underwent AUS surgery between 2011-2019, we identified 23 (3.2%) with PRB herniation and persistent or bothersome SUI who underwent isolated PRB replacement (median age 72 years, IQR 66-80). Four of the 23 patients were excluded from the analysis for subsequent explant unrelated to PRB replacement. At a mean follow up of 21.7 months (range 2-99 months), 94.7% of patients (18/19) noted significant improvement in their SUI, and 78.9% of patients (15/19) achieved continence. Median time between AUS placement and PRB revision was 13 months (IQR 6-34 months).ConclusionsPRB replacement appears to be a safe and effective salvage therapy for AUS patients with PRB herniation and persistent incontinence without mechanical failure. Intraoperative cystoscopic confirmation of enhanced sphincter coaptation appears to be a reliable predictor of treatment success.
- Performance Optimization Strategies for Complex Endourologic Procedures
- Abstract: Publication date: Available online 8 February 2020Source: UrologyAuthor(s): Ron Golan, Ojas ShahAbstractThe shift in urology towards minimally-invasive endoscopic surgery has reduced the morbidity associated with common ailments such as kidney or ureteral stones. Urologists have grown more comfortable performing complex endoscopic procedures over the past several decades, while simultaneously, improvements in technology have facilitated these rapid developments. There remains opportunity for the practicing urologist to understand the intrinsic and extrinsic factors that may affect their performance, well-being, and outcomes. This comprehensive review article draws from lessons in surgical education, ergonomics, and performance psychology to provide the reader with strategies to maintain the highest level of performance for themselves and their patients.
- Abstract: Publication date: Available online 8 February 2020Source: UrologyAuthor(s): Ron Golan, Ojas ShahAbstractThe shift in urology towards minimally-invasive endoscopic surgery has reduced the morbidity associated with common ailments such as kidney or ureteral stones. Urologists have grown more comfortable performing complex endoscopic procedures over the past several decades, while simultaneously, improvements in technology have facilitated these rapid developments. There remains opportunity for the practicing urologist to understand the intrinsic and extrinsic factors that may affect their performance, well-being, and outcomes. This comprehensive review article draws from lessons in surgical education, ergonomics, and performance psychology to provide the reader with strategies to maintain the highest level of performance for themselves and their patients.
- Treatment of estrogen levels in the management of hypogonadism: An
anonymous survey of ISSM members- Abstract: Publication date: Available online 8 February 2020Source: UrologyAuthor(s): Mohit Butaney, Nannan Thirumavalavan, Adithya Balasubramanian, J. Abram McBride, Jabez Gondokusumo, Alexander W. Pastuszak, Larry I. LipshultzAbstractObjectiveTo assess the variability in management of estrogen levels in men treated with testosterone therapy (TTh). With the significant increase in the last two decades in the treatment of hypogonadism and the use of TTh, detailed guidelines for the management of estrogen levels are necessary. (1)Materials and MethodsAn anonymous survey was electronically distributed to the membership of the International Society for Sexual Medicine including questions on demographics, symptoms, and their approach to management of estrogen in patients on TTh. Chi-square test was used to determine associations.ResultsThe response rate was 22.5% (489/2168). 62.4% indicated that they check serum estrogen at initial evaluation, but only 54.7% monitor levels in patients on TTh (p=0.02). Fellowship-trained and North American respondents were more likely to monitor patients(p
- Abstract: Publication date: Available online 8 February 2020Source: UrologyAuthor(s): Mohit Butaney, Nannan Thirumavalavan, Adithya Balasubramanian, J. Abram McBride, Jabez Gondokusumo, Alexander W. Pastuszak, Larry I. LipshultzAbstractObjectiveTo assess the variability in management of estrogen levels in men treated with testosterone therapy (TTh). With the significant increase in the last two decades in the treatment of hypogonadism and the use of TTh, detailed guidelines for the management of estrogen levels are necessary. (1)Materials and MethodsAn anonymous survey was electronically distributed to the membership of the International Society for Sexual Medicine including questions on demographics, symptoms, and their approach to management of estrogen in patients on TTh. Chi-square test was used to determine associations.ResultsThe response rate was 22.5% (489/2168). 62.4% indicated that they check serum estrogen at initial evaluation, but only 54.7% monitor levels in patients on TTh (p=0.02). Fellowship-trained and North American respondents were more likely to monitor patients(p
- How Much Is Not Enough' Contextualizing Recent Trends in the Urology
Residency Match- Abstract: Publication date: Available online 7 February 2020Source: UrologyAuthor(s): Kevin Koo, Eugene B. Cone
- Abstract: Publication date: Available online 7 February 2020Source: UrologyAuthor(s): Kevin Koo, Eugene B. Cone
- Reply to “How Much is Not Enough' Contextualizing Recent Trends in
Urology Residency Match”- Abstract: Publication date: Available online 7 February 2020Source: UrologyAuthor(s): Daniel Wong, Vishnuvardhan Ganesan, Amy Kuprasertkul, Roger K. Khouri, Gary E. Lemack
- Abstract: Publication date: Available online 7 February 2020Source: UrologyAuthor(s): Daniel Wong, Vishnuvardhan Ganesan, Amy Kuprasertkul, Roger K. Khouri, Gary E. Lemack
- Vitamin D and Kidney Stones
- Abstract: Publication date: Available online 4 February 2020Source: UrologyAuthor(s): Michael L. Schulster, David S. GoldfarbAbstractThis review explores the relationship between vitamin D supplementation and lithogenesis. A causal relationship has been assumed despite myriad studies demonstrating that therapeutic doses of vitamin D do not increase lithogenic risk. Select stone formers may be at increased risk for recurrence with vitamin D supplementation, possibly from CYP24A1 gene mutations. Additionally, the evidence for who is vitamin D deficient, and the benefits of supplementation in those not at risk for rickets, is sparse. Concerns may be avoidable as vitamin D screening appears unnecessary in most patients, and superior pharmacology is available which increases bone density, while decreasing stone formation.
- Abstract: Publication date: Available online 4 February 2020Source: UrologyAuthor(s): Michael L. Schulster, David S. GoldfarbAbstractThis review explores the relationship between vitamin D supplementation and lithogenesis. A causal relationship has been assumed despite myriad studies demonstrating that therapeutic doses of vitamin D do not increase lithogenic risk. Select stone formers may be at increased risk for recurrence with vitamin D supplementation, possibly from CYP24A1 gene mutations. Additionally, the evidence for who is vitamin D deficient, and the benefits of supplementation in those not at risk for rickets, is sparse. Concerns may be avoidable as vitamin D screening appears unnecessary in most patients, and superior pharmacology is available which increases bone density, while decreasing stone formation.
- CHALLENGES OF VERY LONG-TERM REPORTING IN STRESS URINARY INCONTINENCE
SURGERIES IN WOMEN- Abstract: Publication date: Available online 4 February 2020Source: UrologyAuthor(s): Amy Kuprasertkul, Philippe ZimmernABSTRACTObjectiveTo review studies on surgeries to correct stress urinary incontinence (SUI) with very long-term results (≥ 10 years) to explore the challenges in reporting long-term follow-up.MethodsA comprehensive Ovid and PubMed search was conducted for articles containing long-term data over 10 years for the most commonly established surgical procedures to correct SUI. The methods of follow-up, lost to follow-up (LTF) rates, cure rates, and complications were compared.ResultsSUI corrective surgeries reviewed included: tension free vaginal tape (TVT), transobturator (TOT) sling, retropubic suspensions (Burch, MMK), autologous fascial sling, and Stamey needle suspension. Mean follow-up of all 17 studies was 12.6 years (range: 10-17 years) with sample sizes ranging from 26 to 650 patients. Methods of follow-up included clinic visits (n = 11), telephone interviews (n = 8), or mailed questionnaires (n = 5). Mean LTF rate was 24% (range: 10-49%). Mean objective and subjective cure rate with varying success definitions was 86% (range 81-91%) and 69%, respectively (range: 33-94%). The most common complications included de novo urgency (range: 2-70%), repeat SUI/prolapse surgeries (range: 2-37%), mesh/suture exposure (range: 1-9%), voiding problems (range: 2-36%), and pain (range: 2-14%).ConclusionsAll very long-term data for SUI surgeries share considerable LTF, infrequent examination data, mostly questionnaire-based information, and variable success rates from varying success definitions. Standardization of all these key outcome measures is urgently needed to provide more reliable long-term information on the outcome of these procedures.
- Abstract: Publication date: Available online 4 February 2020Source: UrologyAuthor(s): Amy Kuprasertkul, Philippe ZimmernABSTRACTObjectiveTo review studies on surgeries to correct stress urinary incontinence (SUI) with very long-term results (≥ 10 years) to explore the challenges in reporting long-term follow-up.MethodsA comprehensive Ovid and PubMed search was conducted for articles containing long-term data over 10 years for the most commonly established surgical procedures to correct SUI. The methods of follow-up, lost to follow-up (LTF) rates, cure rates, and complications were compared.ResultsSUI corrective surgeries reviewed included: tension free vaginal tape (TVT), transobturator (TOT) sling, retropubic suspensions (Burch, MMK), autologous fascial sling, and Stamey needle suspension. Mean follow-up of all 17 studies was 12.6 years (range: 10-17 years) with sample sizes ranging from 26 to 650 patients. Methods of follow-up included clinic visits (n = 11), telephone interviews (n = 8), or mailed questionnaires (n = 5). Mean LTF rate was 24% (range: 10-49%). Mean objective and subjective cure rate with varying success definitions was 86% (range 81-91%) and 69%, respectively (range: 33-94%). The most common complications included de novo urgency (range: 2-70%), repeat SUI/prolapse surgeries (range: 2-37%), mesh/suture exposure (range: 1-9%), voiding problems (range: 2-36%), and pain (range: 2-14%).ConclusionsAll very long-term data for SUI surgeries share considerable LTF, infrequent examination data, mostly questionnaire-based information, and variable success rates from varying success definitions. Standardization of all these key outcome measures is urgently needed to provide more reliable long-term information on the outcome of these procedures.
- Can we clinically distinguish anejaculation from retrograde ejaculation in
patients on α1A-blockers therapy for lower urinary tract symptoms'- Abstract: Publication date: Available online 4 February 2020Source: UrologyAuthor(s): Carlo Pavone, Alberto Abrate, Pietro Li Muli, Calogero Guzzardo, Alessio Giuseppe Guarneri, Salvatore Dioguardi, Chiara Sanfilippo, Marco Vella, Vincenzo Serretta, Alchiede SimonatoABSTRACTObjectiveTo investigate the physiopathology of ejaculatory disorders (EjD) and discriminate between retrograde ejaculation (REj) and anejaculation (AEj) induced by α1A-blockers, through the association between the mean post-orgasm seminal vesicle volume and the presence of sperm in mid-stream urine, in patients with moderate-to-severe lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement.Materials and MethodsTherapy-naïve male patients with LUTS and without previous EjD were treated with α1A-blockers. Pre- and post-treatment EjD were investigated through question 4 of the 4-item Male Sexual Function questionnaire (MSF-4 Q4) and the Male Sexual Health Questionnaire for Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF). After 12 weeks, post-orgasm urine was collected for sperm count and seminal vesicle volume was calculated through trans rectal ultrasound.ResultsAll 42 patients reported with EjD after treatment with α1A-blockers: MSF-4 Q4 and MSHQ-EjD-SF Q4 scores were significantly higher (p < 0.001) and MSHQ-EjD-SF Q1-3 score was significantly lower (p < 0.001) than before. Post-orgasm seminal vesicle volume was significantly higher in patients with post-orgasm sperm-negative urine (AEj), and lower in patients with post-orgasm sperm-positive urine (REj; p < 0.001).ConclusionsWe clearly demonstrated an association between the presence of sperm in the mid-stream urine and seminal vesicle volume after orgasm, strongly confirming and differentiating the hypothesis of a dual etiology for EjD (REj vs. AEj) secondary to α1A-blockers therapy for LUTS.
- Abstract: Publication date: Available online 4 February 2020Source: UrologyAuthor(s): Carlo Pavone, Alberto Abrate, Pietro Li Muli, Calogero Guzzardo, Alessio Giuseppe Guarneri, Salvatore Dioguardi, Chiara Sanfilippo, Marco Vella, Vincenzo Serretta, Alchiede SimonatoABSTRACTObjectiveTo investigate the physiopathology of ejaculatory disorders (EjD) and discriminate between retrograde ejaculation (REj) and anejaculation (AEj) induced by α1A-blockers, through the association between the mean post-orgasm seminal vesicle volume and the presence of sperm in mid-stream urine, in patients with moderate-to-severe lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement.Materials and MethodsTherapy-naïve male patients with LUTS and without previous EjD were treated with α1A-blockers. Pre- and post-treatment EjD were investigated through question 4 of the 4-item Male Sexual Function questionnaire (MSF-4 Q4) and the Male Sexual Health Questionnaire for Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF). After 12 weeks, post-orgasm urine was collected for sperm count and seminal vesicle volume was calculated through trans rectal ultrasound.ResultsAll 42 patients reported with EjD after treatment with α1A-blockers: MSF-4 Q4 and MSHQ-EjD-SF Q4 scores were significantly higher (p < 0.001) and MSHQ-EjD-SF Q1-3 score was significantly lower (p < 0.001) than before. Post-orgasm seminal vesicle volume was significantly higher in patients with post-orgasm sperm-negative urine (AEj), and lower in patients with post-orgasm sperm-positive urine (REj; p < 0.001).ConclusionsWe clearly demonstrated an association between the presence of sperm in the mid-stream urine and seminal vesicle volume after orgasm, strongly confirming and differentiating the hypothesis of a dual etiology for EjD (REj vs. AEj) secondary to α1A-blockers therapy for LUTS.
- Stressors and coping mechanisms related to burnout within urology
- Abstract: Publication date: Available online 4 February 2020Source: UrologyAuthor(s): Julie W. Cheng, Hillary Wagner, Barbara C. Hernandez, Brian R. Hu, Edmund Y. Ko, Herbert C. RuckleAbstractObjectiveTo identify factors and stress coping mechanisms associated with burnout within the field of urology.MethodsA survey study was completed using the abbreviated Maslach Burnout Inventory to evaluate emotional exhaustion, depersonalization, and low personal achievement. Demographic information, training status, practice setting, work hours, and mechanisms used to cope with stress were evaluated. Participants were also asked to comment on contributors to burnout in an open-ended question. Univariate analysis and multivariate regression identified factors associated with measures of burnout.ResultsA total of 476 survey responses from 377 practicing urologists and 99 residents/fellows were included. Burnout was identified in 49.6% of all participants. Burnout through high emotional exhaustion was seen in 40.7%, high depersonalization in 30.7%, and low personal achievement in 18.3%. Trainees exhibited higher levels of depersonalization and lower levels of personal achievement. Higher levels of emotional exhaustion were identified in urologists in the middle of their careers and those in private practice. Urologists identified documentation, insurance and reimbursement, government regulations, medical practice expectations, and patient expectations as stressors contributing to burnout. Exercising and socializing were consistently associated with lower measures of burnout whereas stress eating and alcohol use were associated with higher measures of burnout on multivariate analysis.ConclusionsBurnout in urology was associated with trainee status, years in practice, and practice setting. Exercising and socializing were protective against burnout whereas stress eating and alcohol consumption were associated with higher rates of burnout.
- Abstract: Publication date: Available online 4 February 2020Source: UrologyAuthor(s): Julie W. Cheng, Hillary Wagner, Barbara C. Hernandez, Brian R. Hu, Edmund Y. Ko, Herbert C. RuckleAbstractObjectiveTo identify factors and stress coping mechanisms associated with burnout within the field of urology.MethodsA survey study was completed using the abbreviated Maslach Burnout Inventory to evaluate emotional exhaustion, depersonalization, and low personal achievement. Demographic information, training status, practice setting, work hours, and mechanisms used to cope with stress were evaluated. Participants were also asked to comment on contributors to burnout in an open-ended question. Univariate analysis and multivariate regression identified factors associated with measures of burnout.ResultsA total of 476 survey responses from 377 practicing urologists and 99 residents/fellows were included. Burnout was identified in 49.6% of all participants. Burnout through high emotional exhaustion was seen in 40.7%, high depersonalization in 30.7%, and low personal achievement in 18.3%. Trainees exhibited higher levels of depersonalization and lower levels of personal achievement. Higher levels of emotional exhaustion were identified in urologists in the middle of their careers and those in private practice. Urologists identified documentation, insurance and reimbursement, government regulations, medical practice expectations, and patient expectations as stressors contributing to burnout. Exercising and socializing were consistently associated with lower measures of burnout whereas stress eating and alcohol use were associated with higher measures of burnout on multivariate analysis.ConclusionsBurnout in urology was associated with trainee status, years in practice, and practice setting. Exercising and socializing were protective against burnout whereas stress eating and alcohol consumption were associated with higher rates of burnout.
- Marijuana, lower urinary tract symptoms, and pain in the urologic patient
- Abstract: Publication date: Available online 4 February 2020Source: UrologyAuthor(s): Minh N. Pham, Matthew T. Hudnall, Robert B. NadlerAbstractPURPOSETo describe marijuana's clinical role for urologic symptoms.METHODSStudies related to marijuana, voiding dysfunction, lower urinary tract symptoms (LUTS), and pain through January 2019 from PubMed were evaluated for relevance and quality.RESULTSForty-eight studies were reviewed. Cannabinoids have mixed efficacy for neurogenic LUTS and little evidence for non-neurogenic LUTS, chronic non-cancer-related and perioperative pain. For cancer-related pain, high-level studies demonstrate cannabinoids are well-tolerated with unclear benefit.CONCLUSIONSCannabinoids appear well-tolerated in the short-term, but their efficacy and long-term impact is unproven and unknown in urologic discomfort. Cannabinoids for urologic symptoms should be further explored with well-designed RCTs.
- Abstract: Publication date: Available online 4 February 2020Source: UrologyAuthor(s): Minh N. Pham, Matthew T. Hudnall, Robert B. NadlerAbstractPURPOSETo describe marijuana's clinical role for urologic symptoms.METHODSStudies related to marijuana, voiding dysfunction, lower urinary tract symptoms (LUTS), and pain through January 2019 from PubMed were evaluated for relevance and quality.RESULTSForty-eight studies were reviewed. Cannabinoids have mixed efficacy for neurogenic LUTS and little evidence for non-neurogenic LUTS, chronic non-cancer-related and perioperative pain. For cancer-related pain, high-level studies demonstrate cannabinoids are well-tolerated with unclear benefit.CONCLUSIONSCannabinoids appear well-tolerated in the short-term, but their efficacy and long-term impact is unproven and unknown in urologic discomfort. Cannabinoids for urologic symptoms should be further explored with well-designed RCTs.
- Impact of spinal defects on urinary and sexual outcome in adults with
anorectal malformations – a cross-sectional study- Abstract: Publication date: Available online 4 February 2020Source: UrologyAuthor(s): Thomas Bjørsum-Meyer, Lars Lund, Peter Christensen, Marianne Skytte Jakobsen, Jon Asmussen, Niels QvistAbstractObjectiveTo examine the impact of spinal defects on urinary function, sexual outcome and quality of life in adult patients born with anorectal malformations.Materials and methodsA prospective cohort study at Odense University Hospital in Denmark was conducted. From 1985 to 2000, 93 patients were found eligible for participation. Twenty-seven (29%) consented to participate. One patient refrained from clinical examinations.Patients were examined with magnetic resonance imaging, uroflowmetry and validated questionnaires on urinary function, sexual function and quality of life.ResultsThere were 14 were females and 13 were males, median age of 25 (range 19-31) years and 23 (18-32) years respectively. The type of anorectal malformations in females were vestibular fistula (n=6), anocutaneous fistula (n=4), anal stenosis (n=3) and cloaca (n=1). In males the type of malformations were anocutaneous fistula (n=4), bulbar fistula (n=4), rectovesical fistula (n=2), anal stenosis (n=1), rectal atresia (n=1) and anal atresia with no fistula (n=1). Patients with spinal defects had a lower average voiding rate compared to patients with normal spinal anatomy (p 0.03), a lower voiding-related quality of life (p 0.02) and a tendency was observed towards a worse total urinary incontinence-related quality of life score (p 0.06). Moreover in patients with spinal defect a tendency was seen towards a worse general quality of life (p 0.09)ConclusionsSpinal defects detected by magnetic resonance imaging in adults with anorectal malformations were found to be associated with urinary voiding function.
- Abstract: Publication date: Available online 4 February 2020Source: UrologyAuthor(s): Thomas Bjørsum-Meyer, Lars Lund, Peter Christensen, Marianne Skytte Jakobsen, Jon Asmussen, Niels QvistAbstractObjectiveTo examine the impact of spinal defects on urinary function, sexual outcome and quality of life in adult patients born with anorectal malformations.Materials and methodsA prospective cohort study at Odense University Hospital in Denmark was conducted. From 1985 to 2000, 93 patients were found eligible for participation. Twenty-seven (29%) consented to participate. One patient refrained from clinical examinations.Patients were examined with magnetic resonance imaging, uroflowmetry and validated questionnaires on urinary function, sexual function and quality of life.ResultsThere were 14 were females and 13 were males, median age of 25 (range 19-31) years and 23 (18-32) years respectively. The type of anorectal malformations in females were vestibular fistula (n=6), anocutaneous fistula (n=4), anal stenosis (n=3) and cloaca (n=1). In males the type of malformations were anocutaneous fistula (n=4), bulbar fistula (n=4), rectovesical fistula (n=2), anal stenosis (n=1), rectal atresia (n=1) and anal atresia with no fistula (n=1). Patients with spinal defects had a lower average voiding rate compared to patients with normal spinal anatomy (p 0.03), a lower voiding-related quality of life (p 0.02) and a tendency was observed towards a worse total urinary incontinence-related quality of life score (p 0.06). Moreover in patients with spinal defect a tendency was seen towards a worse general quality of life (p 0.09)ConclusionsSpinal defects detected by magnetic resonance imaging in adults with anorectal malformations were found to be associated with urinary voiding function.
- AUTHOR REPLY
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Raphaëlle Brière, Eboo Versi, Patrick O. Richard, Matthieu Gratton, Le Mai Tu
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Raphaëlle Brière, Eboo Versi, Patrick O. Richard, Matthieu Gratton, Le Mai Tu
- Henoch-Schonlein Purpura Presenting With Bilateral Solid Testicular Masses
in an Adult- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Marissa B. Lobl, Chad A. LaGrange, Ryan M. Trowbridge
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Marissa B. Lobl, Chad A. LaGrange, Ryan M. Trowbridge
- Prostate Artery Embolization for Severe BPH in a Patient Unfit for Surgery
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Eric Ballon-Landa, Seth K. Bechis
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Eric Ballon-Landa, Seth K. Bechis
- Urological, Sexual, and Quality of Life Evaluation of Adult Patients With
Exstrophy-Epispadias Complex: Long-term Results From a Dutch Cohort- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Xiaoye Zhu, Aart J. Klijn, Laetitia M.O. de KortABSTRACTObjectiveTo assess urological function, sexual function, and quality of life in patients with exstrophy or epispadias. Little is known regarding these outcomes in adult patients; our aim is to determine where improvements are needed for long-term management.MethodsThe study population comprised adult (>18 years) patients. Demographic data were gathered and patients were asked to fill out 4 validated questionnaires: (1) International Consultation on Incontinence Questionnaire urinary incontinence form (ICIQ-UI) regarding continence; (2) International Prostate Symptom Score (IPSS) for men and International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) for women regarding lower urinary tract symptoms; (3) 12-Item Short Form Health Survey regarding quality of life; (4) International Index of Erectile Function for men and Female Sexual Function Index for women regarding sexual function.ResultsSeventeen patients were included (9 men and 8 women) with a median age of 36 years (range 19-73). Median score on ICIQ-UI was 5/21. Median IPSS score was 7/35 and median quality of life score was 1 (=pleased). Median scores per domain within ICIQ-FLUTS were 7 for storage, 0 for voiding, and 6 for urinary incontinence with bother scores of 4, 0, and 2.8, respectively. Scores for 12-Item Short Form Health Survey in the study population were comparable with those of the Dutch population, except for Physical Component Summary in women. For sexual function, no difference was found between those in the general population and our participants except for the domain "pain" in Female Sexual Function Index.ConclusionAdult patients with exstrophy or epispadias have a high rate of incontinence and lower urinary tract symptoms with relatively low to some degree of bother. When compared with the general population, quality of life, and sexual function of our patients were more or less similar.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Xiaoye Zhu, Aart J. Klijn, Laetitia M.O. de KortABSTRACTObjectiveTo assess urological function, sexual function, and quality of life in patients with exstrophy or epispadias. Little is known regarding these outcomes in adult patients; our aim is to determine where improvements are needed for long-term management.MethodsThe study population comprised adult (>18 years) patients. Demographic data were gathered and patients were asked to fill out 4 validated questionnaires: (1) International Consultation on Incontinence Questionnaire urinary incontinence form (ICIQ-UI) regarding continence; (2) International Prostate Symptom Score (IPSS) for men and International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) for women regarding lower urinary tract symptoms; (3) 12-Item Short Form Health Survey regarding quality of life; (4) International Index of Erectile Function for men and Female Sexual Function Index for women regarding sexual function.ResultsSeventeen patients were included (9 men and 8 women) with a median age of 36 years (range 19-73). Median score on ICIQ-UI was 5/21. Median IPSS score was 7/35 and median quality of life score was 1 (=pleased). Median scores per domain within ICIQ-FLUTS were 7 for storage, 0 for voiding, and 6 for urinary incontinence with bother scores of 4, 0, and 2.8, respectively. Scores for 12-Item Short Form Health Survey in the study population were comparable with those of the Dutch population, except for Physical Component Summary in women. For sexual function, no difference was found between those in the general population and our participants except for the domain "pain" in Female Sexual Function Index.ConclusionAdult patients with exstrophy or epispadias have a high rate of incontinence and lower urinary tract symptoms with relatively low to some degree of bother. When compared with the general population, quality of life, and sexual function of our patients were more or less similar.
- AUTHOR REPLY
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Michael S. Borofsky, Marcelino E. Rivera, Casey A. Dauw, Amy E. Krambeck, James E. Lingeman
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Michael S. Borofsky, Marcelino E. Rivera, Casey A. Dauw, Amy E. Krambeck, James E. Lingeman
- EDITORIAL COMMENT
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Bodo E. Knudsen
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Bodo E. Knudsen
- Electromagnetic Guided Percutaneous Renal Access Outcomes Among Surgeons
and Trainees of Different Experience Levels: A Pilot Study- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Michael S. Borofsky, Marcelino E. Rivera, Casey A. Dauw, Amy E. Krambeck, James E. LingemanAbstractObjectiveTo determine feasibility of an electromagnetic (EM) guidance system (Auris Health, Redwood City, CA) in obtaining percutaneous renal access among urologists and trainees of different experience levels. EM-guidance is appealing for access as it allows real time, 3-dimensional targeting without radiation. Few studies have explored this for percutaneous nephrolithotomy (PCNL) and none have assessed its potential to decrease the learning curve in obtaining access using traditional techniques.MethodsInstitutional Animal Care and Use Committee approval was obtained to compare EM-guided percutaneous access to fluoroscopic guided access in a porcine model. Voluntary participants included urology trainees and faculty. They were categorized as beginner (no prior primary percutaneous nephrolithotomyexperience), intermediate (10-100 prior) and advanced (>100). Each participant attempted an EM and fluoroscopic guided puncture. Primary outcome was successful puncture. Secondary outcomes included access time, fluoroscopy time, and number of attempts. Participants were limited to 3 attempts and 10 minutes total to obtain access using each technique.ResultsFourteen participants (6 beginners, 4 intermediates, and 4 experts) attempted 28 punctures. Overall success using EM-guidance was 93% compared to 71% using fluoroscopy (P = .33). EM punctures had shorter access times (85 vs 255 seconds, P
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Michael S. Borofsky, Marcelino E. Rivera, Casey A. Dauw, Amy E. Krambeck, James E. LingemanAbstractObjectiveTo determine feasibility of an electromagnetic (EM) guidance system (Auris Health, Redwood City, CA) in obtaining percutaneous renal access among urologists and trainees of different experience levels. EM-guidance is appealing for access as it allows real time, 3-dimensional targeting without radiation. Few studies have explored this for percutaneous nephrolithotomy (PCNL) and none have assessed its potential to decrease the learning curve in obtaining access using traditional techniques.MethodsInstitutional Animal Care and Use Committee approval was obtained to compare EM-guided percutaneous access to fluoroscopic guided access in a porcine model. Voluntary participants included urology trainees and faculty. They were categorized as beginner (no prior primary percutaneous nephrolithotomyexperience), intermediate (10-100 prior) and advanced (>100). Each participant attempted an EM and fluoroscopic guided puncture. Primary outcome was successful puncture. Secondary outcomes included access time, fluoroscopy time, and number of attempts. Participants were limited to 3 attempts and 10 minutes total to obtain access using each technique.ResultsFourteen participants (6 beginners, 4 intermediates, and 4 experts) attempted 28 punctures. Overall success using EM-guidance was 93% compared to 71% using fluoroscopy (P = .33). EM punctures had shorter access times (85 vs 255 seconds, P
- Novel Use of Hydrodissection for the Insertion of Suprapubic Catheter
Under Ultrasound Guidance- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Kenrick Kai Chi Chan, Archie SpeirsABSTRACTObjectiveTo find a method of safely inserting a suprapubic catheter (SPC) under local anesthetic and under ultrasound guidance in patients who may not be fit for a general anesthetic but also are seen to have bowel overlying the anterior bladder wall which obscures a safe route to the bladder.Materials and MethodsWe used ultrasonography to visualize the bladder which was initially filled via the indwelling urethral catheter. A 22-gauge needle attached to a syringe filled with 30 mL of fluid (made up of 10 mL of 1% lidocaine plus 20 mL sterile water) was inserted transabdominally under ultrasound guidance into a space between the pubic symphysis and bowel. The fluid was then injected into the space to hydrodissect the bowel away from the bladder. Once the space had been created, an 18-guage needle was passed into the bladder and a SPC was inserted via the Seldinger technique.ResultsSuccessful SPC insertion was confirmed on ultrasound guidance with no associated bowel or other injury. Telephone follow-up with the patient 6 months later revealed that the patient had no complications and no infections.ConclusionHydrodissection can be considered when inserting SPC under local anesthetic under ultrasound guidance when there is bowel obscuring any safe route to the bladder. This may be particularly useful in patients who may not be fit for a general an aesthetic.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Kenrick Kai Chi Chan, Archie SpeirsABSTRACTObjectiveTo find a method of safely inserting a suprapubic catheter (SPC) under local anesthetic and under ultrasound guidance in patients who may not be fit for a general anesthetic but also are seen to have bowel overlying the anterior bladder wall which obscures a safe route to the bladder.Materials and MethodsWe used ultrasonography to visualize the bladder which was initially filled via the indwelling urethral catheter. A 22-gauge needle attached to a syringe filled with 30 mL of fluid (made up of 10 mL of 1% lidocaine plus 20 mL sterile water) was inserted transabdominally under ultrasound guidance into a space between the pubic symphysis and bowel. The fluid was then injected into the space to hydrodissect the bowel away from the bladder. Once the space had been created, an 18-guage needle was passed into the bladder and a SPC was inserted via the Seldinger technique.ResultsSuccessful SPC insertion was confirmed on ultrasound guidance with no associated bowel or other injury. Telephone follow-up with the patient 6 months later revealed that the patient had no complications and no infections.ConclusionHydrodissection can be considered when inserting SPC under local anesthetic under ultrasound guidance when there is bowel obscuring any safe route to the bladder. This may be particularly useful in patients who may not be fit for a general an aesthetic.
- AUTHOR REPLY
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Akio Horiguchi
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Akio Horiguchi
- EDITORIAL COMMENT
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Gregory T. Bales
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Gregory T. Bales
- Is Primary Realignment Appropriate for the Initial Management of Straddle
Injuries to the Bulbar Urethra'- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Kenichiro Ojima, Akio Horiguchi, Masayuki Shinchi, Ayako Masunaga, Fumihiro Kimura, Eiji Takahashi, Tomohiko Asano, Keiichi Ito, Ryuichi AzumaAbstractObjectiveTo compare the clinical courses of patients with straddle injuries to the bulbar urethra based on the initial management strategy for urinary drainage, mainly suprapubic tube placement (SPT) and primary realignment (PR), and to examine whether PR has a beneficial effect on subsequent urethroplasty with regards to surgical and patient-reported outcomes.MethodsWe reviewed the clinical courses of 126 patients with bulbar urethral stricture following straddle injuries who underwent delayed urethroplasty between August 2010 and April 2019. Patients were categorized as being initially treated with SPT (82 patients) or PR (44 patients). Stricture was considered complicated if preoperative urethrography or cystoscopy revealed iatrogenic scarring or a stricture away from the injury site.ResultsThe percentage of patients who experienced delayed transurethral treatment at least once before referral was significantly higher in patients treated with PR than in those treated with SPT (25/44, 56.8% vs 16/82, 19.8%, P < .0001). Although there was no difference in stricture length in both cohorts, the fraction of patients with complicated stricture was significantly higher in patients treated with PR than in those treated with SPT (15/44, 34.1% vs 14/82, 17.1%, P = .003). There was no significant difference in the selected type of urethroplasty, operative time, blood loss, success rate, postoperative maximum urinary flow rate, voiding symptoms, or erectile function between the 2 groups.ConclusionPR does not facilitate delayed urethroplasty and had no beneficial effect on urethroplasty outcome. PR might lead to delayed transurethral procedures, resulting in increased risk of complicated strictures.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Kenichiro Ojima, Akio Horiguchi, Masayuki Shinchi, Ayako Masunaga, Fumihiro Kimura, Eiji Takahashi, Tomohiko Asano, Keiichi Ito, Ryuichi AzumaAbstractObjectiveTo compare the clinical courses of patients with straddle injuries to the bulbar urethra based on the initial management strategy for urinary drainage, mainly suprapubic tube placement (SPT) and primary realignment (PR), and to examine whether PR has a beneficial effect on subsequent urethroplasty with regards to surgical and patient-reported outcomes.MethodsWe reviewed the clinical courses of 126 patients with bulbar urethral stricture following straddle injuries who underwent delayed urethroplasty between August 2010 and April 2019. Patients were categorized as being initially treated with SPT (82 patients) or PR (44 patients). Stricture was considered complicated if preoperative urethrography or cystoscopy revealed iatrogenic scarring or a stricture away from the injury site.ResultsThe percentage of patients who experienced delayed transurethral treatment at least once before referral was significantly higher in patients treated with PR than in those treated with SPT (25/44, 56.8% vs 16/82, 19.8%, P < .0001). Although there was no difference in stricture length in both cohorts, the fraction of patients with complicated stricture was significantly higher in patients treated with PR than in those treated with SPT (15/44, 34.1% vs 14/82, 17.1%, P = .003). There was no significant difference in the selected type of urethroplasty, operative time, blood loss, success rate, postoperative maximum urinary flow rate, voiding symptoms, or erectile function between the 2 groups.ConclusionPR does not facilitate delayed urethroplasty and had no beneficial effect on urethroplasty outcome. PR might lead to delayed transurethral procedures, resulting in increased risk of complicated strictures.
- AUTHOR REPLY
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Sapan N. Ambani
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Sapan N. Ambani
- EDITORIAL COMMENT
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Brian M. Inouye, Jeffrey R. Gingrich
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Brian M. Inouye, Jeffrey R. Gingrich
- Primary Pediatric Renal Primitive Neuroectodermal Tumor: A Case Report
With Different Stage CT and MRI Images- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Zongyu Zheng, Ping Li, Tianjiao Ma, Song Wang, Zhiyong Ma, Weigang WangAbstractEwing sarcoma/primitive neuroectodermal tumor (ES/PNET) of the kidney in children younger than 10 years of age is extremely rare. We describe here the case of a 7-year-old female patient who was diagnosed with ES/PNET. The timeframe for this case spanned from 8 months prior to diagnosis until 8 months postsurgical removal of the tumor. In addition, we summarized the cases of PNET in children younger than 10 years of age in the last decade.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Zongyu Zheng, Ping Li, Tianjiao Ma, Song Wang, Zhiyong Ma, Weigang WangAbstractEwing sarcoma/primitive neuroectodermal tumor (ES/PNET) of the kidney in children younger than 10 years of age is extremely rare. We describe here the case of a 7-year-old female patient who was diagnosed with ES/PNET. The timeframe for this case spanned from 8 months prior to diagnosis until 8 months postsurgical removal of the tumor. In addition, we summarized the cases of PNET in children younger than 10 years of age in the last decade.
- Osseous Metaplasia in a Bladder Diverticulum in a Patient with Mosaic
Menkes Disease- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Katie L. Canalichio, Karen M. Chisholm, Thomas S. LendvayAbstractMenkes disease, or Kinky Hair Syndrome, is a rare disorder of copper metabolism that causes fatal neurodegenerative disease in infancy. This X-linked disorder results from mutations in the ATP7A gene. Along with neurological decline, characteristic coarse appearance of the hair is seen. Urological issues are prevalent in this patient population, with bladder diverticula being the most common. Herein, we describe a unique male patient with genetic mosaicism and osseous metaplasia found in a ruptured bladder diverticulum.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Katie L. Canalichio, Karen M. Chisholm, Thomas S. LendvayAbstractMenkes disease, or Kinky Hair Syndrome, is a rare disorder of copper metabolism that causes fatal neurodegenerative disease in infancy. This X-linked disorder results from mutations in the ATP7A gene. Along with neurological decline, characteristic coarse appearance of the hair is seen. Urological issues are prevalent in this patient population, with bladder diverticula being the most common. Herein, we describe a unique male patient with genetic mosaicism and osseous metaplasia found in a ruptured bladder diverticulum.
- Utility of Skin Grafting and Tissue Expansion in Penile Reconstruction for
the Exstrophy-Epispadias Complex- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Thomas George William Harris, Mahir Maruf, Angelo Alberto Leto Barone, Richard James Redett, John Patrick GearhartAbstractObjectiveTo describe the use of additional tissue recruited for coverage after penile lengthening in male exstrophy-epispadias complex patients using either local skin from tissue expansion (TE) or extragenital skin with a skin graft (SG) and report their respective outcomes.MethodsAn institutionally approved database of exstrophy-epispadias complex patients was retrospectively reviewed for male patients who received penile reconstruction. This included a penile lengthening procedure and the subsequent use of TE and/or a full thickness skin graft to provide cutaneous coverage of gained corporal length.ResultsA total of 50 patients (mean age 18.1 years) underwent penile reconstruction. TE was used in 27 patients, SG in 19, and 4 received a combination of TE and SG. The mean number of previous penile operations was 2.7 for patients that received TE and 3.1 for SG. A successful outcome from primary reconstruction was achieved in 35 patients (70%) and overall successful reconstruction was achieved by 48 patients (96%).ConclusionTE and SG are useful techniques in providing soft tissue coverage following penile lengthening. TE is the preferred technique for primary reconstruction in a lengthening procedure. When genital skin is not expandable or coverage from TE is insufficient after lengthening, extragenital skin (SG) is recruited.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Thomas George William Harris, Mahir Maruf, Angelo Alberto Leto Barone, Richard James Redett, John Patrick GearhartAbstractObjectiveTo describe the use of additional tissue recruited for coverage after penile lengthening in male exstrophy-epispadias complex patients using either local skin from tissue expansion (TE) or extragenital skin with a skin graft (SG) and report their respective outcomes.MethodsAn institutionally approved database of exstrophy-epispadias complex patients was retrospectively reviewed for male patients who received penile reconstruction. This included a penile lengthening procedure and the subsequent use of TE and/or a full thickness skin graft to provide cutaneous coverage of gained corporal length.ResultsA total of 50 patients (mean age 18.1 years) underwent penile reconstruction. TE was used in 27 patients, SG in 19, and 4 received a combination of TE and SG. The mean number of previous penile operations was 2.7 for patients that received TE and 3.1 for SG. A successful outcome from primary reconstruction was achieved in 35 patients (70%) and overall successful reconstruction was achieved by 48 patients (96%).ConclusionTE and SG are useful techniques in providing soft tissue coverage following penile lengthening. TE is the preferred technique for primary reconstruction in a lengthening procedure. When genital skin is not expandable or coverage from TE is insufficient after lengthening, extragenital skin (SG) is recruited.
- Antibiotic Prophylaxis Prescribing Patterns of Pediatric Urologists for
Children with Vesicoureteral Reflux and other Congenital Anomalies of the
Kidney and Urinary Tract- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Rana F. Hamdy, Hans G. Pohl, Catherine S. ForsterABSTRACTObjectiveTo determine pediatric urologists’ antibiotic prophylaxis prescribing practices for children with vesicoureteral reflux (VUR) and other congenital anomalies of the kidney and urinary tract (CAKUT).MethodsWeb-based survey of pediatric urologists about their practice of antibiotic prophylaxis in children with CAKUT.ResultsWe had a response rate of 17.8% (n = 73). The majority of respondents always or often prescribe prophylactic antibiotics for grade IV or V VUR, while greater variability was seen for lower grades of VUR. 47.9% of respondents report that they often or always prescribe antibiotics for patients with grade 4 hydronephrosis, and most respondents report that they never or rarely prescribe antibiotics for grade 1 or 2 hydronephrosis. The majority of respondents never or rarely prescribe antibiotics for horseshoe or solitary kidney (88% and 86%, respectively), but frequently prescribed antibiotic for ureterocele. For ectopic ureter, almost half of respondents prescribe prophylactic antibiotics always or often, whereas only 18% prescribe antibiotics always or often for duplication anomalies. Only 11% reported prescribing antibiotics for prophylaxis always or often for children with myelomeningocele.ConclusionWe report notable variability in antibiotic prescribing patterns for children with CAKUT. Given the lack of guidelines around the use of prophylaxis in the majority of these conditions, standardization of care may be warranted to decrease this variability.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Rana F. Hamdy, Hans G. Pohl, Catherine S. ForsterABSTRACTObjectiveTo determine pediatric urologists’ antibiotic prophylaxis prescribing practices for children with vesicoureteral reflux (VUR) and other congenital anomalies of the kidney and urinary tract (CAKUT).MethodsWeb-based survey of pediatric urologists about their practice of antibiotic prophylaxis in children with CAKUT.ResultsWe had a response rate of 17.8% (n = 73). The majority of respondents always or often prescribe prophylactic antibiotics for grade IV or V VUR, while greater variability was seen for lower grades of VUR. 47.9% of respondents report that they often or always prescribe antibiotics for patients with grade 4 hydronephrosis, and most respondents report that they never or rarely prescribe antibiotics for grade 1 or 2 hydronephrosis. The majority of respondents never or rarely prescribe antibiotics for horseshoe or solitary kidney (88% and 86%, respectively), but frequently prescribed antibiotic for ureterocele. For ectopic ureter, almost half of respondents prescribe prophylactic antibiotics always or often, whereas only 18% prescribe antibiotics always or often for duplication anomalies. Only 11% reported prescribing antibiotics for prophylaxis always or often for children with myelomeningocele.ConclusionWe report notable variability in antibiotic prescribing patterns for children with CAKUT. Given the lack of guidelines around the use of prophylaxis in the majority of these conditions, standardization of care may be warranted to decrease this variability.
- Frequency and Variability of Advice Given to Parents on Care of the
Uncircumcised Penis by Pediatric Residents: A Need to Improve Education- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Neha R. Malhotra, Ilina Rosoklija, Rachel Shannon, Anthony D'Oro, Dennis B. LiuAbstractObjectiveTo understand the extent to which pediatricians are providing advice on care of the uncircumcised penis and the advice they are providing. We hypothesized that pediatric residents lack preparedness to offer parents advice on caring for the uncircumcised penis and as such are unlikely to offer such advice.MethodsAn IRB approved, anonymous survey was administered to 244 pediatric residents in 5 urban training programs (Appendix). Descriptive statistics were used for clinical and demographic data and Fisher's exact and Kruskal-Wallis tests were used for comparative analysis.ResultsEighty-three residents completed the survey for a response rate of 34%. Less than half (45%) of the residents surveyed were likely, or extremely likely to voluntarily offer advice to parents on care of the uncircumcised penis. On a scale of 0-100, the median confidence level in offering advice was 48 (interquartile range [IQR] 30-52). Forty-nine percent of residents reported never being taught care of the uncircumcised penis. Of those who received education, 72% reported learning informally from a senior resident or attending and only 9% learned from a formal lecture. Pediatric residents varied greatly on advice given to parents in regards to the frequency of retraction and 40% offered no advice.ConclusionThis study demonstrates that pediatric residents currently lack confidence in providing parents advice on preputial care and are unlikely to offer such advice. When offered, the advice given is highly variable. This study emphasizes the need for improved education of pediatric residents.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Neha R. Malhotra, Ilina Rosoklija, Rachel Shannon, Anthony D'Oro, Dennis B. LiuAbstractObjectiveTo understand the extent to which pediatricians are providing advice on care of the uncircumcised penis and the advice they are providing. We hypothesized that pediatric residents lack preparedness to offer parents advice on caring for the uncircumcised penis and as such are unlikely to offer such advice.MethodsAn IRB approved, anonymous survey was administered to 244 pediatric residents in 5 urban training programs (Appendix). Descriptive statistics were used for clinical and demographic data and Fisher's exact and Kruskal-Wallis tests were used for comparative analysis.ResultsEighty-three residents completed the survey for a response rate of 34%. Less than half (45%) of the residents surveyed were likely, or extremely likely to voluntarily offer advice to parents on care of the uncircumcised penis. On a scale of 0-100, the median confidence level in offering advice was 48 (interquartile range [IQR] 30-52). Forty-nine percent of residents reported never being taught care of the uncircumcised penis. Of those who received education, 72% reported learning informally from a senior resident or attending and only 9% learned from a formal lecture. Pediatric residents varied greatly on advice given to parents in regards to the frequency of retraction and 40% offered no advice.ConclusionThis study demonstrates that pediatric residents currently lack confidence in providing parents advice on preputial care and are unlikely to offer such advice. When offered, the advice given is highly variable. This study emphasizes the need for improved education of pediatric residents.
- Clinical Anatomy of the Puboprostatic Ligament for the Safe Guidance for
the Prostate Surgery- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Hyun-Min Choi, So-Young Jung, Soo-Jung Kim, Hee-Jun Yang, Jang-Hwan Kim, Young-Tae Kim, Ji-Cheol Shin, Hye-Yeon LeeObjectiveTo provide the anatomy of the puboprostatic ligament and related structures to save urogenital competence after prostatectomy.Materials and MethodsPelvic areas of 31 adult cadavers were dissected to figure out the shape, number, and location of the puboprostatic ligaments.ResultsThe puboprostatic ligament was the most important support structure between the pubic bone and prostate gland. Puboprostatic ligaments were bilaterally single (61.3%), bilaterally double (19.4%), or mixed (19.4%). Ligaments were mostly I-shaped (53.8%). If ligaments had extra attachment to or from the arcuate line, the ligaments were λ-shaped (36.3%), or Y-shaped (8.8%). In one case, the ligament had a central fusion with an irregular shape. I-shaped puboprostatic ligaments were observed more frequently in specimens with double ligaments, while λ-shaped puboprostatic ligaments were observed more frequently in the cases with single ligaments. The average distance between both puboprostatic ligaments was 8.1 mm at the pubic site and 14.2 mm at the prostate site. The distance was narrower when the specimen had double puboprostatic ligaments on both sides. The neurovascular bundle ran beneath the puboprostatic ligament. If the ligament was the λ-shaped type, the neurovascular bundle frequently pierced the lateral band of the ligament.ConclusionPuboprostatic ligaments hold and stabilize the prostate against the pubic bone. It is believed that a pelvis with bilateral, double puboprostatic ligaments would have advantages in urogenital competence. The morphologic data of the shape, multiplicity, and location of the PPLs would help to make a plan to approach the prostate.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Hyun-Min Choi, So-Young Jung, Soo-Jung Kim, Hee-Jun Yang, Jang-Hwan Kim, Young-Tae Kim, Ji-Cheol Shin, Hye-Yeon LeeObjectiveTo provide the anatomy of the puboprostatic ligament and related structures to save urogenital competence after prostatectomy.Materials and MethodsPelvic areas of 31 adult cadavers were dissected to figure out the shape, number, and location of the puboprostatic ligaments.ResultsThe puboprostatic ligament was the most important support structure between the pubic bone and prostate gland. Puboprostatic ligaments were bilaterally single (61.3%), bilaterally double (19.4%), or mixed (19.4%). Ligaments were mostly I-shaped (53.8%). If ligaments had extra attachment to or from the arcuate line, the ligaments were λ-shaped (36.3%), or Y-shaped (8.8%). In one case, the ligament had a central fusion with an irregular shape. I-shaped puboprostatic ligaments were observed more frequently in specimens with double ligaments, while λ-shaped puboprostatic ligaments were observed more frequently in the cases with single ligaments. The average distance between both puboprostatic ligaments was 8.1 mm at the pubic site and 14.2 mm at the prostate site. The distance was narrower when the specimen had double puboprostatic ligaments on both sides. The neurovascular bundle ran beneath the puboprostatic ligament. If the ligament was the λ-shaped type, the neurovascular bundle frequently pierced the lateral band of the ligament.ConclusionPuboprostatic ligaments hold and stabilize the prostate against the pubic bone. It is believed that a pelvis with bilateral, double puboprostatic ligaments would have advantages in urogenital competence. The morphologic data of the shape, multiplicity, and location of the PPLs would help to make a plan to approach the prostate.
- AUTHOR REPLY
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Barry W. Goy
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Barry W. Goy
- EDITORIAL COMMENT
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Jay P. Ciezki
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Jay P. Ciezki
- Ten-Year Treatment Outcomes of Radical Prostatectomy Vs External Beam
Radiation Therapy Vs Brachytherapy for 1503 Patients With
Intermediate-risk Prostate Cancer- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Barry W. Goy, Raoul Burchette, Margaret S. Soper, Tangel Chang, Harry A. CosmatosABSTRACTObjectiveTo compare 10-year oncologic treatment outcomes of radical prostatectomy (RP) vs external beam radiation therapy (EBRT) vs brachytherapy (BT) for patients with intermediate-risk prostate cancer (IRPC).MethodsA retrospective analysis using propensity score matching was performed on 1503 IRPC patients who underwent treatment from 2004 to 2007. Eight hundred and nineteen underwent RP, 574 underwent EBRT to a median dose of 75.3 Gray, and 110 underwent BT using Iodine-125. Biochemical failure was defined by the American Urological Association definition of failure for RP, and the Phoenix definition for EBRT and BT.ResultsMedian follow-up was 10.0 years for RP, 9.6 for EBRT, and 9.8 for BT. Neoadjuvant androgen deprivation therapy was given in 0.6% of RP, 58.9% of EBRT, and 12.7% of BT patients, P
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Barry W. Goy, Raoul Burchette, Margaret S. Soper, Tangel Chang, Harry A. CosmatosABSTRACTObjectiveTo compare 10-year oncologic treatment outcomes of radical prostatectomy (RP) vs external beam radiation therapy (EBRT) vs brachytherapy (BT) for patients with intermediate-risk prostate cancer (IRPC).MethodsA retrospective analysis using propensity score matching was performed on 1503 IRPC patients who underwent treatment from 2004 to 2007. Eight hundred and nineteen underwent RP, 574 underwent EBRT to a median dose of 75.3 Gray, and 110 underwent BT using Iodine-125. Biochemical failure was defined by the American Urological Association definition of failure for RP, and the Phoenix definition for EBRT and BT.ResultsMedian follow-up was 10.0 years for RP, 9.6 for EBRT, and 9.8 for BT. Neoadjuvant androgen deprivation therapy was given in 0.6% of RP, 58.9% of EBRT, and 12.7% of BT patients, P
- Redefining the Concept of Clinically Insignificant Prostate Cancer
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Daisy E. Frankcombe, Jian Li, Ronald J. CohenAbstractObjectiveTo assess the risk of biochemical recurrence (BCR) in small low-grade prostate tumors following radical prostatectomy (RP), which are defined as clinically insignificant based on the existing criteria developed by Stamey and Epstein.Materials and MethodsWe identified 3784 men who underwent RP in Western Australia from September 1998 to March 2019. These patients had a Gleason sum (GS) of ≤6 or 3+4, prostate confined and negative margins. Pathological data analysis was performed using logistic regression modeling.ResultsMedian follow-up was 96.8 months. BCR occurred in 110 men (2.91%). There was no statistical difference in the rates of failure for patients with a tumor volume 2 mL when the percentage of Gleason pattern 4 was ≤20%. However, once the percentage of Gleason pattern 4 increased to 30%, there was a significant increase in BCR in the larger tumors (> 2 mL).ConclusionThis study did not support either Stamey's or Epstein's criteria of insignificant cancer based on volumes of less than 0.5 mL, GS
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Daisy E. Frankcombe, Jian Li, Ronald J. CohenAbstractObjectiveTo assess the risk of biochemical recurrence (BCR) in small low-grade prostate tumors following radical prostatectomy (RP), which are defined as clinically insignificant based on the existing criteria developed by Stamey and Epstein.Materials and MethodsWe identified 3784 men who underwent RP in Western Australia from September 1998 to March 2019. These patients had a Gleason sum (GS) of ≤6 or 3+4, prostate confined and negative margins. Pathological data analysis was performed using logistic regression modeling.ResultsMedian follow-up was 96.8 months. BCR occurred in 110 men (2.91%). There was no statistical difference in the rates of failure for patients with a tumor volume 2 mL when the percentage of Gleason pattern 4 was ≤20%. However, once the percentage of Gleason pattern 4 increased to 30%, there was a significant increase in BCR in the larger tumors (> 2 mL).ConclusionThis study did not support either Stamey's or Epstein's criteria of insignificant cancer based on volumes of less than 0.5 mL, GS
- EDITORIAL COMMENT
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Daniel D. Shapiro, Jose A. Karam, Christopher G. Wood
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Daniel D. Shapiro, Jose A. Karam, Christopher G. Wood
- AUTHOR REPLY
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Naveen S. Vasudev, Peter J. Selby, Rosamonde E. Banks
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Naveen S. Vasudev, Peter J. Selby, Rosamonde E. Banks
- EDITORIAL COMMENT
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Paul Russo
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Paul Russo
- UK Multicenter Prospective Evaluation of the Leibovich Score in Localized
Renal Cell Carcinoma: Performance has Altered Over Time- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Naveen S. Vasudev, Michelle Hutchinson, Sebastian Trainor, Roisean Ferguson, Selina Bhattarai, Adebanji Adeyoju, Jon Cartledge, Michael Kimuli, Shibendra Datta, Damian Hanbury, David Hrouda, Grenville Oades, Poulam Patel, Naeem Soomro, Grant D. Stewart, Mark Sullivan, Jeff Webster, Michael Messenger, Peter J. Selby, Rosamonde E. BanksABSTRACTObjectiveTo examine changes in outcome by the Leibovich score using contemporary and historic cohorts of patients presenting with renal cell carcinoma (RCC)Patients and MethodsProspective observational multicenter cohort study, recruiting patients with suspected newly diagnosed RCC. A historical cohort of patients was examined for comparison. Metastasis-free survival (MFS) formed the primary outcome measure. Model discrimination and calibration were evaluated using Cox proportional hazard regression and the Kaplan-Meier method. Overall performance of the Leibovich model was assessed by estimating explained variation.ResultsSeven hundred and six patients were recruited between 2011 and 2014 and RCC confirmed in 608 (86%) patients. Application of the Leibovich score to patients with localized clear cell RCC in this contemporary cohort demonstrated good model discrimination (c-index = 0.77) but suboptimal calibration, with improved MFS for intermediate- and high-risk patients (5-year MFS 85% and 50%, respectively) compared to the original Leibovich cohort (74% and 31%) and a historic (1998-2006) UK cohort (76% and 37%). The proportion of variation in outcome explained by the model is low and has declined over time (28% historic vs 22% contemporary UK cohort).ConclusionPrognostic models are widely employed in patients with localized RCC to guide surveillance intensity and clinical trial selection. However, the majority of the variation in outcome remains unexplained by the Leibovich model and, over time, MFS rates among intermediate- and high-risk classified patients have altered. These findings are likely to have implications for all such models used in this setting.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Naveen S. Vasudev, Michelle Hutchinson, Sebastian Trainor, Roisean Ferguson, Selina Bhattarai, Adebanji Adeyoju, Jon Cartledge, Michael Kimuli, Shibendra Datta, Damian Hanbury, David Hrouda, Grenville Oades, Poulam Patel, Naeem Soomro, Grant D. Stewart, Mark Sullivan, Jeff Webster, Michael Messenger, Peter J. Selby, Rosamonde E. BanksABSTRACTObjectiveTo examine changes in outcome by the Leibovich score using contemporary and historic cohorts of patients presenting with renal cell carcinoma (RCC)Patients and MethodsProspective observational multicenter cohort study, recruiting patients with suspected newly diagnosed RCC. A historical cohort of patients was examined for comparison. Metastasis-free survival (MFS) formed the primary outcome measure. Model discrimination and calibration were evaluated using Cox proportional hazard regression and the Kaplan-Meier method. Overall performance of the Leibovich model was assessed by estimating explained variation.ResultsSeven hundred and six patients were recruited between 2011 and 2014 and RCC confirmed in 608 (86%) patients. Application of the Leibovich score to patients with localized clear cell RCC in this contemporary cohort demonstrated good model discrimination (c-index = 0.77) but suboptimal calibration, with improved MFS for intermediate- and high-risk patients (5-year MFS 85% and 50%, respectively) compared to the original Leibovich cohort (74% and 31%) and a historic (1998-2006) UK cohort (76% and 37%). The proportion of variation in outcome explained by the model is low and has declined over time (28% historic vs 22% contemporary UK cohort).ConclusionPrognostic models are widely employed in patients with localized RCC to guide surveillance intensity and clinical trial selection. However, the majority of the variation in outcome remains unexplained by the Leibovich model and, over time, MFS rates among intermediate- and high-risk classified patients have altered. These findings are likely to have implications for all such models used in this setting.
- EDITORIAL COMMENT
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Puneet Sindhwani
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Puneet Sindhwani
- Childless Men at the Time of Vasectomy are Unlikely to Seek Fertility
Restoration- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Darren J. Bryk, Prithvi B. Murthy, Molly DeWitt-Foy, Andrew Y. Sun, Neel V. Parekh, Edmund Sabanegh, Sarah C. VijABSTRACTOBJECTIVETo examine whether men who were childless at the time of vasectomy sought consultation for fertility restoration.METHODSRetrospective chart review was performed to determine if patients without children at the time of vasectomy sought consultation for fertility restoration (defined as vasectomy reversal or sperm retrieval). If the patient had not been seen in our healthcare system within the previous 12 months, he was contacted by phone to determine whether he had sought consultation for fertility restoration.RESULTSOf 1656 men, 68 men (4.1%) were childless at the time of vasectomy. Fifteen patients were excluded as they were not followed in our hospital system and were unreachable by phone. Zero patients sought consultation for fertility restoration.CONCLUSIONOur single institution study demonstrated that no men who were childless at the time of vasectomy sought consultation for fertility restoration. Given that there are no other FDA approved methods for nonbarrier sterilization for males, men with no children at the time of vasectomy should receive the same AUA guideline-recommended counseling that men with children receive.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Darren J. Bryk, Prithvi B. Murthy, Molly DeWitt-Foy, Andrew Y. Sun, Neel V. Parekh, Edmund Sabanegh, Sarah C. VijABSTRACTOBJECTIVETo examine whether men who were childless at the time of vasectomy sought consultation for fertility restoration.METHODSRetrospective chart review was performed to determine if patients without children at the time of vasectomy sought consultation for fertility restoration (defined as vasectomy reversal or sperm retrieval). If the patient had not been seen in our healthcare system within the previous 12 months, he was contacted by phone to determine whether he had sought consultation for fertility restoration.RESULTSOf 1656 men, 68 men (4.1%) were childless at the time of vasectomy. Fifteen patients were excluded as they were not followed in our hospital system and were unreachable by phone. Zero patients sought consultation for fertility restoration.CONCLUSIONOur single institution study demonstrated that no men who were childless at the time of vasectomy sought consultation for fertility restoration. Given that there are no other FDA approved methods for nonbarrier sterilization for males, men with no children at the time of vasectomy should receive the same AUA guideline-recommended counseling that men with children receive.
- A Systematic Review and Evidence-based Analysis of Ingredients in Popular
Male Fertility Supplements- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Manish Kuchakulla, Yash Soni, Premal Patel, Neel Parekh, Ranjith RamasamyABSTRACTObjectiveTo study the level of evidence available for ingredients of popular over-the-counter male fertility supplements.MethodsThe top 17 male fertility supplements in the United States were identified from the most popular online retailers: A1 Supplements, Amazon, Vitamin Shoppe, and Walmart. Individual ingredients were identified for each supplement. The PUBMED and Cochrane online databases were reviewed for randomized controlled trials studying the efficacy of each ingredient. Each ingredient was categorized based on availability of evidence using an adapted version of the scoring system by the American Heart Association. Scores were assigned to each categorical level of evidence for each ingredient and a composite score for each supplement was calculated.ResultsNinety unique ingredients were identified. The 5 most commonly used ingredients were vitamin E, folic acid, zinc, vitamin C, and selenium whereas the 5 ingredients with most evidence were L-carnitine, Vitamin E, Vitamin C, CoQ10, and Zinc. In all, only 22% of ingredients used were found to have published evidence for improvement in semen parameters and only 17% of ingredients had data published showing a positive effect. Our evidence-based analysis demonstrated an average composite rating of 1.66 (on a scale to 5). Evolution 60 and Conception XR had the highest composite scores with 3.6 and 3.5, respectively.ConclusionMany male fertility supplements claim to improve fertility; however, their products are rarely backed by evidence and their efficacy remains unproven. Few ingredients used in popular fertility supplements have positive evidence in randomized clinical trials and should therefore be used cautiously.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Manish Kuchakulla, Yash Soni, Premal Patel, Neel Parekh, Ranjith RamasamyABSTRACTObjectiveTo study the level of evidence available for ingredients of popular over-the-counter male fertility supplements.MethodsThe top 17 male fertility supplements in the United States were identified from the most popular online retailers: A1 Supplements, Amazon, Vitamin Shoppe, and Walmart. Individual ingredients were identified for each supplement. The PUBMED and Cochrane online databases were reviewed for randomized controlled trials studying the efficacy of each ingredient. Each ingredient was categorized based on availability of evidence using an adapted version of the scoring system by the American Heart Association. Scores were assigned to each categorical level of evidence for each ingredient and a composite score for each supplement was calculated.ResultsNinety unique ingredients were identified. The 5 most commonly used ingredients were vitamin E, folic acid, zinc, vitamin C, and selenium whereas the 5 ingredients with most evidence were L-carnitine, Vitamin E, Vitamin C, CoQ10, and Zinc. In all, only 22% of ingredients used were found to have published evidence for improvement in semen parameters and only 17% of ingredients had data published showing a positive effect. Our evidence-based analysis demonstrated an average composite rating of 1.66 (on a scale to 5). Evolution 60 and Conception XR had the highest composite scores with 3.6 and 3.5, respectively.ConclusionMany male fertility supplements claim to improve fertility; however, their products are rarely backed by evidence and their efficacy remains unproven. Few ingredients used in popular fertility supplements have positive evidence in randomized clinical trials and should therefore be used cautiously.
- Rectal Swabs for Detecting Multidrug Resistant Bacteria Prior to
Transrectal Prostate Fusion Biopsy: A Prospective Evaluation of Risk
Factor Screening and Microbiologic Findings- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Christoph Würnschimmel, Luis Busto Martin, Sami-Ramzi Leyh-Bannurah, Su Jung Oh-Hohenhorst, Mykyta Kachanov, Tobias Maurer, Sophie Knipper, Markus Graefen, Lars BudäusABSTRACTObjectiveTo assess the prevalence of fluoroquinolone resistant (QR) bacteria, multidrug resistant (MDR) bacteria and Enterococcus faecalis (E. faecalis) in rectal swabs of patients undergoing transrectal prostate biopsy and for evaluating if risk factor assessment is reliable for prediction of QR bacteria, MDR bacteria, or E. faecalis.Patients and MethodsTwo hundred consecutive patients received a rectal swab examination prior to transrectal magnetic resonance imaging-guided fusion biopsy, for evaluating the prevalence of QR bacteria, MDR bacteria, and E. faecalis. The results of a standardized risk factor questionnaire, assessing known prognosticators for higher prevalence of resistant bacteria in rectal flora were correlated with the occurrence of QR bacteria, MDR bacteria, and E. faecalis in rectal swabs.ResultsQR E. coli was detected in 12 patients (6%). Regarding MDR bacteria, extended spectrum β- lactamase- producing E. coli occurred in 8 patients (4%). E. faecalis was found in 15 patients (7.5%). A total of 193 patients completed the risk factor questionnaire. Of those, 107 (53.2%) patients harbored no risk factors, while 86 (42.8%) had at least 1 risk factor, of which the most common was repeat biopsy. No association was found between any risk factor and occurrence of QR bacteria, MDR bacteria, or E. faecalis (P>.05).ConclusionThe prevalence of resistant germs in our cohort was lower compared to other series. Moreover, the rate of QR bacteria, MDR bacteria, or E. faecalis in rectal swabs was not reliably associated with risk factor assessment.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Christoph Würnschimmel, Luis Busto Martin, Sami-Ramzi Leyh-Bannurah, Su Jung Oh-Hohenhorst, Mykyta Kachanov, Tobias Maurer, Sophie Knipper, Markus Graefen, Lars BudäusABSTRACTObjectiveTo assess the prevalence of fluoroquinolone resistant (QR) bacteria, multidrug resistant (MDR) bacteria and Enterococcus faecalis (E. faecalis) in rectal swabs of patients undergoing transrectal prostate biopsy and for evaluating if risk factor assessment is reliable for prediction of QR bacteria, MDR bacteria, or E. faecalis.Patients and MethodsTwo hundred consecutive patients received a rectal swab examination prior to transrectal magnetic resonance imaging-guided fusion biopsy, for evaluating the prevalence of QR bacteria, MDR bacteria, and E. faecalis. The results of a standardized risk factor questionnaire, assessing known prognosticators for higher prevalence of resistant bacteria in rectal flora were correlated with the occurrence of QR bacteria, MDR bacteria, and E. faecalis in rectal swabs.ResultsQR E. coli was detected in 12 patients (6%). Regarding MDR bacteria, extended spectrum β- lactamase- producing E. coli occurred in 8 patients (4%). E. faecalis was found in 15 patients (7.5%). A total of 193 patients completed the risk factor questionnaire. Of those, 107 (53.2%) patients harbored no risk factors, while 86 (42.8%) had at least 1 risk factor, of which the most common was repeat biopsy. No association was found between any risk factor and occurrence of QR bacteria, MDR bacteria, or E. faecalis (P>.05).ConclusionThe prevalence of resistant germs in our cohort was lower compared to other series. Moreover, the rate of QR bacteria, MDR bacteria, or E. faecalis in rectal swabs was not reliably associated with risk factor assessment.
- AUTHOR REPLY
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): David Baunoch
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): David Baunoch
- EDITORIAL COMMENT
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Glenn T. Werneburg
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Glenn T. Werneburg
- Is it Time to Say Goodbye to Culture and Sensitivity' The Case for
Culture-independent Urology- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Matthew Dixon, Sybil Sha, Maria Stefil, Michael McDonaldABSTRACTNext-generation sequencing has highlighted the limitations of conventional culture methods in the role of urology while discovering the intricate details of the role of microbiota in urologic health and disease. This review article explores: the utility and limitations of conventional culture methods; how culture-independent technologies are revolutionizing medicine; and how the implementation of these technologies may lead to improved patient outcomes. Finally, this article discusses the barriers to widespread adoption of culture-independent technologies, with suggestions for how these hurdles may be overcome.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Matthew Dixon, Sybil Sha, Maria Stefil, Michael McDonaldABSTRACTNext-generation sequencing has highlighted the limitations of conventional culture methods in the role of urology while discovering the intricate details of the role of microbiota in urologic health and disease. This review article explores: the utility and limitations of conventional culture methods; how culture-independent technologies are revolutionizing medicine; and how the implementation of these technologies may lead to improved patient outcomes. Finally, this article discusses the barriers to widespread adoption of culture-independent technologies, with suggestions for how these hurdles may be overcome.
- AUTHOR REPLY
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Timothy D. Lyon, Nilay D. Shah, Matthew K. Tollefson, Paras H. Shah, Lindsey R. Sangaralingham, Dennis Asante, R. Houston Thompson, R. Jeffrey Karnes, Igor Frank, Stephen A. Boorjian
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Timothy D. Lyon, Nilay D. Shah, Matthew K. Tollefson, Paras H. Shah, Lindsey R. Sangaralingham, Dennis Asante, R. Houston Thompson, R. Jeffrey Karnes, Igor Frank, Stephen A. Boorjian
- EDITORIAL COMMENT
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Pratik M.S. Gurung, Edward M. Messing, Jean V. Joseph, Guan Wu
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Pratik M.S. Gurung, Edward M. Messing, Jean V. Joseph, Guan Wu
- Comparison of Urologic Transfers to Academic Medical Centers: A
Multi-institutional Perspective- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Patrick Michael, Vi T. Tran, Marilyn Hopkins, Ian Berger, Justin Ziemba, Utsav K. Bansal, Adithya Balasubramanian, Jessie Chen, Wesley Mayer, Andrew Fang, Soroush Rais-Bahrami, Andrew James, Andrew HarrisABSTRACTObjectiveTo examine urologic transfers and rate of tertiary center interventions from 4 geographically distinct academic medical centers.MethodsFour academic medical centers were selected for this study including Baylor College of Medicine, University of Alabama at Birmingham, University of Kentucky, and University of Pennsylvania Hospital (Penn). Baylor College of Medicine and Penn primarily service large metropolitan city centers and University of Kentucky and University of Alabama at Birmingham primarily service large rural populations. Transfer logs were pulled for each institution over a 2-year period, and a retrospective chart review was performed to evaluate transfer diagnosis and need for procedural management upon admission. Date of transfer, transfer diagnosis, and interventions performed during tertiary center admission were extracted from the transfer log data sets. The transfer diagnosis was categorized into 1 of 11 mutually exclusive categories.ResultsOverall, 984 urologic transfers were included. Sixty-nine percent (682/984) of patients were transferred to the 2 rural centers, and 30.7% (302/984) were transferred to the 2 metropolitan centers. The most common reason for transfer was nephrolithiasis at 26% (256 of 984 transfers). The overall surgical intervention rate for all urologic transfers in this study was 44.4% (437 of 984 total transfers). Rural center transfers had a lower rate of surgical intervention than metropolitan centers (42.7% vs 48.3%) as well as a markedly higher number of total transfers during the study period (682 vs 302).ConclusionGiven that a majority of patients did not require surgical intervention, methods for avoiding unnecessary urologic transfers are warranted.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Patrick Michael, Vi T. Tran, Marilyn Hopkins, Ian Berger, Justin Ziemba, Utsav K. Bansal, Adithya Balasubramanian, Jessie Chen, Wesley Mayer, Andrew Fang, Soroush Rais-Bahrami, Andrew James, Andrew HarrisABSTRACTObjectiveTo examine urologic transfers and rate of tertiary center interventions from 4 geographically distinct academic medical centers.MethodsFour academic medical centers were selected for this study including Baylor College of Medicine, University of Alabama at Birmingham, University of Kentucky, and University of Pennsylvania Hospital (Penn). Baylor College of Medicine and Penn primarily service large metropolitan city centers and University of Kentucky and University of Alabama at Birmingham primarily service large rural populations. Transfer logs were pulled for each institution over a 2-year period, and a retrospective chart review was performed to evaluate transfer diagnosis and need for procedural management upon admission. Date of transfer, transfer diagnosis, and interventions performed during tertiary center admission were extracted from the transfer log data sets. The transfer diagnosis was categorized into 1 of 11 mutually exclusive categories.ResultsOverall, 984 urologic transfers were included. Sixty-nine percent (682/984) of patients were transferred to the 2 rural centers, and 30.7% (302/984) were transferred to the 2 metropolitan centers. The most common reason for transfer was nephrolithiasis at 26% (256 of 984 transfers). The overall surgical intervention rate for all urologic transfers in this study was 44.4% (437 of 984 total transfers). Rural center transfers had a lower rate of surgical intervention than metropolitan centers (42.7% vs 48.3%) as well as a markedly higher number of total transfers during the study period (682 vs 302).ConclusionGiven that a majority of patients did not require surgical intervention, methods for avoiding unnecessary urologic transfers are warranted.
- Impact of Strength and Nature of Patient Health Values on Compliance and
Outcomes for Physiotherapy Treatment for Pelvic Floor Dysfunction- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Phil Reed, C. Mair Whittall, Lisa A. Osborne, Simon EmeryAbstractObjectiveTo determine whether patient values impact on compliance and outcome for physiotherapy treatment for pelvic floor dysfunction. Although studies have related “health values” to behaviors in the laboratory, or to behaviors such as exercise, there have been no studies of the impact of patient values on actual medical treatments.MethodsA prospective observational study of the impact of patient values on compliance and outcomes for physiotherapy treatment for pelvic floor dysfunction was conducted in a physiotherapy clinic in the urogynaecological outpatients unit of a hospital. Two hundred eighteen patients were approached and agreed to participate. Prior to treatment, pelvic floor functioning was assessed using the Oxford Grading System, and Queensland Pelvic Floor Questionnaire, and values were assessed using the Personal Values Questionnaire (PVQ-II). Following a 6-month physiotherapy treatment programme, pelvic floor function was reassessed.ResultsThe strength of patient health-related values measured by the PVQ-II significantly predicted compliance with the intervention, but the nature of health value (intrinsically-valued, as opposed to externally-controlled) predicted objective outcome.ConclusionPatient values impact on physiotherapy adherence and outcomes, and could be considered as part of future assessment/screening procedures.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Phil Reed, C. Mair Whittall, Lisa A. Osborne, Simon EmeryAbstractObjectiveTo determine whether patient values impact on compliance and outcome for physiotherapy treatment for pelvic floor dysfunction. Although studies have related “health values” to behaviors in the laboratory, or to behaviors such as exercise, there have been no studies of the impact of patient values on actual medical treatments.MethodsA prospective observational study of the impact of patient values on compliance and outcomes for physiotherapy treatment for pelvic floor dysfunction was conducted in a physiotherapy clinic in the urogynaecological outpatients unit of a hospital. Two hundred eighteen patients were approached and agreed to participate. Prior to treatment, pelvic floor functioning was assessed using the Oxford Grading System, and Queensland Pelvic Floor Questionnaire, and values were assessed using the Personal Values Questionnaire (PVQ-II). Following a 6-month physiotherapy treatment programme, pelvic floor function was reassessed.ResultsThe strength of patient health-related values measured by the PVQ-II significantly predicted compliance with the intervention, but the nature of health value (intrinsically-valued, as opposed to externally-controlled) predicted objective outcome.ConclusionPatient values impact on physiotherapy adherence and outcomes, and could be considered as part of future assessment/screening procedures.
- Successful Ejaculatory Sperm Cryopreservation After Cessation of Long-term
Estrogen Therapy in a Transgender Female- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Ashley V. Alford, Katherine M. Theisen, Nicholas Kim, Joshua A. Bodie, Joseph J. Pariser
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Ashley V. Alford, Katherine M. Theisen, Nicholas Kim, Joshua A. Bodie, Joseph J. Pariser
- EDITORIAL COMMENT
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Stephanie Kielb
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Stephanie Kielb
- A Preliminary Study on the Impact of Detrusor Overactivity on the Efficacy
of Selective Bladder Denervation for the Treatment of Female Refractory
Overactive Bladder- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Raphaëlle Brière, Eboo Versi, Patrick O. Richard, Matthieu Gratton, Le Mai TuABSTRACTObjectiveTo determine whether the presence of detrusor overactivity (DO) is associated with the 12-week and 12-month clinical outcomes of selective bladder denervation (SBD) in women with refractory overactive bladder (OAB).MethodsProspective single institutional study of refractory OAB females who underwent a urodynamic study and were categorized according to DO status (DO− vs DO+) prior to receiving SBD.ResultsAmong the 23 patients, 10 were DO− and 13 were DO+. Both groups reported improvement at 12 weeks on the 24-hour pad weight test, in urgency urinary incontinence (UUI) and urgency. At 12 months, both groups still reported improvement in urgency, but only the DO− group reported reduction on the pad weight test and only the DO+ group maintained improvement in the UUI rate. Clinical success (≥50% reduction in UUI) was achieved by all DO− and by 69% of DO+ patients at 12 weeks, and by 60% of DO− and 92% of DO+ patients at 12 months. Treatment benefit (Treatment Benefit Scale ≤2) was reported in 90% of DO− and 85% of DO+ patients at 12 weeks, and in 60% of DO− and 85% of DO+ patients at 12 months. When directly comparing both group outcomes, the only significant difference was the greater reduction of UUI in the DO− group at 12 weeks (−9.0 vs −6.5; P = .045).ConclusionRefractory OAB females appear to be effectively treated by SBD regardless of baseline DO status. DO status does not seem to be associated with the 12-week and 12-month outcomes of SBD.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Raphaëlle Brière, Eboo Versi, Patrick O. Richard, Matthieu Gratton, Le Mai TuABSTRACTObjectiveTo determine whether the presence of detrusor overactivity (DO) is associated with the 12-week and 12-month clinical outcomes of selective bladder denervation (SBD) in women with refractory overactive bladder (OAB).MethodsProspective single institutional study of refractory OAB females who underwent a urodynamic study and were categorized according to DO status (DO− vs DO+) prior to receiving SBD.ResultsAmong the 23 patients, 10 were DO− and 13 were DO+. Both groups reported improvement at 12 weeks on the 24-hour pad weight test, in urgency urinary incontinence (UUI) and urgency. At 12 months, both groups still reported improvement in urgency, but only the DO− group reported reduction on the pad weight test and only the DO+ group maintained improvement in the UUI rate. Clinical success (≥50% reduction in UUI) was achieved by all DO− and by 69% of DO+ patients at 12 weeks, and by 60% of DO− and 92% of DO+ patients at 12 months. Treatment benefit (Treatment Benefit Scale ≤2) was reported in 90% of DO− and 85% of DO+ patients at 12 weeks, and in 60% of DO− and 85% of DO+ patients at 12 months. When directly comparing both group outcomes, the only significant difference was the greater reduction of UUI in the DO− group at 12 weeks (−9.0 vs −6.5; P = .045).ConclusionRefractory OAB females appear to be effectively treated by SBD regardless of baseline DO status. DO status does not seem to be associated with the 12-week and 12-month outcomes of SBD.
- A Prospective Comparative Study of the Feasibility and Reliability of
Telephone Follow-Up in Female Urology: The Patient Home Office Novel
Evaluation (PHONE) Study- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Matteo Balzarro, Emanuele Rubilotta, Nicolò Trabacchin, Vito Mancini, Elisabetta Costantini, Walter Artibani, Alessandro AntonelliAbstractObjectiveTo determinate the feasibility, reliability, and patient satisfaction of telephonic follow-up in women treated for stress urinary incontinence (SUI) or pelvic organ prolapse (POP): Patient-Home-Office-Novel-Evaluation (PHONE) study.MethodsThis is a prospective comparative study in women following surgery for SUI underwent middle urethral sling (MUS) (Group A), or symptomatic anterior vaginal wall (AVW) defect underwent AVW repair (fascial/mesh/biomesh) (Group B). The 1-year follow-up included a telephonic interview using a checklist and validated questionnaires followed by a standard outpatient clinic visit 7-12 days later including: an interview, validated questionnaires, objective examination, and score satisfaction with the telephone follow-up.ResultsWe enrolled 420 pts: 215 for SUI in Group A, and 205 for POP in Group B. SUI recurrence was 19.1% and 11.6% at the telephone and office follow-up, respectively. De-novo urgency urinary incontinence rate was 7.5%. Telephone follow-up was able to detect POP recurrence and related symptoms. Tape and mesh extrusions were detected only at the objective evaluation: 1.9% and 4.4% respectively. No difference was found at the questionnaires. Satisfaction with the telephone follow-up was high.ConclusionDue to the wrongly interpretation of de-novo urge urinary incontinence as a recurrence of SUI, a telephone interview may lose reliability in case of reported incontinence. Thus, telephone follow-up was feasible and reliable in women not reporting incontinence. In patients treated for POP the phone interview was a valid tool only in case of no-prosthetic surgery due to the absence of extrusion in these cases.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Matteo Balzarro, Emanuele Rubilotta, Nicolò Trabacchin, Vito Mancini, Elisabetta Costantini, Walter Artibani, Alessandro AntonelliAbstractObjectiveTo determinate the feasibility, reliability, and patient satisfaction of telephonic follow-up in women treated for stress urinary incontinence (SUI) or pelvic organ prolapse (POP): Patient-Home-Office-Novel-Evaluation (PHONE) study.MethodsThis is a prospective comparative study in women following surgery for SUI underwent middle urethral sling (MUS) (Group A), or symptomatic anterior vaginal wall (AVW) defect underwent AVW repair (fascial/mesh/biomesh) (Group B). The 1-year follow-up included a telephonic interview using a checklist and validated questionnaires followed by a standard outpatient clinic visit 7-12 days later including: an interview, validated questionnaires, objective examination, and score satisfaction with the telephone follow-up.ResultsWe enrolled 420 pts: 215 for SUI in Group A, and 205 for POP in Group B. SUI recurrence was 19.1% and 11.6% at the telephone and office follow-up, respectively. De-novo urgency urinary incontinence rate was 7.5%. Telephone follow-up was able to detect POP recurrence and related symptoms. Tape and mesh extrusions were detected only at the objective evaluation: 1.9% and 4.4% respectively. No difference was found at the questionnaires. Satisfaction with the telephone follow-up was high.ConclusionDue to the wrongly interpretation of de-novo urge urinary incontinence as a recurrence of SUI, a telephone interview may lose reliability in case of reported incontinence. Thus, telephone follow-up was feasible and reliable in women not reporting incontinence. In patients treated for POP the phone interview was a valid tool only in case of no-prosthetic surgery due to the absence of extrusion in these cases.
- Accuracy of Patient Reported Stone Passage for Patients With Acute Renal
Colic Treated in the Emergency Department- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Andrew C. Meltzer, Pamela Katzen Burrows, Ziya Kirkali, Judd E. Hollander, Michael Kurz, Patrick Mufarrij, Allan B. Wolfson, Cora MacPherson, Scott Hubosky, Nataly Montano, Stephen V. JackmanAbstractObjectiveTo study patients who initially presented to the Emergency Department with acute renal colic to determine if patient-reported stone passage detects stone expulsion as accurately as follow-up computed tomography (CT) scan.MethodsThis is a secondary analysis of a multi-center prospective trial of patients diagnosed by a CT scan with a symptomatic ureteral stone
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Andrew C. Meltzer, Pamela Katzen Burrows, Ziya Kirkali, Judd E. Hollander, Michael Kurz, Patrick Mufarrij, Allan B. Wolfson, Cora MacPherson, Scott Hubosky, Nataly Montano, Stephen V. JackmanAbstractObjectiveTo study patients who initially presented to the Emergency Department with acute renal colic to determine if patient-reported stone passage detects stone expulsion as accurately as follow-up computed tomography (CT) scan.MethodsThis is a secondary analysis of a multi-center prospective trial of patients diagnosed by a CT scan with a symptomatic ureteral stone
- EDITORIAL COMMENT
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Margaret S. Pearle
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Margaret S. Pearle
- AUTHOR REPLY
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Eric Bortnick, Jeffrey Stock, Vannita Simma-Chiang
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Eric Bortnick, Jeffrey Stock, Vannita Simma-Chiang
- EDITORIAL COMMENT
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): John Roger Bell
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): John Roger Bell
- Mentorship in Urology Residency Programs in the United States
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Eric Bortnick, Jeffrey Stock, Vannita Simma-ChiangABSTRACTObjectiveTo characterize the status of mentorship programs for Urology residencies in the United States, highlight the importance of mentorship in the career of a urology resident, and identify the obstacles of implementing a mentorship program.MethodsWith Internal Review Board exemption and approval from the Society of Academic Urologists, a survey was sent to the Program Directors of the Urology Residency programs in the United States containing questions about the presence and structure of a mentorship program in their department.ResultsResponse rate was 54%. Seventy-five percent of respondents approved of formal mentorship programs. Fifty-eight percent of respondents had 1 established. Five percent of programs had an official training course for faculty mentors. Thirty-eight percent of programs had no requirement on mentor and/or mentee meeting frequency. The most common reason for not having a formal mentorship program was because the program felt that informal mentorship sufficed.ConclusionWhile the vast majority of Program Directors for Urology Residency programs in the United States approve of formal mentorship programs, only a little over half have 1 established. Programs should strive to create a formal mentorship program in their residency programs due to their recognized importance.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Eric Bortnick, Jeffrey Stock, Vannita Simma-ChiangABSTRACTObjectiveTo characterize the status of mentorship programs for Urology residencies in the United States, highlight the importance of mentorship in the career of a urology resident, and identify the obstacles of implementing a mentorship program.MethodsWith Internal Review Board exemption and approval from the Society of Academic Urologists, a survey was sent to the Program Directors of the Urology Residency programs in the United States containing questions about the presence and structure of a mentorship program in their department.ResultsResponse rate was 54%. Seventy-five percent of respondents approved of formal mentorship programs. Fifty-eight percent of respondents had 1 established. Five percent of programs had an official training course for faculty mentors. Thirty-eight percent of programs had no requirement on mentor and/or mentee meeting frequency. The most common reason for not having a formal mentorship program was because the program felt that informal mentorship sufficed.ConclusionWhile the vast majority of Program Directors for Urology Residency programs in the United States approve of formal mentorship programs, only a little over half have 1 established. Programs should strive to create a formal mentorship program in their residency programs due to their recognized importance.
- AUTHOR REPLY
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Gary E. Lemack
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Gary E. Lemack
- EDITORIAL COMMENT
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Jonathan S. Shoag, Gilbert J. Wise
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Jonathan S. Shoag, Gilbert J. Wise
- EDITORIAL COMMENT
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Soum D. Lokeshwar, John Z. Benton, Sherita A. King, Martha K. Terris, Christopher J.D. Wallis, Zachary Klaassen
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Soum D. Lokeshwar, John Z. Benton, Sherita A. King, Martha K. Terris, Christopher J.D. Wallis, Zachary Klaassen
- Optimizing Opioid Pain Medication Use After Vasectomy—A Prospective
Study- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Benjamin H. Baker, Janelle A. Fox, Paul R. Womble, Ines H. Stromberg, Erik T. Grossgold, R. Chanc WaltersABSTRACTOBJECTIVETo act as good stewards, urologists need to balance patient's pain requirements against the risk of narcotic abuse.MATERIALS AND METHODSWe prospectively consented subjects who underwent vasectomies. Procedural technique was not standardized. All subjects received hydrooxycodone/acetaminophen 5-325 mg tablets and Ibuprofen 800 mg tablets. The subjects were then contacted by phone 1-3 weeks after their procedure with a follow-up questionnaire. Data collected included age, weight, number of pills used and pills remaining, number of days pain medication used, need for additional medication, pain treatment satisfaction, disposal knowledge, and complications.RESULTSA total of 76 subjects completed the study. Overall, 88.3% rated excellent pain treatment satisfaction with score ⩾4 (scale 1-5). No opioid medication was used by 18.2% of subjects, 33.8% used 1-5 tablets, and 24.7% used all 15 tablets. At the end, 9 subjects (11.7%) reporting needing more pain medication. Using Pearson correlation, younger age was significantly related to number of pills used. (P
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Benjamin H. Baker, Janelle A. Fox, Paul R. Womble, Ines H. Stromberg, Erik T. Grossgold, R. Chanc WaltersABSTRACTOBJECTIVETo act as good stewards, urologists need to balance patient's pain requirements against the risk of narcotic abuse.MATERIALS AND METHODSWe prospectively consented subjects who underwent vasectomies. Procedural technique was not standardized. All subjects received hydrooxycodone/acetaminophen 5-325 mg tablets and Ibuprofen 800 mg tablets. The subjects were then contacted by phone 1-3 weeks after their procedure with a follow-up questionnaire. Data collected included age, weight, number of pills used and pills remaining, number of days pain medication used, need for additional medication, pain treatment satisfaction, disposal knowledge, and complications.RESULTSA total of 76 subjects completed the study. Overall, 88.3% rated excellent pain treatment satisfaction with score ⩾4 (scale 1-5). No opioid medication was used by 18.2% of subjects, 33.8% used 1-5 tablets, and 24.7% used all 15 tablets. At the end, 9 subjects (11.7%) reporting needing more pain medication. Using Pearson correlation, younger age was significantly related to number of pills used. (P
- State of the Art of Thulium Laser Enucleation and Vapoenucleation of the
Prostate: A Systematic Review- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Daniele Castellani, Giacomo Maria Pirola, Andrea Pacchetti, Giovanni Saredi, Marco DellabellaABSTRACTTm:YAG laser operates at a wavelength of 1940-2013 nm in a continuous wave mode, which enables smooth incision and rapid vaporization of prostatic tissue, with a shallow penetration of only 0.2 mm. These characteristics make Tm:YAG a versatile laser, allowing the surgeon to perform resection, vaporization, and vapoenucleation. This systematic review aims to summarize the current evidence of safety and efficacy, long-term durability, impact on sexual function following Tm:YAG laser enucleation and vapoenucleation of the prostate and to compare the outcomes of these procedures vs other surgical treatments of benign prostatic hyperplasia.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Daniele Castellani, Giacomo Maria Pirola, Andrea Pacchetti, Giovanni Saredi, Marco DellabellaABSTRACTTm:YAG laser operates at a wavelength of 1940-2013 nm in a continuous wave mode, which enables smooth incision and rapid vaporization of prostatic tissue, with a shallow penetration of only 0.2 mm. These characteristics make Tm:YAG a versatile laser, allowing the surgeon to perform resection, vaporization, and vapoenucleation. This systematic review aims to summarize the current evidence of safety and efficacy, long-term durability, impact on sexual function following Tm:YAG laser enucleation and vapoenucleation of the prostate and to compare the outcomes of these procedures vs other surgical treatments of benign prostatic hyperplasia.
- EDITORIAL COMMENT
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Yaw A. Nyame
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Yaw A. Nyame
- Health Care Disparities in Urologic Oncology: A Systematic Review
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Hrishikesh Das, Ronald RodriguezFor prostate cancer, we review racial differences in incidence, androgen pathways, growth factors, tumor location, rate of definitive treatment, and outcomes. We review the effect of race on risk-stratification and discuss studies of active surveillance in the African American population. For bladder cancer, race- and gender- associated differences in incidence, sex hormone pathways. For renal cell carcinoma, disparities in incidence, genetic factors, tumor pathology, time to presentation, and disease specific survival have been observed. We evaluate the impact of race and ethnicity on tumor pathology and discuss gaps in our current understanding of renal cell carcinoma pathogenesis.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Hrishikesh Das, Ronald RodriguezFor prostate cancer, we review racial differences in incidence, androgen pathways, growth factors, tumor location, rate of definitive treatment, and outcomes. We review the effect of race on risk-stratification and discuss studies of active surveillance in the African American population. For bladder cancer, race- and gender- associated differences in incidence, sex hormone pathways. For renal cell carcinoma, disparities in incidence, genetic factors, tumor pathology, time to presentation, and disease specific survival have been observed. We evaluate the impact of race and ethnicity on tumor pathology and discuss gaps in our current understanding of renal cell carcinoma pathogenesis.
- Accidentally Discovered Testicular Tumor Through MRI Spine
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Fabiola Oquendo, Asmaa Ismail, Hazem Elmansy, Walid Shahrour, Owen Prowse, Nicholas Escott, Ahmed Kotb
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Fabiola Oquendo, Asmaa Ismail, Hazem Elmansy, Walid Shahrour, Owen Prowse, Nicholas Escott, Ahmed Kotb
- Torsion of the Epididymis—Unusual Cause of Acute Scrotum in Adult
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Senjin Djozić, Sandra Trivunić-Dajko, Jovo Bogdanović
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Senjin Djozić, Sandra Trivunić-Dajko, Jovo Bogdanović
- Aims and Scope
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s):
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s):
- Cover 1
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s):
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s):
- Angiomatosis of the Urinary Bladder: A New Anatomic Location for a Rare
Tumor- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Edward Kloniecke, Andrew Pridjian, Ilia ZeltserAbstractWe report a case of primary angiomatosis of the bladder. To our knowledge, angiomatosis has never been reported in the genitourinary tract.
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Edward Kloniecke, Andrew Pridjian, Ilia ZeltserAbstractWe report a case of primary angiomatosis of the bladder. To our knowledge, angiomatosis has never been reported in the genitourinary tract.
- A Case of a Primary Intratesticular Leiomyosarcoma With Metastatic Disease
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Courtney Berg, Jogarao Vedula, Amanda Le Sueur, Steven Drexler, Jeffrey Schiff
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Courtney Berg, Jogarao Vedula, Amanda Le Sueur, Steven Drexler, Jeffrey Schiff
- Multimodality Treatment of Bilateral Wilms Tumor in a Pregnant Female
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Laura S. Graham, George R. Schade, Michael T. Schweizer
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Laura S. Graham, George R. Schade, Michael T. Schweizer
- Superior Mesenteric Artery Syndrome – A Rare Complication Following Left
Radical Nephrectomy and IVC Thrombectomy- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Ashwin Shekar P, Prateek Ramdev, Vinod Chauhan, V. Chandrashekar Rao
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Ashwin Shekar P, Prateek Ramdev, Vinod Chauhan, V. Chandrashekar Rao
- Parapelvic Dystrophic Calcification as a Result of Mitomycin C
Extravasation- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Joon Yau Leong, Seth Teplitsky, Timothy M. Han, Mihir Shah, Thenappan Chandrasekar, Mark Mann
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Joon Yau Leong, Seth Teplitsky, Timothy M. Han, Mihir Shah, Thenappan Chandrasekar, Mark Mann
- Testicular Coccidioidomycosis as the Initial Manifestation of Disseminated
Disease- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Pedro A. Madero-Morales, Efrain Ruiz-Galindo, J. Gustavo Arrambide-Herrera, J. Iván Robles-Torres, Raquel Guajardo-Garza, Eirali G. García-Chapa, Lauro S. Gómez-Guerra, Gustavo Arrambide-Gutiérrez
- Abstract: Publication date: February 2020Source: Urology, Volume 136Author(s): Pedro A. Madero-Morales, Efrain Ruiz-Galindo, J. Gustavo Arrambide-Herrera, J. Iván Robles-Torres, Raquel Guajardo-Garza, Eirali G. García-Chapa, Lauro S. Gómez-Guerra, Gustavo Arrambide-Gutiérrez
