Medicine and Health Sciences Commons^™

Breakthroughs In Hormonal Male Contraception, Alexander Patton, Seth Vann

Physician Assistant Capstones, 2020-current

Objective: Assess the efficacy of a nestorone plus testosterone gel at suppressing progestin levels and spermatogenesis.

Design: Systematic literature review.

Methods: Searches were done in PubMed and Dartmouth library using the terms nestorone, randomized control trial, human, and male. Limits used while searching included published in the last 10 years, randomized control trials, and English.

Results: Using the search criteria the following three studies were found that met the inclusion/exclusion criteria of this study: Ilani et al, Zitzmann et al, and Anawalt et al. All three studies were found on PubMed and reference the Ilani et al study.

Conclusion: Nestorone …

Strocss 2021: Strengthening The Reporting Of Cohort, Cross-Sectional And Case-Control Studies In Surgery, Ginimol Mathew, Riaz Agha, Strocss Group, Joerg Albrecht, Prabudh Goel, Indraneil Mukherjee, Prathamesh Pai, Anil K. D'Cruz, Ather Enam, Hammad Ather

Section of Neurosurgery

Introduction: Strengthening The Reporting Of Cohort Studies in Surgery (STROCSS) guidelines were developed in 2017 in order to improve the reporting quality of observational studies in surgery and updated in 2019. In order to maintain relevance and continue upholding good reporting quality among observational studies in surgery, we aimed to update STROCSS 2019 guidelines.
Methods: A STROCSS 2021 steering group was formed to come up with proposals to update STROCSS 2019 guidelines. An expert panel of researchers assessed these proposals and judged whether they should become part of STROCSS 2021 guidelines or not, through a Delphi consensus exercise.
Results: 42 …

Laparoscopic Assisted Robotic Radical Prostatectomy With Pelvic Lymph Node Dissection Using Viable Cryopreserved Umbilical Tissue To Improve Cavernosal Nerve Function., Joshua Volin, Brett Watson, Lior Kopel, Samantha Kraemer, Jason Hafron

Conference Presentation Abstracts

Radical prostatectomy is the preferred treatment for patients with clinically localized prostate cancer and is typically performed using a robotic approach. Surgical techniques that preserve the neurovascular bundle minimize the risk of incontinence and erectile dysfunction post-operatively. Umbilical cord tissue is a relatively new technique, which has been shown to reduce inflammation and promote regenerative healing. In this video we show a robotic radical prostatectomy with bilateral nerve sparing technique utilizing a cryopreserved umbilical cord allograft nerve wrap.

Post Traumatic Internal Iliac Arteriovenous Fistula Presenting With Persistent Gross Hematuria., Amanda Smart, Michael Wynne, Daniel Stein

Urology Faculty Publications

No abstract provided.

Frequency Of Lower Ureteric Stones And Their Treatment By Tamsulosin, Aden, Ali Ahmed Salem Hatroom

Hadhramout University Journal of Natural & Applied Sciences

The aim of the study is to find out the frequency of lower ureteric stones related to sex, age, and the outcome of using tamsulosin in their treatment This was a retrospective study of all patients who suffer from lower ureteral stone and seen in our Private Urology Clinic from January 2014 to December 2017 in Aden. The total patients were 160. They were 98 (61.3%) males and 62 (38.7%) females) with ratio male to female 1.6 :1. The mean age of patients is (35.2 ± 11.2) years, range (15 to 56) years. The most involved side is left ureter …

Anal Human Papillomavirus Infection Among Men Who Have Sex With Men And Transgender Women Living With And Without Hiv In Pakistan: Findings From A Cross-Sectional Study, Muslima Ejaz, Soren Andersson, Salma Batool, Tazeen Saeed Ali, Anna Mia Ekström

Community Health Sciences

Objectives: The aim of this study was to determine the prevalence of infection, genotypes and risk factors for human papillomavirus (HPV) among men who have sex with men (MSM) and transgender women living with and without HIV in Pakistan. Anal infection with HPV is very common worldwide among MSM, particularly among MSM living with HIV. The high prevalence of HIV among MSM and male-to-female transgendered individuals in Pakistan is a significant health concern since access to screening and health-seeking is often delayed in this stigmatised key population.
Design: This cross-sectional study was conducted between March 2016 and November 2017.
Participants, …

Dysfunctional Voiding: Does A Validated Urine Color Scale Correlate With Dysfunctional Voiding Severity Score?, Katharina Mitchell, Chad Crigger, Tyler Overholt, Tyler Trump, John Barnard, Osama Al-Omar, Hilary Morley

Marshall Journal of Medicine

Introduction

Dysfunctional voiding (DV), defined as abnormal coordination between the urinary sphincter and the detrusor muscle in a neurologically intact individual, affects approximately 40% of patients that populate pediatric urology clinics. Improper hydration affects the specific gravity and concentration of urinary irritants, resulting in symptoms similar to those seen in DV patients.

Methods

Herein, we administered a validated DV survey (the Dysfunctional Voiding Symptom Score [DVSS]) and a validated dehydration severity chart (the Urine Color Chart [UCC]) to toilet trained pediatric patients and compared DV patients to patients presenting with non-urologic concerns. Data was analyzed on an item-for-item basis and …

Androgen Receptor Signaling In Prostate Cancer And Therapeutic Strategies, Aasems Jacob, Rishi Raj, Derek B. Allison, Zin W. Myint

Markey Cancer Center Faculty Publications

Understanding of the molecular mechanisms of prostate cancer has led to development of therapeutic strategies targeting androgen receptor (AR). These androgen-receptor signaling inhibitors (ARSI) include androgen synthesis inhibitor-abiraterone and androgen receptor antagonists-enzalutamide, apalutamide, and darolutamide. Although these medications provide significant improvement in survival among men with prostate cancer, drug resistance develops in nearly all patients with time. This could be through androgen-dependent or androgen-independent mechanisms. Even weaker signals and non-canonical steroid ligands can activate AR in the presence of truncated AR-splice variants, AR overexpression, or activating mutations in AR. AR splice variant, AR-V7 is the most studied among these and …

Parenteral Corticosteroids After Fragility Fracture Increases The Odds Of A Repeat Fracture, Justin David, Marc R. Zucker, Timothy F. Carroll, Ross E. Straughan, Mishra Jaya, Jessie R. Gills, M Westerman

Medical Student Research Poster Symposium

Osteoporosis is a skeletal disorder characterized by porous and low-density bones. Patients with osteoporosis have an increased risk of fragility fractures and subsequent repeat fractures. Due to the high morbidity and mortality associated with fractures, medications that cause high risk of falls and decreased bone density should be used with caution to prevent repeat fractures. Some studies have shown that there is no change in fracture-associated medication use before and after a fracture. This study aims to explore the trends of systemic corticosteroid use, which causes a known physiologic decrease in bone density, before and after primary fracture and their …

Multipara With Utero-Vesical Fistula Following Repeat Cesarean Section: A Rare Iatrogenic Complication, Gulnaz Shafqat, Anam Khan, Salma Azam, Rehana Murad

Department of Radiology

Utero-Vesical fistulas are the rarest of all urogenital fistulas, with most cases occurring after cesarean section. Its prevalence is increasing worldwide because of the increasing indications of cesarean section. Patient usually presents with urine leak, amenorrhea and cyclic hematuria. Herein, we present a case of patient presenting with complain of severe urinary tract infection following cesarean section. Review and update of recent literature regarding the diagnostic imaging of this entity are described.

Periaortic Venous Necklace And Renal Right Double Arteries; Case Report, Petru Bordei, Constantin Andrei Rusali, Constantin Ionescu, Dragos Serban, Valeriu Ardeleanu

Journal of Mind and Medical Sciences

The case was found on an organic sample consisting of the two kidneys with the renal pedicles and the corresponding segments of the abdominal aorta and inferior vena cava. From the inferior face of the left renal vein, on the lower side of the aorta, a venous branch with an upward path of 8.02 mm was detached, passing on the anterior face of the aorta, passing before its right side, in order to end on the left side of the inferior vena cava, 13.9 mm above the end of the left renal vein in the inferior vena cava, this branch …

Cystoscopy Scenarios You Should Recognize, Jason P. Gilleran

Conference Presentation Abstracts

No abstract provided.

A Case Of Penile Fracture With Bilateral Corporal Injury And Complete Urethral Disruption, Brett Watson, Samantha Kraemer, Bradley Rosenberg

Conference Presentation Abstracts

Introduction: Penile fracture with bilateral corporal rupture and complete urethral disruption is an uncommon injury, with approximately 60 cases reported in the literature. Case: A 54-year-old man presented with penile pain, ecchymosis, and detumescence, as well as urethral bleeding after blunt trauma sustained during vaginal intercourse. Clinical diagnosis of penile fracture was made and he was taken to the operating room for penile exploration. Complete transection of the urethra and bilateral disruptions of the corpora cavernosa were identified in the proximal penile shaft. The corpora were repaired with 3-0 vicryl. Primary urethroplasty was then performed using 4-0 PDS. Foley catheter …

Robotic Radical Prostatectomy Using Umbilical Tissue To Improve Cavernosal Nerve Function, Joshua Volin, Brett Watson, Lior Kopel, Samantha Kraemer, Jason M. Hafron

Conference Presentation Abstracts

No abstract provided.

Reimbursement Incentive Associated With Decreased Inpatient Opioid Prescribing Following Robotic Radical Prostatectomy, Brett Watson, Ross Touriel, Joshua Volin, Frank Burks

Conference Presentation Abstracts

Introduction: Various strategies have been explored to decrease the quantity of opioids prescribed for post-operative pain. The Michigan Opioid Prescribing Engagement Network, in partnership with BCBS-Michigan, has developed a pain optimization pathway for several surgical procedures, including prostatectomy. Urologists who follow the pain optimization pathway, which includes pre-operative patient education and limiting discharge opioids to 6 tablets of oxycodone 5 mg, can report a modifier for additional reimbursement. We explored the impact of this incentive on inpatient opioid prescribing practices following robotic assisted radical prostatectomy (RARP). Methods: Patients undergoing RARP between January 2017 and August 2019 at a single institution …

Acute Segmental Testicular Infarction Resulting From Illicit Anabolic Steroid Use, Jacob Stephens, Frank Burks

Conference Presentation Abstracts

Introduction: Segmental testicular infarction (STI) is a rare cause of acute scrotum of unknown etiology. The diagnosis is often made by color Doppler ultrasonography (CDUS) demonstrating absent perfusion in a well-defined testicular region. Previously patients underwent surgical exploration, but currently conservative therapy is recommended. Methods: We report a case of STI related to anabolic steroid use. Results: A 44-year-old male with a history of hypertension presented to the emergency room with acute, severe right testicular pain which was unprovoked and constant. Physical exam was notable only for tenderness at the inferior right testicle. CDUS showed small bilateral hydroceles but preserved …

Concordance Between Antibiotic Resistance Genes By Multiplex Polymerase Chain Reaction And Antibiotic Susceptibility By Pooled Antibiotic Sensitivity Testing In Symptomatic Patients With Urinary Tract Infection, Annah Vollstedt, Dakun Wang, Natalie Luke, David Baunoch, Kirk J. Wojno, Howard Korman, Natalie Gaines, Shuguang Huang, S Mohammad Jafri, David Wenzler, Patrick Cacdac, Frank Burks, Larry Sirls

Conference Presentation Abstracts

Introduction: Studies have shown many genes influence antibiotic resistance, and the relationship between genotypic and phenotypic antibiotic resistance is unclear. We sought to analyze the concordance between the presence of antibiotic resistance (ABR) genes and antibiotic susceptibility results. Methods: Urine samples were collected from patients presenting with possible UTI to 37 Urology clinics from July 2018 to February 2019. Multiplex polymerase chain reaction (M-PCR) was used to test for 33 ABR genes. Pooled Antibiotic Susceptibility Testing (P-AST) was performed against 14 different antibiotics. The concordance rate between the ABR genes and P-AST results was generated. The concordance rates for each …

Fractional Carbon Dioxide Vaginal Laser For The Treatment Of Urinary Symptoms: Preliminary Short-Term Results, Annah Vollstedt, Lauren Tennyson, Michael Rezaee, Ly Hoang Roberts, Larry Sirls, Priya Padmanabhan, Kenneth M. Peters

Conference Presentation Abstracts

Introduction: It has been proposed that fractional carbon dioxide (fCO2) vaginal laser can also treat stress urinary incontinence (SUI) by increasing collagen production. The aim of our study was to evaluate the effect of vaginal fCO2 laser therapy in patients complaining of SUI. Methods: This is a prospective, open-label study of women over 18 years old with complaints of urogenital symptoms. Women with a history of vaginal estrogen use within the last 3 months were excluded. Participants received 3 laser treatments 6 weeks apart. Cough stress test (CST) was performed at each visit. Incontinence-Quality of Life (I-QOL), Questionnaire for Urinary …

Metastatic Crohn's Disease: A Case Of Genital Cutaneous Crohn's Disease Involving The Penis And Scrotum, Zubin Shetty, Megen Schober

Conference Presentation Abstracts

Introduction: Crohn’s disease is an autoimmune inflammatory disorder affecting the gastrointestinal tract. Rarely, Crohn’s disease can cause cutaneous manifestations that are non-contiguous with the GI tract or “metastatic.” Genital Cutaneous Crohn’s Disease (CCD) is the most frequent presentation of CCD in the pediatric population and has shown to be difficult to manage. Case: A 13-year-old boy with a history of fistulizing Crohn’s disease presented with severe penile and scrotal edema for the previous 4 years. While his gastrointestinal symptoms were responsive to Adalimumab, his genital swelling only minimally and temporarily improved between treatments. He was referred to pediatric urology for …

Stimwave For Pudendal Neuralgia, Ly Hoang Roberts, Joshua Volin, Teresa Mccartney, Annah Vollstedt, Kenneth M. Peters

Conference Presentation Abstracts

Introduction: In patients with pudendal neuralgia refractory to traditional therapies, prior studies have shown efficacy in chronic stimulation with Interstim® (Medtronic, Inc., Minneapolis, MN). This study reports on a wireless system to power an implanted lead at the pudendal nerve, StimWave®, to treat pudendal neuralgia. Methods: Retrospective chart review identified patients with a lead placed at the pudendal nerve for neuralgia and powered wirelessly. Clinical outcomes were assessed at postoperative visits and phone calls. Administered non-validated follow-up questionnaire evaluated the GRA, percentage of pain improvement, satisfaction with device, and initial and current settings of the device (hours/day of stimulation). Results: …

Patient Reported Outcomes Of Urinary Incontinence Rates Using Viable Cryopreserved Umbilical Tissue Over Neurovascular Bundles During Robotic Assisted Radical Prostatectomy, Samantha Kraemer, Mit Shah, Chirag Dave, Ji Qi, Fionna Sun, Sugandh Shetty, Brian Seifman, Jason Hafron

Conference Presentation Abstracts

Introduction: Incontinence remains a side effect from robotic assisted radical prostatectomy (RAP) for prostate cancer despite nerve sparing (NS) techniques. Use of growth factors and anti-inflammatory substances over neurovascular bundles is an emerging technique to enhance recovery of continence and potency. Viable cryopreserved umbilical tissue (vCUT) is FDA approved for homologous use in surgery. The objective is to determine if vCUT use in NS-RAP accelerates return to continence. Methods: Retrospective review of 176 patients who underwent NS-RAPs from October 2015 through July 2020 were identified through the Michigan Urological Surgery Improvement Collaborative (MUSIC). Return to social urinary continence (0-1 pads …

A Unique Case Of Renal Pelvic Urothelial Carcinoma With Extensive Small Round Cell Sarcoma Differentiation Showing Swsr1 Gene Rearrangement, Zubin Shetty, Mitual Amin, Savitha Balaraman, Sugandh Shetty

Conference Presentation Abstracts

Introduction: Ewings-like sarcoma is a rare subgroup of small round cell sarcoma with immunohistochemistry and morphological similarities to Ewing Sarcoma. We report a rare case of renal pelvis invasive urothelial carcinoma with small round cell sarcoma differentiation showing EWSR1 gene rearrangement. Case: An 84-year-old male presented with 6 months of intermittent painless gross hematuria. Workup revealed a 5.4cm left renal pelvicalyceal mass suspicious for transitional cell carcinoma and a 2.5cm enhancing left renal cortical lesion. The patient underwent an uncomplicated robotic left nephroureterectomy. Pathology revealed small round cell sarcoma composing greater than 80% of the renal pelvis tumor with the …

A Comparative Analysis Of Pelvic Fracture Urethral Injury Repairs In U.S. And Third World Country Patients, Jacob Stephens, Daniel Rosenstein, Frank Burks

Conference Presentation Abstracts

Introduction: Pelvic fracture urethral injury (PFUI) often results from significant, high energy trauma such as motor vehicle accidents or crush injuries. PFUI doesn’t spare those in third-world countries who may not have access to reliable healthcare. We aim to compare outcomes of PFUI repair in the US and third-world countries. Methods: A retrospective chart review and comparative analysis were performed on patients who had a PFUI repair during international trips to Haiti and Rwanda and a cohort of US patients from 2014-2020. FNB performed all US repairs while FB and DR collaborated internationally with local urologists. Results: A total of …

A Novel Approach To Short Bulbar Urethral Strictures: Ventral Urethrotomy For A Non-Transection Excision And Primary Anastomosis, Alexander Geisenhoff, Samantha Kraemer, Frank Burks

Conference Presentation Abstracts

Introduction: Excision and primary anastomosis (EPA) has been the gold standard procedure for definitively managing short bulbar urethral strictures. A non-transecting approach was developed to help preserve proximal blood supply of the urethra. The previously described technique involves a dorsal urethrotomy and excision of the stricture without disrupting the anterior spongiosum. We describe a novel approach by performing a ventral urethrotomy leaving the posterior spongiosum intact. By not requiring urethral rotation, we believe this technique is simpler and does not compromise outcomes. Methods: Retrospective chart review was performed on 8 consecutive patients from April 2019 to February 2021 who underwent …

The Altis Mid-Urethral Sling: One Surgeon's Experience With Immediate Post-Operative Adjustment, Jennifer Nguyen, Brett Friedman, Annah Vollstedt, Mireya Diaz, Ly Hoang Roberts, Larry Sirls

Conference Presentation Abstracts

Introduction: The Altis® transobturator sling uses a dynamic anchor on a pulley suture for intraoperative tension adjustment. Given the potential for over-tensioning seen with any sling, we have adopted a technique using the pulley suture that allows for sling tightening should stress urinary incontinence (SUI) persist in the immediate post-operative period or sling loosening if there is bladder outlet obstruction. Our objective is to describe our technique and rate of post-operative adjustment. Methods: In this single-surgeon experience, retrospective chart review, demographic and clinical data were collected on patients who had received the Altis® sling between 2014 and 2020. Descriptive statistics …

Multi-Institutional Outcomes Of A One-Sided Dorsal Onlay Buccal Mucosal Urethroplasty For Penile Urethral Strictures Accessed Via A Penoscrotal Incision, David Abramowitz, Felicia Balzano, Jay Simhan, Frank Burks, Dmitriy Nikolavsky, Stephen Blakely

Conference Presentation Abstracts

Introduction: Optimal surgical management of penile urethral strictures remains unclear. Herein, we report our multi-institutional series of patients undergoing a one-sided dorsal onlay buccal mucosal urethropalsty for penile urethral strictures accessed via a penoscrotal invagination technique. Methods: We retrospectively reviewed consecutively treated penile urethral stricture patients who underwent a one-sided dorsal onlay buccal mucosal urethroplasty accessed via a penoscrotal incision and penile invagination across 7 institutions. This technique is a modification of the Kulkarni invagination technique to include penoscrotal rather than perineal incision for penile strictures. Thus, allowing for supine positioning, and less dissection to reach the stricture location. Minimum …

A Rare Case Of Pure N4-Acetyl-Sulfaethoxazole Nephrolithiasis Associated With Trimethoprim-Sulfamethoxazole Treatment Of Pulmonary Nocardiosis, Alexander Geisenhoff, Sugandh Shetty

Conference Presentation Abstracts

Introduction: Trimethoprim-sulfamethoxazole is a commonly used antibiotic for treatment of urinary tract infections (UTIs). It is also commonly used to treat nocardia infections. Less common are reports of nephrolithiasis consisting purely of N4-acetyl-sulfamethoxazole, the primary metabolite of trimethoprim-sulfamethoxazole. Case: A 70-year-old male with history of mantle cell lymphoma and T-cell leukemia treated with bone marrow transplant now with nocardia lung infection receiving trimethoprimsulfamethoxazole for the past 6 months who presented to the emergency room with confusion and a fall. He had no prior history of nephrolithiasis, but during hospitalization developed renal colic and was found to have obstructing right proximal …

A Case Report Of Metastatic Castration-Resistant Prostate Cancer Harboring A Pten Loss, Zin W. Myint, Derek B. Allison, Carleton S. Ellis

Internal Medicine Faculty Publications

The treatment landscape of metastatic castration-resistant prostate cancer (mCRPC) has dramatically improved over the last decade; however, patients with visceral metastases are still faced with poor outcomes. Phosphatase and tensin homolog (PTEN) loss is observed in 40%–60% of mCRPC patients and is also associated with a poor prognosis. Several PI3K/AKT/mTOR pathway inhibitors have been studied, with disappointing anti-tumor activity. Here, we present a case of a patient with heavily treated mCRPC who had a modest tumor response to concurrent carboplatin, abiraterone acetate/prednisone, and liver-directed radiation therapy. We discuss the potential rationale supporting the use of this combination therapy …

Gaps In Public Awareness About Brca And Genetic Testing In Prostate Cancer: Social Media Landscape Analysis, Stacy Loeb, Philip Massey, Amy Leader, Sameer Thakker, Emily Falge, Sabina Taneja, Nataliya Byrne, Meredith Rose, Matthew Joy, Dawn Walter, Matthew S Katz, Risa L Wong, Preethi Selvan, Scott W Keith, Veda N. Giri

Department of Medical Oncology Faculty Papers

BACKGROUND: Genetic testing, particularly for BRCA1/2, is increasingly important in prostate cancer (PCa) care, with impact on PCa management and hereditary cancer risk. However, the extent of public awareness and online discourse on social media is unknown, and presents opportunities to identify gaps and enhance population awareness and uptake of advances in PCa precision medicine.

OBJECTIVE: The objective of this study was to characterize activity and engagement across multiple social media platforms (Twitter, Facebook, and YouTube) regarding BRCA and genetic testing for PCa compared with breast cancer, which has a long history of public awareness, advocacy, and prominent social media …

Gaps In Public Awareness About Brca And Genetic Testing In Prostate Cancer: Social Media Landscape Analysis., Stacy Loeb, Philip Massey, Amy E. Leader, Sameer Thakker, Emily Falge, Sabina Taneja, Nataliya Byrne, Meredith Rose, Matthew Joy, Dawn Walter, Matthew S. Katz, Risa L. Wong, Preethi Selvan, Scott W. Keith, Veda N. Giri

Department of Medical Oncology Faculty Papers

BACKGROUND: Genetic testing, particularly for BRCA1/2, is increasingly important in prostate cancer (PCa) care, with impact on PCa management and hereditary cancer risk. However, the extent of public awareness and online discourse on social media is unknown, and presents opportunities to identify gaps and enhance population awareness and uptake of advances in PCa precision medicine.

OBJECTIVE: The objective of this study was to characterize activity and engagement across multiple social media platforms (Twitter, Facebook, and YouTube) regarding BRCA and genetic testing for PCa compared with breast cancer, which has a long history of public awareness, advocacy, and prominent social media …