Medicine and Health Sciences Commons^™

Internet Transparency Of Local Men’S Health Clinics In Nebraska, Jinfeng Jiang, Jordan Stegman, Christopher M. Deibert

Graduate Medical Education Research Journal

An overview of Men’s Health Clinics offering Testosterone Therapy in a Midwest State.

Introduction/ Background – Since 2001, there has been a 300% increase in the use of Testosterone therapy. However, there remains limited published data on the demographics of facilities and providers that advertise this service. This study aims to look at such demographics of advertised Men’s health clinics in Nebraska.

Methods/ Materials – An internet search was conducted with the phrases “Nebraska Male health clinics, Nebraska Low T/testosterone, Nebraska Hormone Replacement Therapy”. All clinics that were found offering Testosterone therapy with Men’s health in their mission statement were …

Author Reply., Selin Isguven, Paul H. Chung, Priscilla Machado, Lauren J. Delaney, Antonia F. Chen, Flemming Forsberg, Noreen J. Hickok

Department of Radiology Faculty Papers

No abstract provided.

Intraoperative Icg-Nir Fluorescence Angiography Visualization Of Testicular Perfusion In Operations For Testicular Torsion, Colton D. Wayne, Mohammad A. Emran, Leon Smith-Harrison, P. Stephen Almond, Haroon I. Patel, Shannon Koehler

MEDI 9331 Scholarly Activities Clinical Years

Purpose: Indocyanine Green (ICG) near-infrared (NIR) fluorescence angiography is used in assessing testicular perfusion after reduction of testicular torsion to assess tissue viability.

Introduction: Determination of viability of a testicle after reduction of a testicular torsion has been performed by numerous methods including visual assessment, Doppler ultrasound, and cutting the testicular capsule. Each of these has limitations, are not always reproducible, and may involve damage to the testicle and confusion of capsular blood flow for internal perfusion. A possible alternative to these methods is the use of ICG-NIR fluorescence angiography. ICG was FDA-approved in 1959 and has been …

The Effect Of Mtor Inhibitor Rapamycin On A Dietary Drosophila Melanogaster Model Of Calcium Oxalate Nephrolithiasis, Michael T. Pignanelli

Electronic Thesis and Dissertation Repository

Impaired cellular tolerance of reactive oxygen species (ROS) has been suggested as a common mechanistic link associated with aging in both metabolic syndrome and nephrolithiasis. The mechanistic (mammalian) target of rapamycin (mTOR) activity is characteristic of metabolic syndrome. When nutrients are abundant, mTOR is active. Conversely, fasting inhibits mTOR. Metabolic syndrome is correlated with an increased risk of self-reported or imaging findings of nephrolithiasis. At the individual level, patients with a higher BMI have an increased prevalence of recurrent symptomatic nephrolithiasis, 24-hour urinary excretion of oxalate, sodium, uric acid, calcium, and phosphorous as well as lower pH. Calcium oxalate crystals …

Interobserver Reliability Of The Renal Nephrometry Scoring System: Experience From A Developing Nation, Kumail Khandwala, Dawar Khan, Zainab Hussain, Nida Sajjad, Muhammad Ismail Alvi

Department of Radiology

Introduction: The RENAL (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior/posterior, location relative to polar lines) nephrometry score (RENAL-NS) has been described as a structured and quantifiable method to describe a renal tumor’s relevant anatomic features as they relate to the complexity of the lesion. We aim to evaluate a tumor’s RENAL-NS and to assess the reproducibility of the score among different observers.
Methods: This retrospective study included 49 patients diagnosed with renal cell carcinoma (RCC) who had complete computed tomography (CT) data, RENAL-NS, and histopathology results. All patients underwent renal surgery/intervention at …

The Correlation Between Stone Nephrolithometry Score And Hemoglobin Drop In Patients Undergoing Percutaneous Nephrolithotomy, Mohammad Shoaib, Muhibullah Bangash, Basit Salam, Hammad Ather

Section of Urology

Objective: In this study, we aimed to determine the correlation between the STONE score [(S)ize of the stone, (T)opography or location, degree of (O)bstruction of the urinary system, (N)umber of stones, and (E)valuation of Hounsfield units] and postoperative hemoglobin drop in patients undergoing percutaneous nephrolithotomy (PCNL).
Methods: This was a prospective observational study and all adult patients aged 18-65 years undergoing unilateral, single-tract PCNL using 26 Ch. Amplatz sheath for renal calculi were included. The five variables of the STONE nephrolithometry score were calculated prior to the procedure. The stone-free rates were assessed on imaging at four weeks and complications …

Relationship Of Spot Urine Oxalate To Creatinine Ratio And 24 Hours Urinary Oxalate Excretion In Patients With Urolithiasis, Syed Bilal Hashmi, Lena Jafri, Hafsa Majid, Jamsheer Jehangir Talati, Wajahat Aziz, Aysha Habib Khan

Department of Pathology and Laboratory Medicine

Background: The evaluation of 24 h urinary oxalate excretion is the gold standard for diagnosing hyperoxaluria in patients with recurrent urolithiasis. However, 24 h urine sample collection is cumbersome. Therefore we aim to see if oxalate to creatinine ratio in random urine sample can be used as an alternative.
Materials and methods: A cross-sectional study was conducted at Section of Chemical Pathology, Department of Pathology and Laboratory Medicine Aga Khan University Karachi from 1st February to December 31, 2019. A total of 62 adult patients, 18-60 years of age with history of kidney stones presenting to the clinical laboratory for …

Perspectives And Experiences Of Transgender And Non-Binary Individuals On Seeking Urological Care., Paul H Chung, Sabina Spigner, Vishal Swaminathan, Seth Teplitsky, Rosemary Frasso

Department of Urology Faculty Papers

OBJECTIVE: To describe perspectives and experiences related to urology care-seeking of transgender and non-binary (TGNB) individuals assigned male at birth.

MATERIALS AND METHODS: This HIPAA-compliant study was IRB approved and followed Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines. Through semistructured interviews, perspectives, and experiences of individuals related to urology care-seeking were explored. Open-ended questions were designed to elicit a range of responses rather than quantifiable data. Thematic codes were developed and explicitly defined. Codes pertaining to patient experiences were assessed and described.

RESULTS: Twenty-five TGNB individuals assigned male at birth were interviewed. Participants reported an array of factors that …

Identification Of Plasma Glycosphingolipids As Potential Biomarkers For Prostate Cancer (Pca) Status, Ashley J. Snider, Michael C. Seeds, Laurel Johnstone, Justin M. Snider, Brian Hallmark, Rahul Dutta, Cristina Moraga Franco, John S. Parks, Jeannette T. Bensen, Corey D. Broeckling, James L. Mohler, Gary J. Smith, Elizabeth T.H. Fontham, Hui Kuan Lin, William Bresette, Susan Sergeant, Floyd H. Chilton

School of Public Health Faculty Publications

Prostate cancer (PCa) is the most common male cancer and the second leading cause of cancer death in United States men. Controversy continues over the effectiveness of prostate-specific antigen (PSA) for distinguishing aggressive from indolent PCa. There is a critical need for more specific and sensitive biomarkers to detect and distinguish low-versus high-risk PCa cases. Discovery metabolomics were performed utilizing ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS) on plasma samples from 159 men with treatment naïve prostate cancer participating in the North Carolina-Louisiana PCa Project to determine if there were metabolites associated with aggressive PCa. Thirty-five identifiable plasma small molecules were …

Paroxysmal Nocturnal Hemoglobinuria: Pandora’S Box?, Mihnea Alexandru Găman, Iulia Ursuleac, Daniel Coriu

Journal of Mind and Medical Sciences

Introduction. Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired non-malignant hematological disorder which affects the pluripotent hematopoietic stem cell. The cause of PNH development is the occurrence of somatic mutations in the phosphatidylinositol glycan-A gene which encodes a protein necessary for the biosynthesis of glycosylphosphatidylinositol anchors. The diagnosis of PNH requires the presence of signs of intravascular hemolysis, thrombosis, and (or) bone marrow failure. Case Report. We report the case of a 42-year-old female, diagnosed with PNH at the age of 27, whose evolution was initially characterized predominantly by hemolytic attacks and whose disease pattern evolved towards thromboembolic episodes …

Minimizing Penile Prosthesis Implant Infection: What Can We Learn From Orthopedic Surgery?, Selin Isguven, Paul H. Chung, Priscilla Machado, Lauren J. Delaney, Antonia Chen, Flemming Forsberg, Noreen J. Hickok

Department of Radiology Faculty Papers

The implantation of penile protheses for the surgical treatment of erectile dysfunction has risen in popularity over the past several decades. Considerable advances have been made in surgical protocol and device design, specifically targeting infection prevention. Despite these efforts, device infection remains a critical problem, which causes significant physical and emotional burden to the patient. The aim of this review is to broaden the discussion of best practices by not only examining practices in urology, but additionally delving into the field of orthopedic surgery to identify techniques and approaches that may be applied to penile prothesis surgery.

Urdu Translation And Validation Of Premature Ejaculation Diagnostic Tool (Pedt), Muhibullah Bangash, Wajahat Aziz, Mohammad Shoaib, Hammad Ather

Section of Urology

Objective: To validate an Urdu translation of premature ejaculation diagnostic tool (PEDT) by analyzing the association of this diagnostic tool with the clinical diagnosis of premature ejaculation (PE) and intravaginal ejaculatory latency time (IELT).
Methods: This cross-sectional study was conducted at the urology section of the Aga Khan University Hospital, Karachi, for six months duration, from July 2018 to December 2018. In our study 108 subjects, aged 20 to 50 years, who were in a stable sexual relationship (heterosexual) for a minimum duration of six months, were asked to fill the Urdu version of PEDT, 61 with PE and 47 …

Ureteroscopic Biopsy Of Upper Tract Urothelial Carcinoma And Role Of Urinary Biomarkers, Katherine E Smentkowski, Demetrius H. Bagley, Scott G. Hubosky

Department of Urology Faculty Papers

Ureteroscopic biopsy is an integral part of diagnosis of urothelial carcinoma of the upper urinary tract. It can be a technical challenge, but diagnostic rates have improved remarkably with refinements in surgical technique and specimen processing. Cytology aids with diagnosis and other urinary biomarkers continue to evolve, which may help further stratify patients for treatment. The current literature on the ureteroscopic biopsy and role of urinary biomarkers is reviewed and summarized below.

Snail Fever Of The Bladder In A Non-Endemic Area, Romana Idress, Zehra Jamil, Muhammad Areeb Ashfaq, Daniya Umer, Romana Idress, Hammad Ather

Department of Pathology and Laboratory Medicine

Schistosomiasis is rarely seen in Pakistan and is generally not very high on the list of differential diagnoses. However, it is an important cause of haematuria in certain endemic areas. It can affect multiple organs including the bladder, liver and lungs. We present a case of a young Pakistani male, travelling to and from Africa, who presented with complains of haematuria and suprapubic discomfort. Final pathologic diagnosis was urinary schistosomiasis (hematobium species). This case is particularly notable for the characteristic sago nodules identified on cystoscopy. It is important to consider schistosomiasis in the differential of haematuria in such scenarios as …

Stress Urinary Incontinence Post-Holmium Laser Enucleation Of The Prostate: A Single-Surgeon Experience., Akhil K Das, Seth Teplitsky, Tomy Perez, Jenny Guo, Joon Yau Leong, Patrick J Shenot

Department of Urology Faculty Papers

PURPOSE: To identify incidence and predictors of stress urinary incontinence (SUI) following Holmium laser enucleation of the prostate (HoLEP).

MATERIALS AND METHODS: We performed a retrospective review of 589 HoLEP patients from 2012-2018. Patients were assessed at pre-operative and post-operative visits. Univariate and multivariate regression analyses were performed to identify predictors of SUI.

RESULTS: 52/589 patients (8.8%) developed transient SUI, while 9/589 (1.5%) developed long-term SUI. tSUI resolved for 46 patients (88.5%) within the first six weeks and in 6 patients (11.5%) between 6 weeks to 3 months. Long-term SUI patients required intervention, achieving continence at 16.4 months on average, …

Natural Disasters In The Americas, Dialysis Patients, And Implications For Emergency Planning: A Systematic Review, Rashida Smith, Mph, Robert Zucker, Rosemary Frasso, Phd, Cph

College of Population Health Faculty Papers

INTRODUCTION: Natural hazards are elements of the physical environment caused by forces extraneous to human intervention and may be harmful to human beings. Natural hazards, such as weather events, can lead to natural disasters, which are serious societal disruptions that can disrupt dialysis provision, a life-threatening event for dialysis-dependent people. The adverse outcomes associated with missed dialysis sessions are likely exacerbated in island settings, where health care resources and emergency procedures are limited. The effect of natural disasters on dialysis patients living in geographically vulnerable areas such as the Cayman Islands is largely understudied. To inform predisaster interventions, we systematically …

Simple Frameshifts In Minimally Invasive Surgery Postoperative Pain Management Significantly Reduce Opiate Prescriptions., Thenappan Chandrasekar, Lydia Glick, Daniella Wong, Timothy M. Han, Joon Yau Leong, Misung Yi, James R. Mark, Mark J. Mann, Edouard J. Trabulsi, Costas D. Lallas

Department of Urology Faculty Papers

INTRODUCTION: To evaluate the impact of an 'opt-in' non-narcotic postoperative pain regimen on narcotic utilization and patient-reported pain scores.

MATERIALS AND METHODS: A prospective, non-blinded pre- and post-interventional trial was conducted, including a lead-in period for baseline evaluation. The intervention group received a new pain protocol prioritizing non-narcotic medications, an 'opt-in' requirement for opiates, and standardized patient education. Study outcomes included opiate prescription and utilization (measured in Morphine Equivalent Doses) and reported pain scores on postoperative day (POD) 1, discharge and follow up.

RESULTS: At discharge, 70% fewer patients were prescribed any opioids (ARR: -0.7; p < 0.001); the amount prescribed was reduced by 95% (pre-intervention 69.3 mg versus post-intervention 3.5 mg, p < 0.001). Mean opioids used following discharge decreased by 76% (14.7 mg versus 3.5 mg, p = 0.011). In a subgroup analysis of robotic prostatectomies, there was a 95% reduction in mean opioids prescribed at discharge (64.6 mg versus 3.2 mg, p < 0.001) and 82% reduction in utilization over entire postoperative course (87.6 mg versus 15.7 mg, p = 0.001). There was no significant difference in pain scores between intervention groups at POD 1, discharge and follow up for patients (entire cohort and post-prostatectomy).

CONCLUSION: A standardized pain …

Twin Pregnancy Complicated By Intrauterine Death Of One Fetus And Herniated Bowel Loops Over Gravid Uterus, Malika Hameed, Khalid Ahsan

Department of Anaesthesia

No abstract provided.

Preventing Prostate Biopsy Complications: To Augment Or To Swab?, L. Glick, S. Vincent, T. M. Han, C. Caputo, D. Squadrito, J. Y. Leong, C. Fonshell, K. Syed, J. F. Danella, S. Ginzburg, T. J. Guzzo, M. Hagg, J. D. Raman, M. Smaldone, R. G. Uzzo, J. J. Tomaszewski, A. C. Reese, E. J. Trabulsi, L. G. Gomella, M. J. Mann

House Staff Quality Improvement and Patient Safety Conference (2020-)

Aims for Improvement

• The aim of this study was to determine the antibiotic prophylaxis associated with the fewest infectious complications following prostate biopsy
• Determining the safest method allows the Jefferson Department of Urology to modify its biopsy protocol and improve the rate of post-biopsy complications

Simple Frameshifts In Mis Postoperative Pain Management Significantly Reduce Opiate Prescriptions, L. Glick, D. Wong, T. M. Han, J. Y. Leong, A. Uhr, J. R. Mark, M. J. Mann, E. J. Trabulsi, C. D. Lallas, T. Chandrasekar

House Staff Quality Improvement and Patient Safety Conference (2020-)

Aims for Improvement

• The intervention aimed to reduce narcotics provided to patients after MIS by reducing number of narcotic prescriptions and amount prescribed by 25% without affecting patientreported pain scores
• Usage measured in Morphine Equivalent Doses (MED)
• MED and pain score assessed at 3 time points: post-op day 1 (POD1), discharge (D/C) and follow-up (FU) apt
• Pre- and Post-intervention cohorts - Month 1 (Pre-intervention): 21 patients and Month 2 (Post-intervention): 30 patients

Non-Obstetrical Robotic-Assisted Laparoscopic Surgery In Pregnancy: A Systematic Literature Review., Courtney Capella, Joseph Godovchik, Thenappan Chandrasekar, Huda B. Al-Kouatly

Department of Urology Faculty Papers

Urologic and gynecologic surgeons are the top utilizers of robotic surgery; however, non-obstetrical robotic-assisted laparoscopic surgery (RALS) in pregnant patients is infrequent. A systematic literature review was performed to ascertain the frequency, indication and complications of RALS in pregnancy. Results showed thirty-eight pregnancies from eleven publications between 2008-2020. Five cases were for urologic indication and thirty-three for gynecologic indication. Minimal surgical alterations were required. Although no adverse maternal-fetal outcomes were reported, there are not enough cases published to determine safety. This review demonstrates the feasibility of RALS for the pregnant population in the hands of competent robotic surgeons.

Robotic Adrenalectomy For Functional Adenoma In Second Trimester Treats Worsening Hypertension., Courtney E. Capella, Thenappan Chandrasekar, May Jean Counsilman, Christopher Sebastiano, Costas D. Lallas, Huda B. Al-Kouatly

Department of Urology Faculty Papers

A 33-year-old G6P3023 was found to have a 4.2 cm right adrenal incidentaloma during an admission for right pyelonephritis. Computed tomography (CT) was performed to rule out perinephric abscess in the setting of worsening leukocytosis while on antibiotics ( Fig. 1). Initial differential diagnosis from endocrinology included pheochromocytoma and primary aldosteronism. Due to the lack of typical physical exam stigmata, Cushing syndrome was initially of low concern. Of note, her past medical history included hypertension treated with amlodipine 10 mg and hydrochlorothiazide 12.5 mg. During admission, extensive endocrine laboratory workup demonstrated an elevated aldosterone:plasma renin activity, suppressed dehydroepiandrosterone (DHEA), normal …

Underactive Bladder - An Underestimated Entity, Spinu Arsenie Dan, Ovidiu Gabriel Bratu, Dragos Radu Marcu, Adina Elena Stanciu, Florentina Gherghiceanu, Florentina Ionita-Radu, Simona Bungau, Ana Maria Alexandra Stanescu, Dan Mischianu

Journal of Mind and Medical Sciences

Introduction. The concept of underactive bladder is relatively new. Currently there is no generally accepted definition of this pathology. Diagnosis depends on urodynamic findings, and symptoms are usually rare and intricated with the symptoms of other urinary pathology.

Matherials and methods. This review examines the current literature on underactive bladder regarding pathology, definition, diagnosis, current guidelines, and any further potential medical developments.

Conclusions. Underactive bladder is a poorly understood pathologic condition. Only since 2002 has there been any consensus regarding the definition. The diagnosis relies only on urodynamics; clinical diagnosis is a challenge even for a consultant; and treatment does …

Anorexia Nervosa And Reproduction: Connecting Brain To Gonads, Mihaela Poterasu, David L. Rowland, Corina Ciobanu, Simona Fica

Journal of Mind and Medical Sciences

Anorexia nervosa (AN) is a psychiatric disorder that predominantly affects young women and is characterized by low caloric intake and a major dissatisfaction with one’s body image. It is often overlooked and, while patients and family seek medical help, emaciation and nutritional misbalances may become extreme and potentially life threatening. Among the many somatic complications, an accumulation of early endocrine adaptations occurs, leading to functional amenorrhea and impaired reproduction as a result of dysfunction of the hypothalamic-pituitary-ovarian axis. Even though these conditions are reversible, long-term consequences may affect the fertility of women with AN and can lead to maternal and …

Does Race Impact Functional Outcomes In Patients Undergoing Robotic Partial Nephrectomy?, Ugo G Falagario, Alberto Martini, John Pfail, Patrick-Julien Treacy, Kennedy E Okhawere, Bheesham D Dayal, John P Sfakianos, Ronney Abaza, Daniel D Eun, Akshay Bhandari, James R Porter, Ashok K Hemal, Ketan K Badani

Articles, Abstracts, and Reports

Background: The role of race on functional outcomes after robotic partial nephrectomy (RPN) is still a matter of debate. We aimed to evaluate the clinical and pathologic characteristics of African American (AA) and Caucasian patients who underwent RPN and analyzed the association between race and functional outcomes.

Methods: Data was obtained from a multi-institutional database of patients who underwent RPN in 6 institutions in the USA. We identified 999 patients with complete clinical data. Sixty-three patients (6.3%) were AA, and each patient was matched (1:3) to Caucasian patients by age at surgery, gender, Charlson Comorbidity Index (CCI) and renal score. …

Male Luts – Introduction And Overview, Thenappan Chandrasekar, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Outline & Goals

• Background – What are “LUTS”?

• Anatomy

• Pathophysiology

• Storage – bladder filling symptoms
• Voiding – urine flow symptoms
• Post-micturition

• Major etiologies and management

• BPH / BOO
• OAB
• Nocturia

• Related to Prostate Cancer?

The Impact Of Post Pcnl Tube Type On Blood Loss And Postoperative Pain, Salman Jamil, Hammad Ather

Section of Urology

Objective: To evaluate the impact of nephrostomy tube type on postoperative pain and blood loss following percutaneous nephrolithotomy (PCNL).
Methods: This is a prospective non-randomized study performed at Aga Khan University Hospital from July 2017 to June 2018. In this study we prospectively studied adult patients (16 to 65 years) who underwent unilateral PCNL. Patients who had nephrostomy with balloon (12Fr Foley's catheter) were compared with patients who had nephrostomy without balloon (12Fr Nelaton™ catheter). STONE Nephrolithometry score was used to assess the stone complexity. Mean pain score at six and 24 hours and mean hemoglobin drop at 24 hours …

Nephron Sparing Surgery For Renal Tumors-Comparison Of Off-Clamp Partial Nephrectomy With Hilar Clamping, Imran K. Jalbani, Syed Muhammad Nazim, Maria Ahmed, Farhat Abbas

Section of Urology

Background and objective: Open partial nephrectomy (PN) is still considered gold standard procedure for T1 localized renal tumors. Conventional technique involves clamping of the renal artery with or without vein however, renal ischemia produces a certain level of damage to the kidneys. This study aims to investigate potential effect of off-clamp vs. hilar clamping PN on renal function.
Methods: This is a retrospective cohort study of patients who underwent unilateral, open partial nephrectomy for renal tumors b/w January 2009 December 2016 at our institution. A total of 90 partial nephrectomies were performed of which 65 cases were eligible for analysis. …

Setting The Standards: Examining Research Productivity Among Academic Urologists In The Usa And Canada In 2019., Thenappan Chandrasekar, Timothy M. Han, Lydia Glick, Joon Yau Leong, Seth Teplitsky, Rodrigo Noorani, Hanan Goldberg, Zachary Klaassen, Christopher J.D. Wallis, James R. Mark, Edouard J. Trabulsi, Costas D. Lallas, Leonard G. Gomella

Department of Urology Faculty Papers

BACKGROUND: Research productivity among academic urologists is strongly encouraged, but little data are available on productivity metrics within the field.

OBJECTIVE: To provide the first comprehensive survey of research productivity among academic urologists in the USA and Canada.

DESIGN, SETTING, AND PARTICIPANTS: Using the Accreditation Council for Graduate Medical Education, the Canadian Resident Matching Service, and individual program websites, all active accredited urology faculties were identified. For each individual, we collected data on American Urological Association section, title, gender, fellowship training, Scopus H-index, and citations. Comprehensive searches were completed during March-May 2019.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Descriptive statistics for …

Robotic Adrenalectomy For Functional Adenoma In Second Trimester Treats Worsening Hypertension, Courtney Capella, Bs, Joseph Godovchik, Bs, May Jean Counsilman, Md, Thenappan Chandrasekar, Md, Costas D. Lallas, Md, Huda B. Al-Kouatly, Md

Department of Obstetrics and Gynecology Posters

Robotic adrenalectomy is a feasible surgical alternative in the second trimester and can reverse the hypertensive disease and its associated maternal-fetal complications