Variant Presentations of the Exstrophy-Epispadias Complex: A 40 Year Experience To investigate the diagnosis, surgical management and outcomes in patients with variant EEC. Variant presentations of the exstrophy-epispadias complex (EEC) span a wide range of abnormalities. The rarity and diversity of EEC variants can lead to challenges in the diagnosis and subsequent management of this population.
Moving Patient Reported Outcomes Towards Disease Specific Knowledge We would like to thank [insert name of reviewer] for [his/her] thoughtful examination of this manuscript. As outlined, a major finding of this work is that patients with high-risk non-muscle invasive bladder cancer (NMIBC) as defined by the European Urological Association and American Urological Association [ref] had significantly worse patient reported outcomes compared to those with non-high-risk disease. The survey tools utilized for the Medicare Health Outcomes Survey (MHOS) are not cancer specific instruments, yet still demonstrated statistically and clinically significant decreases in physical and mental health-related quality of life.
Testicular Acute Segmental Infarct Following Endovascular Repair of a Juxta-renal Abdominal Aortic Aneurysm: Case Report and Literature Review A 61-year-old male presented to our Accident & Emergency department with a three-day history of nausea and vomiting. On examination, he had a soft non-tender abdomen but pronounced pulsation of his abdominal aorta. A CT angiogram revealed a 6 cm juxta-renal abdominal aortic aneurysm with thrombus within the aneurysm sac and juxta-renal neck segment. There was also moderate atherosclerotic change of the common, internal and external iliac arteries bilaterally. Given the lack of a suitable infra-renal sealing zone for the stent graft, he underwent a complex endovascular aortic aneurysm repair using a stent graft (Cook Medical, Limerick, Ireland) with supra-renal coverage with four-vessel fenestrations (coeliac axis, superior mesenteric and left and right renal arteries).
Predictors Of Post-Operative Urinary Incontinence After Holmium Laser Enucleation Of The Prostate: 12 Months Follow Up Holmium laser enucleation of the prostate (HoLEP) is a well-studied, contemporary surgical treatment for benign prostatic hyperplasia (BPH), with multiple series reporting on its efficacy and safety.1-8 In these reports, varying rates of post-operative urinary incontinence (UI) have been described. During the early post-operative period, UI is common, but typically transient. Reported post-operative incontinence rates at less than 6 months range from 16.6-29.4%,1-6 with rates at 12 month follow up decreasing to 0-3.3%.
Reply to Letter to the Editor Comment on "Low-intensity Extracorporeal Shock Wave Therapy for Erectile Dysfunction: A Systematic Review and Meta-analysis" There are relatively few studies on using low-intensity extracorporeal shock wave therapy (LI-ESWT) for erectile dysfunction (ED), and the available studies have small sample sizes and heterogeneous populations. The heterogeneity among the studies could not be avoided completely, since many factors may contribute to ED, such as older age, hypertension, and diabetes. We did realize that there was heterogeneity in our meta-analysis.1 Currently, a practical way to decrease the heterogeneity is to use subgroup analysis to reduce confounders.
Sarcomatoid Cancer of Penis in a 45 Year Old Male A 42-year-old male patient presented to the outpatient department of our hospital with purulent discharge per urethra when voiding and a mass at the tip of the penis for the past 3 months. The patient had visited multiple practitioners of alternative medicine at his hometown before visiting our centre, but had no relief in his symptoms along with a progression in the size of the mass. There was no history of any surgical intervention or intervention on the penis in the past. The patient was sexually active and monogamous.
Comment on “Low-intensity Extracorporeal Shock Wave Therapy for Erectile Dysfunction: A Systematic Review and Meta-analysis.” We recently read with great interest the article published in Urology by Man Libo et al1, which described a systematic review and meta-analysis of low-intensity extracorporeal shock wave therapy (LI-ESWT) for erectile dysfunction (ED). Their meta-analysis included nine randomized controlled trials (RCTs) to investigate the LI-ESWT for patients with ED, the therapeutic efficacy of LI-ESWT for patients with ED, and the relationship of therapeutic efficacy and different setup parameters and protocols.
Obstructing Nephrolithiasis in an 84-year-old Patient With a Diaphragmatic Herniated Ureter Diaphragmatic herniations of the ureter are a rare occurrence overall, with fewer than 10 cases reported. Obstructing nephrolithiasis in the setting of diaphragmatic ureteral herniation has sparsely been documented. Management options to consider include ureteroscopy and laser lithotripsy to alleviate obstruction in herniated ureters. The abnormal path of the ureter and surrounding structures pose unique risks that require careful attention and a high level of operator skill.We present imaging of an 84-year-old woman incidentally found to have right ureteral herniation through the diaphragm with an obstructing 8 mm stone in the right proximal ureter with moderate hydronephrosis.
Urologic Management of Priapism Secondary to Chronic Myeloid Leukemia A 27-year-old Caucasian male with a history of chronic myeloid leukemia (CML), diagnosed at age 19, presented to his local emergency department with a painful persistent erection of 9 hours duration. He reported a history of 2 prior episodes of painful erections unrelated to sexual activity over the last 2 months, with each episode lasting less than 4 hours. Although his CML had been managed long-term with Imatinib (Gleevec), on presentation he admitted to medication noncompliance with Imatinib over the past year.
Traumatic Penile Pseudoaneurysm After Straddle Injury Presenting With Life Threatening Anemia: A Unique Case and a Diagnostic Challenge Partial urethral disruption after blunt perineal trauma can be initially managed with urethral catheterization. Lower urinary tract symptoms after catheter removal should raise suspicion for urethral stricture and requires further investigation. Lesser known complications require high index of suspicion to prevent life threatening sequelae. In this report, we describe a case of blunt perineal trauma and partial urethral disruption in a pediatric patient presenting with refractory anemia due to a penile artery pseudoaneurysm.
Partially Obstructed Longitudinal Vaginal Septum Presenting in Adulthood With Complaint of Urinary Incontinence A longitudinal vaginal septum can be obstructive or nonobstructive. We report on an adult woman who presented with involuntary fluid loss per vagina and had a partially obstructive longitudinal vaginal septum. A 36-year-old nulliparous female presented with malodorous, clear, leakage per vagina that she described as “urinary incontinence.” Examination revealed a fluid-filled fluctuant anterior vaginal wall with a draining sinus. Imaging revealed a solitary right kidney with duplicated ectopic fluid-filled ureters inserting into a partially obstructed left hemivagina with a longitudinal vaginal septum.
“Re: Direct Vision Internal Urethrotomy for Short Anterior Urethral Strictures and Beyond: Success Rates, Predictors of Treatment Failure, and Recurrence Management” I have read the articles of Kluth et al named “Direct Vision Internal Urethrotomy for Short Anterior Urethral Strictures and Beyond: Success Rates, Predictors of Treatment Failure and Recurrence Management” with interest.1 In the discussion part of the article, publications of Zehri et al were referenced.2 It is stated in the article that the success rate after internal urethrotomy is given as 37% in writing of Zehri et al titled “Predictors of recurrence of urethral stricture disease following optical Urethrotomy.” However, in abstract section of original article of Zehri et al, it is said: “For a mean follow up of 8.9+/-11 months, the overall recurrence rate was 37%, with mean time to recurrence of 4.5 months.” This means 37% is not a success rate, it is the rate of repeat (unsuccess).
CDC73 Germline Mutation in a Family With Mixed Epithelial and Stromal Tumors To describe a family in which 3 members presented with mixed epithelial tumor of the kidney (MEST) and were found to possess a germline mutation in CDC73, a gene which is associated with hyperparathyroidism-jaw tumor syndrome (HPT-JT).
Robotic-assisted Proximal Perineal Urethroplasty: Improving Visualization and Ergonomics To describe the use of the robotic platform for proximal suture placement during perineal urethroplasty in the posterior and proximal anterior urethra. Repair of posterior urethral and proximal bulbar strictures requires deep perineal dissection, making visualization and accurate placement of sutures challenging. The robotic platform has demonstrated benefits in these characteristics in deep pelvic surgery.
En Bloc Thulium Laser Enucleation of the Prostate: A Step-by-Step Guide to Improve Enucleation Time and Efficiency for Endoscopic Enucleation of Prostatic Adenoma To present a reproducible step-by-step approach to en bloc thulium laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia surgical treatment. Laser adenoma enucleation is nowadays a recognized surgical treatment for benign prostatic enlargement. Some variants to the classical 3-lobes laser technique have been proposed, in order to overcome the main concerns regarding the original procedure.1-4 After a vast experience with the 3-lobes ThuLEP, we developed our own en bloc enucleation technique.
Ambulatory Tubeless Mini-Percutaneous Nephrolithotomy Using Moses Technology and Dusting Technique To demonstrate the use of the Moses technology for holmium laser lithotripsy in conjunction with mini-percutaneous nephrolithotomy (PCNL) to treat a lower pole stone. The Moses technology is a pulse modulation method that can reduce stone retropulsion, which may have advantages when used during mini-PCNL.
Isoflavone Intake in Early Pregnancy and Hypospadias in the Japan Environment and Children's Study To explore the association between isoflavone intake in early pregnancy (the critical window of masculinisation) and hypospadias. Since oestrogen is likely to contribute to the differentiation of male external genitalia, dietary intake of isoflavone, which has a similar structure to human oestrogen, may be associated with the occurrence of hypospadias. However, there has been little evidence of this association.
The DACRON Ureter: A Case of Ureter to Aorto-Femoral Dacron Graft Fistulization We present a case of chronic, severe, intermittent hematuria found to be associated with a ureteral to aorto-femoral bypass fistulization. The graft was directly visualized on ureteroscopy and identified as the source of hematuria during exploratory laparotomy. Ureteral fistulization is a rare etiology of hematuria. Ureteral fistulization to an arterial graft has been reported several times in past decades. However, no cases have reported direct visualization of the dacron graft on ureteroscopy.
Case of Delayed Ileal Conduit Necrosis Related to Infiltrative Diffuse Large B-cell Lymphoma The ileal conduit (IC) is the most common form of urinary diversion, accounting for 33%-84% of all diversions performed in the United States.1,2 IC is an excellent reconstructive option for patients who require cystectomy for bladder cancer, other pelvic malignancies or benign conditions such as neurogenic bladder/spina bifida, refractory radiation cystitis, and bladder fistulae. While IC is the simplest form of urinary diversion to construct and manage long-term, early and late complications are not uncommon.
Dermatofibrosarcoma Protuberans in a Male Infant Dermtofibrosarcoma protuberans is a rare cutaneous malignancy known to be locally aggressive. It is uncommonly seen in the pediatric population and can be difficult to distinguish from other benign skin lesions. We present a case of dermatofibrosarcoma protuberans of the penis in a 6-month-old child managed with surgical resection. This case highlights the challenges of diagnosis of genital lesions in children and the complexities of genitourinary reconstruction following surgical resection.
Onabotulinum toxin A Injections in Men With Refractory Idiopathic Detrusor Overactivity To establish the effectiveness and safety profile of Onaboulinum toxin A (BTX-A) in men with idiopathic detrusor overactivity and compare with the outcomes observed in women. Several randomized trials have demonstrated the effectiveness of intradetrusor BTX-A injections in improving symptoms and quality of life in patients with overactive bladder (OAB) symptoms. Most trials however contained relatively few men or excluded men altogether.
Primary Extrarenal Type 2 Papillary Renal Cell Carcinoma: A Case Report Type 2 papillary renal cell carcinoma (PRCC) is a malignant tumor originated from renal tubular epithelial cells. Here we present a rare case of extrarenal type 2 PRCC which is located at the right lateral side of the retroperitoneal inferior vena cava. No suspicious lesions were detected in the bilateral kidneys. The diagnosis was confirmed by histopathological examination after complete excision of the tumor. No recurrence was observed in 5 months of follow-up after surgery.
The Treatment of Genitoperineal Hidradenitis Suppurativa: A Review of the Literature Hidradenitis suppurativa is a chronic inflammatory condition affecting the axilla, genitals, perineum, and perianal regions. The pathophysiology of hidradenitis suppurativa is complex and requires a multidisciplinary approach to treatment involving medical and surgical management when indicated. We describe our multidisciplinary protocol for treatment, which includes rheumatology-monitored immunotherapy, medical management, wide surgical resection, wound care, and reconstruction. The multidisciplinary care team includes rheumatology, wound care, and reconstructive urologic surgery.
Renal Replacement Lipomatosis: From Conception to Birth Renal replacement lipomatosis is a rare disease characterized by renal parenchymal atrophy and proliferation of inflammatory and fatty cells within the renal sinus, hilum, and perirenal region. The exact pathogenesis is unknown, however more than 75% of cases are associated with renal stones. Here, we provide images from a case with 10 years of follow-up, outlining the radiographic progression of the disease through time. Although only histopathology can confirm the diagnosis, high clinical suspicion in combination with the radiographic findings can differentiate the disease from other fat-containing entities.
Rare Images of Urethral Hemangioma and its Management Hemangioma of the genitor-urinary tract commonly involves the kidney and the bladder. Urethral hemangioma is rarely encountered with only case reports available in literature.1 Larger lesions involving almost the entire penile urethra in length and width, and requiring open excision and reconstruction, are even rarer. We report the case of a 23-year-old male presenting with recurrent, intermittent urethral bleeding with normal urination for 3 years. Evaluation revealed a urethral growth which was managed with excision and reconstruction using buccal mucosa.
Cystadenoma of the Seminal Vesicle: A Case Report of Rare Seminal Vesical Tumor and Review of Literature Although the secondary involvement of the seminal vesicles by prostate cancer is relatively common, seminal vesicle as a primary site for neoplastic disease is uncommon.1 There are a wide variety of tumors among primary seminal vesicle tumors that are derived from both the epithelium and stroma. Hence, they have been classified as mixed epithelial-stromal tumors. This report describes a 32-year-old man who presented with a retrovesical cystic mass that was initially thought to be a prostatic tumor but demonstrated pathologically to be a cystadenoma of the seminal vesicles.
Vapoenucleation of the Prostate Using 180 W GreenLight Laser The vapoenucleation of the prostate using green laser is an alternative hybrid technique between vaporization and enucleation. It consists of vaporizing the lateral lobes and enucleating the median lobe.The advantages compared with photoselective vaporization of the prostate (PVP) are: a fairly fast operation, low reoperation rates, it is suitable for large glands and provides pathology specimen.The aim of this video is to demonstrate the vapoenucleation technique step-by-step.
Delayed Return of Ejaculatory Function in Adolescent Males Treated With Retroperitoneal Lymph Node Dissection and Adjuvant Therapy for Paratesticular Rhabdomyosarcoma Due to the rarity of the disease, adverse events related to ejaculatory function following the management of paratesticular rhabdomyosarcoma with multimodal therapy in adolescents are rarely discussed. Two patients, age 14 and 15 at time of diagnosis were treated with multimodal therapy with nerve-sparing retroperitoneal lymph node dissection, chemotherapy, and radiotherapy. Each developed ejaculatory dysfunction during the treatment period, which resolved 1 year after completion of all therapies.
Management of High-grade, Nonmuscle Invasive Urothelial Carcinoma in a Prepubertal Patient With TURBT and Intravesical BCG High-grade urothelial carcinoma of the bladder is rare in the pediatric population with no established guidelines for management. We treated a single female patient, 10 years of age, who was found to have high-grade, nonmuscle invasive urothelial carcinoma endoscopically and with intravesical bacille calmette guerin (BCG). Given the child's age, no local adult institution could provide BCG therapy. Utilizing the experience of the local adult institutions, we developed a comprehensive protocol for first-time delivery of BCG at a free-standing children's hospital.
Real-World Impact of Minimally Invasive Versus Open Radical Cystectomy on Perioperative Outcomes and Spending To evaluate the effect of the minimally invasive approach on spending and perioperative outcomes for patients undergoing radical cystectomy for bladder cancer. In a randomized control trial conducted at high-volume centers, robotic, and open cystectomy were shown to have similar outcomes. However, because the majority of cystectomies are performed in low-volume centers, it is unknown whether these findings are broadly generalizable.
A Serrated Hyperplastic Colonic Polyp of the Urinary Bladder Intestinal metaplasia of the urinary bladder can occur within the surface urothelium due to chronic irritation in repaired exstrophic urinary bladder. Colonic villous adenomas and tubulovillous adenomas with high-grade dysplasia and associated adenocarcinoma have been reported in adult patients with a history of augmented exstrophic bladder. To our knowledge, we report the first example of a nonadenomatous serrated hyperplastic colonic polyp in an elderly patient with a history of exstrophic bladder.
Reduced Recurrence of Low-grade Papillary Bladder Tumors Associated With Asymptomatic Bacteriuria To determine tumor recurrence rate of low-grade, papillary, and non–muscle-invasive (TaLG) bladder tumors in patients who have asymptomatic bacteriuria (ABU). Microbes in the urine trigger immune responses like intravesical Bacillus Calmette-Guerin, suggesting that common bacteria may also exert an antitumor effect.
Extreme Price Variation for Generic Benign Prostatic Hyperplasia Medications To characterize geographic variability of generic benign prostatic hyperplasia (BPH) medications in order to improve drug price transparency and improve patient access to affordable medication sources. This is of interest because BPH is one of the most common chronic diseases in men and contributes to individual healthcare cost. Medical therapy is the main treatment modality for BPH, burdening patients with lifelong medication expenses which may impact adherence and subsequent outcomes. With an aging population, this is compounded by many older individuals requiring multiple daily medications.
An Antenatally Detected Pure Malignant Rhabdoid Tumor of the Bladder Pediatric malignant rhabdoid tumors are a rare entity with poor prognosis. The extrarenal variants of this disease are sparsely presented within the literature. Our case represents, to our knowledge, the first antenatally detected bladder-variant. At 19 months of age, this patient has benefited from early detection and intervention and remains disease free following partial cystectomy and chemotherapy.
Proteinaceous Renal Stones in a Kidney Transplant Candidate Presenting as Bilateral Filling Defects Suspicious for Upper Urinary Tract Transitional Cell Carcinoma Our patient is a 60-year-old female with a past medical history significant for diabetes mellitus type 2, smoking, anal cancer status-post transrectal excision with no evidence of recurrence or metastasis, rheumatoid arthritis, systemic lupus erythematosus, and end-stage renal disease on hemodialysis (HD). She had progressive chronic kidney disease for approximately 25 years, ultimately starting HD 3 years prior to this evaluation. She presented to the urology department for evaluation prior to kidney transplantation.
Risk of Ovarian Malignancy in Patients Undergoing Radical Cystectomy for Bladder Cancer To determine whether there is an increased risk of ovarian cancer in women undergoing radical cystectomy (RC) for bladder cancer using a large population-based data source. Current American Urologic Association guidelines suggest removal of ovaries during RC in women with bladder cancer, presumably to mitigate the risk ovarian cancer. However, recent data have demonstrated an increased risk of all-cause mortality, cardiovascular disease, osteoporosis, cognitive impairment, and diminished sexual function in some populations of women after oophorectomy.
Diabetic Bladder Dysfunction:A Review Diabetic bladder dysfunction affects almost half of all diabetic patients, making it one of the most common complications of diabetes mellitus. The clinical presentation of diabetic bladder dysfunction can be varied and may be extremely bothersome to patients, negatively impacting their quality of life. Despite this, it remains understudied and under-represented in the medical literature. This review summarizes the current literature on pathophysiology, clinical presentation, urodynamic findings, evaluation, and management.
Re: Dal Moro: Concerns About the Use Of A Free Graft During York-Mason Intervention (Urology 2018;XX:XXX–XXX) While we recognize the thoughtful nature of this critique regarding the use of interposing fat grafts during the modified York-Mason procedure, we disagree with the concept of aberrant functionality or healing results. On the contrary, urinary and fecal streams are individually repaired to completion—the fat graft then is placed between the water-tight suture lines as a finalizing barrier. We reject the notion that interposing fat in this manner creates anatomic distortion of any physiological significance.
Concerns About the Use of a Free Graft During York-Mason Intervention I would like to congratulate McKibben et al1 on their recent paper, focused on the York-Mason intervention in the treatment of iatrogenic rectourinary fistulas. The analysis of the functional results of their series demonstrated that this approach is safe and efficacious in treating this devastating complication of prostatic surgery. Interestingly, they introduced an adjunctive maneuvre modifying the original York-Mason technique: the interposition of a local free graft of subcutaneous fat between the urothelial and the rectal tissues.
Hypoglycemia in Renal Cell Carcinoma: A Rare Paraneoplastic Syndrome A 65-year-old male adult foster care patient presented to the emergency room with altered mental status and respiratory depression which required intubation. The patient was also found to be hypoglycemic and hypertensive. He was admitted to the medical intensive care unit where a chronic type B aortic dissection and an exophytic superior pole right renal mass measuring 4.5 × 5.5 cm were discovered on computed tomography scan (Fig. 1). He continued experiencing recurrent episodes of hypoglycemia during his admission and was placed on double portion meals and intravenous glucose with dextrose 10% (D10) in water.
A Large Urinary Bladder Hemangioma Mimicking Urachal Cancer: A Case Report and Literature Review Urinary bladder hemangiomas are rare, especially in children and adolescents. We present a case of a 17-year-old young man with persistent gross hematuria for 1 month. Computed tomography revealed a 3.6 cm mass on the superior anterior wall of the urinary bladder, which was highly suspected as an urachal tumor. We carried out an en bloc resection of the urachus and bladder tumor. The pathologic report indicated a cavernous hemangioma of the urinary bladder. No tumor recurrence or bleeding was found during the 2-year follow-up.
Herniated Kidney Postoperative incisional hernia is a relatively common complication following abdominal surgery. Herniation of the kidney is a less common entity and typically occurs as a congenital or acquired diaphragmatic defect, and rare case reports have demonstrated partial flank or lumbar herniation of the kidney. Herein we present a unique case of a postoperative incisional hernia containing the entire right kidney.
Post-prostatectomy Lymphocoele Presenting With Renal Failure Since its advent in 2001, robotic-assisted laparoscopic prostatectomy has become the gold standard treatment for the management of localized prostate cancer.Pelvic lymphocoele is most commonly found after gynecological or renal transplant surgery or following extensive pelvic lymphadenectomy. Its formation following prostatectomy is not uncommon1 but it seldom causes major complications or morbidity.2We present a case of a 66-year-old man who presented with left-sided abdominal pain, a palpable infra-umbilical mass, and renal failure.
Active Surveillance of Small Renal Masses Most renal masses in the United States are incidentally detected via abdominal imaging. This has led to an increase in the incidence of small renal masses (≤4 cm). Active surveillance is, an oncologically safe option in slow growing and indolent tumors in other organs and has recently become more widely studied in small renal masses. For selected patients, particularly those who harbor significant comorbidities, active surveillance is a safe option for small renal masses. Renal biopsy may be helpful in the decision making process, but remains an optional component for the active surveillance of small renal masses.
Testosterone therapy for high-risk prostate cancer survivors: a systematic review and meta-analysis A systematic review and meta-analysis was performed to determine the relationship between testosterone therapy and risk of recurrence in testosterone-deficient survivors of curatively treated high-risk prostate cancer. Primary outcome was the risk of biochemical recurrence (BCR) in 109 high-risk patients in 13 included studies (1997-2017). Biochemical and symptomatic effects of therapy were also reviewed. The BCR rate was 0.00 (0.00-0.05), lower than the expected rate for high-risk prostate cancer survivors, suggesting that testosterone therapy may not increase their BCR risk.
Surgical Outcomes of Three vs Four Arm Robotic Partial Nephrectomy: Is the Fourth Arm Necessary? To compare the cost, efficacy, and safety of 3-arm versus 4-arm technique in robotic partial nephrectomy (RPN). Surgeons may either elect to utilize three vs four robotic instruments depending on preference. The purpose of this study is to compare the outcomes between the two techniques.
The History of Urology at the Minneapolis Veterans Affairs Health Care System The Section of Urology at the Minneapolis Veteran's Affairs (VA) Medical Center has a long history of contributions to Urology including the Gleason Score, Fuhrman Grading system, testicular tumor marker development and the birth of Endourology. The objective of this manuscript is to compile and present the Urologic history of the Minneapolis VA.
Reply by the Authors: Shock-wave Lithotripsy for Pediatric Patients: Which Nomogram Can Better Predict Postoperative Outcomes? The prediction of the success rate of shock-wave lithotripsy is an important issue, especially for pediatric patients. Therefore, clinicians should use these nomograms more often in daily practice to improve surgical planning. In our study, we compared the accuracy of the Onal and Dogan nomograms. We demonstrated that both nomograms are effective and independent predictors of stone-free rate. We used objective variables such as gender, age, stone size, number of stones, stone localization, and history of previous treatment.
Transurethral Enucleation With Bipolar Energy (TUEB):AINU Technique and Short-term Outcomes To present our transurethral enucleation with bipolar energy (TUEB) technique, wherein the enucleated adenoma is resected while keeping it attached near the verumontanum avoiding the need of a morcellator, and to evaluate the safety and short-term outcomes of our technique of TUEB for the treatment of symptomatic benign prostatic hypertrophy (BPH).
Pathologic Specimens at Time of Pyeloplasty: Frequency and Practice Patterns To assess national and regional practice patterns and rates of pathologic specimen identification sent at time of pyeloplasty, as well as project associated costs, we used a national administrative database. The rate at which the excised ureteropelvic junction obstruction (UPJO) is sent for pathologic identification is variable, arguably without a clear clinical purpose.
Understanding the Popcorn Effect During Holmium Laser Lithotripsy for Dusting To assess low and high power settings for the popcorn technique, and relationship of laser fiber-to-stone distance and calyceal size on submillimeter fragmentation. Our in vitro findings may help guide strategies to improve a dusting technique for ureteroscopy.
Single Session Bilateral Vs Staged Bilateral Ureteroscopy for Nephrolithiasis: An Assessment of Safety and Efficacy To compare outcomes of patients undergoing single session bilateral ureteroscopy (SSBU) to those undergoing planned staged ureteroscopy (URS) for bilateral nephrolithiasis. While SSBU has the advantage of 1 anesthetic procedure, some may pursue a staged approach due to the potential higher risk of complications and patient discomfort with 2 ureteral stents.
Locally Metastatic Ductal Adenocarcinoma of the Prostate: A Therapeutic and Prognostic Dilemma An asymptomatic 64-year-old male with an elevated prostate specific antigen (PSA) of 28.0 ng/dL underwent transrectal ultrasound-guided prostate biopsy and was diagnosed with Gleason 8 (4+4) ductal adenocarcinoma in 8 of 12 cores sampled. Bone scan, chest x-ray, and abdominal CT scan were all radiographically negative for metastatic disease. He underwent curative intensity-modulated radiation therapy (IMRT) with 79.2 Gy in 44 fractions as well as adjuvant androgen deprivation (ADT) incorporating leuprolide, per American Urologic Assosciation (AUA) and National Comprehensive Cancer Network (NCCN) guidelines.
Acceptability of Mobile Health Technology for Promoting Fluid Consumption in Patients With Nephrolithiasis To evaluate kidney stone patients’ interest in lifestyle behavior modification and a variety of mobile health (mHealth) technologies to improve adherence to fluid consumption recommendations for the prevention of nephrolithiasis. Of particular interest was the acceptability of various intervention components for the design of a stone-specific mHealth technology.
Stratification of Patients With Interstitial Cystitis/Bladder Pain Syndrome According to the Anatomical Bladder Capacity To compare the data of score symptoms (Interstitial Cystitis Problem Index, Interstitial Cystitis Symptom Index, Pelvic Pain and Urgency/Frequency Patient Symptom Scale and SF-36quality of life), voiding diaries, urodynamic studies, and cystoscopy under general anesthesia according to the anatomical bladder capacity for patients with interstitial cystitis/bladder pain syndrome (IC/BPS).
Care Seeking Patterns for Women Requiring a Repeat Pelvic Organ Prolapse Surgery Due to Native Tissue Repair Failure Compared to a Mesh Complication To explore patient migration patterns in patients requiring repeat surgery after Pelvic Organ Prolapse (POP) repair as there is a limited understanding of care seeking patterns for repeat surgery after POP repair. We hypothesized that undergoing repeat surgery for a prolapse mesh complication would be associated with an increased incidence of migration to a new facility for care compared to those undergoing repeat surgery for recurrent POP.
Post TURBT Discovery of Urachal Remnant in a 62-Year-Old Man A 62-year-old male with a past medical history of cigarette smoking and laparoscopic repair of bilateral inguinal hernias using total extraperitoneal (TEP) mesh presented with persistent dysuria and perineal pain. Urine culture was negative, and he was treated with an extended course of antibiotics for a working diagnosis of prostatitis. His urinary symptoms improved but he returned with gross hematuria a few months later. CT urogram was concerning for a bladder tumor, with soft tissue thickening from the dome of the bladder extending to the abdominal wall and left inguinal region.
Variability of Retail Pricing of Generic Urologic Medications in a Major US Metropolitan Area Objective: To investigate retail pricing for generic urologic medications in the St. Louis area as a function of pharmacy type, zip-code, and median income.Materials and Methods: Pharmacies spanning 51 zip-codes were identified. From May-June 2017, pharmacies were inquired regarding cost, without insurance, for 30- and 90-tablet prices for finasteride 5mg, tamsulosin 0.4mg, oxybutynin 5mg, and oxybutynin ER 5mg and 10mg. Median income was determined using US census data.K-means clustering defined groupings based on zip-code, median income, and a combination of the two.
Current State of Urologic Medical School Education: A Scoping Review To review current literature pertaining to the availability and implementation of urology-focused curricula, in an effort to highlight current approaches to urologic education at the medical school level.
Late Relapse of Nonseminomatous Germ Cell Tumor 24 Years Later A 60-year-old man with a history of coronary artery disease status-post coronary artery bypass graft, hypertension, type II diabetes, current every-day smoker, and testicular cancer presented with abdominal and left flank pain. A CT and PET scan was performed, revealing a PET-avid 5.5 × 4.4 cm left para-aortic and renal hilar mass (Figs. 1 and 2). Serum tumor markers were normal.
Retroperitoneal Paraganglioma Involving the Renal Hilum: A Case Report and Literature Review A 27-year-old female with past medical history of hypertension presented to Urology clinic for evaluation of a right renal mass discovered incidentally by her Obstetrician on renal ultrasound obtained for work-up of her refractory hypertension. Her hypertension was uncontrolled despite being on a low-sodium diet, hydrochlorothiazide 50 mg daily and lisinopril 10 mg daily. Review of systems was notable for occasional headaches and blurry vision. She had regular annual physicals and negative pap smear with her Obstetrician, and reported no prior surgical history.
Comparison of RENAL, PADUA, CSA, and PAVP Nephrometry Scores in Predicting Functional Outcomes After Partial Nephrectomy To evaluate the accuracy of radius, exophytic/endophytic, nearness to collecting system/sinus, anterior/posterior, and location relative to polar lines (RENAL), preoperative aspects and dimensions used for anatomical classification (PADUA), contact surface area (CSA), and preoperative assessment of volume preservation (PAVP) nephrometry scores in predicting postoperative renal functional outcomes after partial nephrectomy (PN). Few studies have compared the accuracy of tumor complexity systems directly in the same set of PN patients.
Congenital Duplication of the Urogenital Sinus in an Adult Female A 28-year-old female presented to the emergency room with symptoms of left pyelonephritis. She was admitted and was found on imaging study to have left hydronephrosis and duplicated bladder. A left nephrostomy tube was placed, and urology was consulted for management of her infections in context of her anatomy. During her evaluation, the patient reported 3-4 urinary tract infections or episodes of left pyelonephritis per year, as well as recurrent left flank pain and mixed urinary incontinence for several years.
High Catastrophizing in Subjects With Painful Mesh Complications Leads to Worse Outcomes To identify the rate of catastrophizing in a cohort of subjects with chronic pain after self-reported mesh complications and identify interactions of catastrophization with other patient factors, such as age, number of pelvic surgeries, and intent to sue. Catastrophizing has been shown to be a risk factor for chronicity of pain, disability, and depression.
Association Between Exstrophy-epispadias Complex And Congenital Anomalies: A German Multicenter Study To further investigate associated anomalies in exstrophy-epispadias complex (EEC) patients congenital uro-rectal malformations network (CURE-Net) database was systematically screened. In literature the EEC comprises a spectrum of anomalies, mainly occurring “isolated” without additional congenital defects. Nevertheless, previous epidemiological studies indicated a higher association with renal, anorectal, and lower neurotubular anomalies, which may originate from the same developmental morphogenetic fields.
Determinants of Active Surveillance in Patients With Small Renal Masses To evaluate trends in the utilization of active surveillance (AS) in a nationally representative cancer database. AS has been increasingly recognized as an effective strategy for patients with small renal masses but little is known about national usage patterns.
Urologic Complications Following Pelvic Radiotherapy Radiotherapy is widely used as a curative treatment for pelvic malignancies. The location of these organs leads to unavoidable exposure of the bladder, urethra, and distal ureters to radiation and may cause subsequent development of radiation cystitis, fistulae, strictures, and secondary malignancy. As cancer survival improves, an ever-increasing number of patients is living with the long-term complications of radiotherapy. Symptoms are not only debilitating for the patient but also pose a treatment challenge to the urologist.
The Prognostic Value of PIK3CA Copy Number Gain in Penile Cancer To determine whether phosphatidylinositol-4,5-bisphosphate 3- kinase, catalytic subunit alpha (PIK3CA) copy number gain in penile cancer has prognostic value and association with histopathological parameters, human papillomavirus (HPV), and clinical outcome.
Localized Inflammatory Myofibroblastic Tumor Involving the Genitourinary System: Adolescent Case Series and Review We describe four adolescent cases of inflammatory myofibroblastic tumor involving the genitourinary system. Two patients with masses of the urinary bladder presented with gross hematuria. The third patient presented with left flank pain and a mass encasing the left ureter causing hydronephrosis. The fourth patient presented with a painless, growing palpable mass of the left hemiscrotum. Currently, no standards exist for the management of inflammatory myofibroblastic tumors. Herein, we discuss the work-up and treatment approaches taken in each case.
A Case of Fatal Clostridial Necrotizing Fasciitis After Radical Prostatectomy A 70-year-old Caucasian male with pT3aN1Mx G3+4 prostate cancer underwent an open radical retropubic prostatectomy with lymphadenectomy without surgical complications. He experienced a slightly prolonged postoperative hospitalization (3 days) secondary to a reaction to an anesthesia study drug (tachycardia and drowsiness) that resolved after discontinuation of said drug and was subsequently discharged. Two weeks later, he was brought to the emergency department after the sudden onset of an acutely severe right groin pain and swelling that began that afternoon.
The Urology Match and Postinterview Communication To understand the frequency and nature of postinterview communication as it relates to the rules and regulations of the American Urological Association Urology Residency Match, as well as the impact of such communication on the outcomes of the match.
Oral Propranolol in a Child With Infantile Hemangioma of the Urethra Infantile hemangiomas (IH) are the most common in the head and neck region.1 They can occur anywhere in the skin, however, urethral hemangiomas are very rare. We describe a case report of a 3-year-old boy with extensive lesions of IH in the anterior urethra. Urethral IH were disappeared during 1 year of oral administration of propranolol though it brought on urinary retention. This is the first report about oral propranolol treatment in a child with urethral IH. Oral administration of propranolol may be effective for urethral IH and beneficial especially for lesions requiring extensive surgical resection and reconstruction.
Complications of Delivery Among Mothers With Spina Bifida To determine rates and types of peripartum morbidity among delivering women with spina bifida (SB) compared to those without SB. The rates of pregnancy and delivery among women with SB have been significantly increasing. Current knowledge of peripartum outcomes for these women is limited.
Growing Teratoma Syndrome of Testicular Origin A 20-year-old Hispanic male who is a semiprofessional soccer player with no medical history presented to the emergency department with 1 month of abdominal distension and 4 days of left lower extremity swelling. During initial interview, the patient offered that his testicle had been enlarged for approximately 4-6 years, without any workup or intervention. A firm nontender abdomen, enlarged left hemiscrotum, and left lower extremity swelling were noted on physical examination. A left supraclavicular lymph node was also palpable.
Bladder Agenesis and Associated Pelvic Arterial Anomaly in 2 Female Pediatric Patients Bladder agenesis is an extremely rare congenital anomaly of the genitourinary tract. Two female patients with known diagnoses of bladder agenesis presented for prerenal transplant evaluation and neobladder creation. Similar unique pelvic arterial malformations were identified through preoperative imaging and intraoperative examination. With these similar findings, it could be proposed that such anatomical variants are products of the same insult or involve a causal relationship, with vascular aberrancies potentially provoking pelvic organ maldevelopment.
Impact of Statin Intake on Kidney Stone Formation To determine whether statin intake affects nephrolithiasis risk, and whether higher lipid levels correlate with stone risk. Dyslipidemia is a known independent risk factor for urolithiasis, and emerging evidence suggests common biological pathways. Previous work has suggested that statins protect against new stone formation, but these findings have not been verified by other investigators.
Dual Pathology Causing Congenital Bladder Outlet Obstruction Anterior urethral syringocele is an uncommon congenital deformity characterised by cystic dilatation of bulbo-urethral gland ducts and is usually asymptomatic. We present a case on 4-day-old male neonate who presented with bilateral antenatal hydroureteronephrosis and renal impairment and found to have urethral syringocele and posterior urethral valves (PUV).
Author Reply The comments of the editor truly reflect the findings of our study on the surgical treatment of giant penoscrotal lymphedema. All the 19 patients described in the study were to be treated by surgery. Eight patients, however, defaulted, possibly because of their belief in alternative traditional herbal medicine and or financial constraint, because health insurance schemes are yet to be fully established in our environment.
WITHDRAWN: Stented or Unstented Distal Hypospadias Repair The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2017.04.057. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
WITHDRAWN: Editorial Comment on “Abnormal Expression of Sg I is Closely Related to Seminal Vesiculitis” The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2015.08.052. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
WITHDRAWN: Reply The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2015.08.053. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
WITHDRAWN: Editorial Comment The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2013.02.086.The duplicate article has therefore been withdrawn.
EDITORIAL COMMENT Our specialty takes pride in attracting the best and brightest medical students into the field. Several times over the past decade, the question of moving to the National Residency Matching Program (NRMP) Match has been discussed among the leaders in academic urology, currently the Society of Academic Urologists (SAU). Each time, we have chosen to stay with an early match administered by the American Urological Association (AUA Match). There has been the assumption by most, that the AUA Match is conducted with the same Code of Conduct1 as the NRMP Match, just earlier in the year.
EDITORIAL COMMENT The Urology Residency Match Program has been in existence for more than a quarter of a Century. The Match process is the way medical school graduates obtain a urology residency in the United States. The American Urological Association (AUA) contractually conducts the annual Match Program for the Society of Academic Urologists (SAU). The Match process and guidelines are accessible on the AUA website [http://www.auanet.org/education/auauniversity/residents/residency/urology-and-specialty-matches].
AUTHOR REPLY We appreciate the editorial comment and the discussion it initiates. We agree with the sentiments of the reviewer that increased awareness of the National Resident Matching Program's (NRMP) Communication Code of Conduct and the Urology Match's Guidelines to Programs statements are among the first steps toward reforming the Match process in urology. In addition to reviewing the guidelines available with participating faculty prior to each interview season, we have made several changes at our own program.
EDITORIAL COMMENT This article also addresses issues related to the conduct of the Urology Residency Match and echoes many of the findings of Farber and colleagues (1). In this study all US applicants to a single urology residency program (NY Section) were sent an anonymous survey regarding their experiences during the 2017 Match cycle. The response rate was 58% and again the findings are rather concerning. Fifty-eight percent of applicants received follow-up communication from at least one program, and 19% felt misled by this.
AUTHOR REPLY In reply: We thank the commenters for their interest in this paper and their editorial remarks, and we share many of their concerns. In particular, the practice of encouraging second-look visits warrants discussion. Although data on the cost of second-look visits to urology applicants are scarce, findings similar to those of our study are seen in other surgical subspecialties, where the mean cost to an applicant of second look visits can reach $600 per visit.1 We concur with the commenters that this may disadvantage many candidates from certain economic backgrounds, especially given the substantial burden of medical school debt.
EDITORIAL COMMENT The Urology Residency Match Program has been in existence for more than a quarter of a century. The Match process is the way medical school graduates obtain a urology residency in the United States. The American Urological Association (AUA) contractually conducts the annual Match Program for the Society of Academic Urologists (SAU). The Match process and guidelines are accessible on the AUA website [http://www.auanet.org/education/auauniversity/residents/residency/urology-and-specialty-matches].
EDITORIAL COMMENT This is an important article that looks at postinterview communications and their potential impact on the results of the Urology Match. The authors surveyed all 231 applicants to a single urology residency training program in the NE sector of the country during the 2017 American Urological Association Match cycle. The surveys were sent out 1 month after the match was completed and the response rate was 34%, so there may have been some responder bias. Nevertheless, the results are very concerning and worthy of discussion.
EDITORIAL COMMENT Our specialty takes pride in attracting the best and brightest medical students into the field. Several times over the past decade, the question of moving to the National Residency Matching Program (NRMP) Match has been discussed among the leaders in academic urology, currently the Society of Academic Urologists (SAU). Each time, we have chosen to stay with an early match administered by the American Urological Association (AUA Match). There has been the assumption by most, that the AUA Match is conducted with the same Code of Conduct1 as the NRMP Match, just earlier in the year.
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