Medicine and Health Sciences Commons^™

Klrf1, A Novel Marker Of Cd56bright Nk Cells, Predicts Improved Survival For Patients With Locally Advanced Bladder Cancer, Neelam Mukherjee, Niannian Ji, Xi Tan, Chun-Liang Chen, Onika D. V. Noel, Maria Rodriguez-Padron, Chun-Lin Lin, David G. Alonzo, Tim H. Huang, Robert S. Svatek

School of Medicine Publications and Presentations

Background

Bladder tumor-infiltrating CD56bright NK cells are more tumor cytotoxic than their CD56dim counterparts. Identification of NK cell subsets is labor-intensive and has limited utility in the clinical setting. Here, we sought to identify a surrogate marker of bladder CD56bright NK cells and to test its prognostic significance.

Methods

CD56bright and CD56dim NK cells were characterized with the multiparametric flow (n = 20) and mass cytometry (n = 21) in human bladder tumors. Transcriptome data from bladder tumors (n = 351) profiled by The Cancer Genome Atlas (TCGA) were analyzed. The expression levels of individual markers in intratumoral …

Patient Factors Impacting Perioperative Outcomes For T1b-T2 Localized Renal Cell Carcinoma May Guide Decision For Partial Versus Radical Nephrectomy, Yash B Shah, Rishabh K Simhal, Kerith Wang, Hanan Goldberg, Costas D. Lallas, Thenappan Chandrasekar

Department of Urology Faculty Papers

There remains debate surrounding partial (PN) versus radical nephrectomy (RN) for T1b-T2 renal cell carcinoma (RCC). PN offers nephron-sparing benefits but involves increased perioperative complications. RN putatively maximizes oncologic benefit with complex tumors. We analyzed newly available nephrectomy-specific NSQIP data to elucidate predictors of perioperative outcomes in localized T1b-T2 RCC. We identified 2094 patients undergoing nephrectomy between 2019-2020. Captured variables include surgical procedure and approach, staging, comorbidities, prophylaxis, peri-operative complications, reoperations, and readmissions. 816 patients received PN while 1278 received RN. Reoperation rates were comparable; however, PN patients more commonly experienced 30-day readmissions (7.0% vs. 4.7%, p = 0.026), bleeds …

Expansion Of The Detrusor Muscular Ring Surrounding The Bladder Neck On Mri: Moving Beyond The Prostate As An Etiology Of Lower Urinary Tract Symptoms Due To Benign Prostatic Hyperplasia, Kiran Nandalur, David Walker, Hong Ye, Sayf A. Al-Katib, Brian Seifman, David Gangwish, Abhay Dhaliwal, Connor Ervin, Kayla Dobies, Channing Sesoko, Sirisha Nandalur, Bernadette Zwaans, Jennifer Nguyen, Jason Hafron

Conference Presentation Abstracts

Purpose: The etiology of lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH) remains uncertain. The purpose of our study was to quantitatively analyze pelvic anatomic characteristics on magnetic resonance imaging (MRI) to assess for independent factors for symptoms.
*Methods and Materials: This retrospective single-institution study evaluated treatment-naïve men who underwent prostate MRI within 3 months of International Prostate Symptom Score (IPSS) from June 2021 to February 2022. Factors measured on MRI included: detrusor muscular ring surrounding the bladder neck measured as area and alternatively diameter, central gland (CG) mean apparent diffusion coefficient (ADC), levator hiatus (LH) volume, intrapelvic …

Screening For Social Determinants Of Health To Improve Care In Pediatric Patients With Recurrent Urinary Tract Infections: A Scoping Review, Emily Gray Msn, Fnp-C, Michelle Rickard Dnp, Cpnp-Ac

Doctor of Nursing Practice Projects

Purpose: To describe what is known about how SDoH screening impacts adherence to treatment in pediatric patients with recurrent UTIs.

Prostate Imaging Reporting And Data System Score (Pi-Rads) And Glutathione S-Transferase P1 Methylation Status (Gst-P1) In The Diagnosis Of Prostate Cancer Patients With Borderline Psa Values, Marius Stan, Vladimir Botnarciuc, Andra Iulia Suceveanu, Andreea Cristina Costea, Adrian Paul Suceveanu, Laura Mazilu, Ciprian Iorga, Tony Hangan, Corneliu Tudor, Dragos Epistatu, Sergiu Chirila, Viorel Gherghina, Felix Voinea

Journal of Mind and Medical Sciences

Objectives. The objective of this study was to evaluate the potential use of Prostate Imaging – Reporting and Data System version 2 (PI-RADS) in combination with Glutathione S-transferase P1 (GST-P1) expression for an improved diagnosis of prostate cancer, in patients with inconclusive values of prostate-specific antigen (PSA). Materials and Methods. The study was conducted on 80 patients for whom PSA values were evaluated and were found to be inconclusive (4-10 ng/ml). These patients underwent imagistic evaluation (PI-RADS), followed by transurethral prostate biopsy, with the evaluation of GST-P1 expression and histopathological examination (for diagnosis confirmation). Results. By combining the results of …

Presentation And Predictors Of Metastatic Testicular Cancer: A Contemporary Population-Based Analysis, Yash Shah, Hanan Goldberg, Thenappan Chandrasekar

Student Papers, Posters & Projects

Introduction

• Testicular cancer (TC) is the most common solid malignancy in males aged 14-44, with incidence rising globally, although there are few established risk factors besides cryptorchidism.
• While 70% of men present with localized TC, 18% have regional spread and 12% have metastases. Moreover, one-third of patients diagnosed with Stage I TC actually have occult metastases.

Small Bowel, Appendix, And Conduit Fistula Formation After Ileal Conduit Urinary Diversion., Shivangi Bhatt, Gina Rooker, Kyle Schuyler

Tower Health Research Day

No abstract provided.

Genitourinary And Sexual Symptoms And Treatments In Transfeminine Individuals: A Qualitative Exploration Of Patients' Needs, Paul Chung, Vishal Swaminathan, Sabina Spigner, Joon Yau Leong, Jessica Bulafka, Rosemary Frasso

Department of Urology Faculty Papers

Introduction: Medical providers may not be familiar with the genitourinary and sexual symptoms of transgender and non-binary (TGNB) individuals. This lack of familiarity may hinder a provider's ability to address these issues as patients may hesitate to report symptoms due to fear of stigma, misgendering, and being treated disrespectfully.

Aim: To describe the array of genitourinary and sexual symptoms in transfeminine individuals.

Methods: Upon institutional review board approval, researchers used semi-structured interviews with 25 transfeminine individuals assigned male at birth to explore urinary and sexual symptoms on a sample of convenience. Participants were recruited and interviews were conducted until saturation …

Roundtable Discussion: 68-Year-Old Man With Mhspc, Jason M. Hafron

Articles

No abstract provided.

Case Discussion: 66-Year-Old Man With Low-Volume Prostate Cancer, Jason M. Hafron

Articles

An interview with Michigan Institute of Urology's Doctor Jason M. Hafron is presented. He presents a case of a 66-year-old male with low-volume prostate cancer to discuss his possible prognosis and the risk group he should be categorized. He explains his preferred approach to treat the patient like ordering a bone scan, computed tomography (CT) of the chest, abdomen and pelvis, and germline testing. He recommends some treatments for metastatic castration-sensitive prostate cancer (CSPC).

Successful Treatment Of Symptomatic Cystitis Glandularis Presenting As Bladder Mass, With Cox-2 Inhibitor: A Case Report, Bilal Muhammad, Kenneth Peters

Website/Multimedia Contributions

No abstract provided.

Comparison Of Major Adverse Cardiovascular Events Risk With Androgen Deprivation Therapy By Personal History Of Cardiovascular Diseases Using Real World Data, Jason Hafron, Deborah Boldt-Houle, Stuart Atkinson

Website/Multimedia Contributions

No abstract provided.

Make A Wish: Happy Birthday Bladder Candle, Alexander Geisenhoff, Mit Shah, Megan Schober

Website/Multimedia Contributions

No abstract provided.

Isopsa: Clinical Performance Of A Single Parameter, Structure Based Test For High Grade Prostate Cancer Unaffected By 5-Ari And A-Blocker Medications, Eric Klein, Alan Partin, Yair Lotan, Jack Baniel, Martin Dineen, Jason Hafron, Kannan Manickam, Marc Pliskin, Matthew Wagnet, Ao Zhang

Website/Multimedia Contributions

No abstract provided.

Steap1-4 (Six-Transmembrane Epithelial Antigen Of The Prostate 1-4) And Their Clinical Implications For Prostate Cancer, Michael Xu, Latese Evans, Candice L Bizzaro, Fabio Quaglia, Cecilia E Verrillo, Li Li, Julia Stieglmaier, M J Schiewer, Lucia R Languino, William Kevin Kelly

Department of Urology Faculty Papers

Six-Transmembrane Epithelial Antigen of the Prostate 1-4 (STEAP1-4) compose a family of metalloproteinases involved in iron and copper homeostasis and other cellular processes. Thus far, five homologs are known: STEAP1, STEAP1B, STEAP2, STEAP3, and STEAP4. In prostate cancer, STEAP1, STEAP2, and STEAP4 are overexpressed, while STEAP3 expression is downregulated. Although the metalloreductase activities of STEAP1-4 are well documented, their other biological functions are not. Furthermore, the properties and expression levels of STEAP heterotrimers, homotrimers, heterodimers, and homodimers are not well understood. Nevertheless, studies over the last few decades have provided sufficient impetus to investigate STEAP1-4 as potential biomarkers and therapeutic …

A Scoping Review Of Penile Implant Biofilms-What Do We Know And What Remains Unknown?, Joon Yau Leong, Courtney E Capella, Maria J D'Amico, Selin Isguven, Caroline Purtill, Priscilla Machado, Lauren J Delaney, Gerard D Henry, Noreen J Hickok, Flemming Forsberg, Paul H Chung

Department of Urology Faculty Papers

Background: Penile prosthesis (PP) is a gold standard for treatment of erectile dysfunction given its reliability and efficacy. Infection remains the most feared complication of prosthetic surgery, which usually results in device removal, and places a significant economic burden on the healthcare system. While biofilms have shown to support the persistence of microorganisms, the degree by which this matrix is truly pathogenic remains unknown given its high prevalence even in asymptomatic patients. We aim to review and summarize the current literature pertaining to biofilm formation in the setting of PP surgeries in clinically infected and non-infected cases.

Methods: Searches were …

A Rare Case Of Penile Mucosal Melanoma, Safiya-Hana Belbina, Sofia Gereta, Mia Rose Schmolze, James Mclain Bradford, Christopher Yang, Aaron A. Laviana

School of Medicine Publications and Presentations

No abstract provided.

Shockwave Lithotripsy Of Upper Urinary Tract Calculi - Outcomes Of A Multicentre International Prospective Observational Study, Fernanda C. Gabrigna Berto

Electronic Thesis and Dissertation Repository

Introduction

Shockwave lithotripsy (SWL) is a surgical procedure used in urolithiasis treatment. Several factors can influence its results. This study aims to evaluate “real-world” success rates and identify predictors of treatment success in patients undergoing SWL.

Methods

Adult patients undergoing SWL for urolithiasis at three institutions in Canada and Oman were prospectively enrolled. Treatment success after a maximum of two SWL sessions was assessed by post-operative imaging. Logistic regression assessed for predictors of treatment success.

Results

Between May 2021 and February 2022, 271 patients were prospectively enrolled. Overall success rate was 46.1% after one SWL session, and 58.3% after two …

The Role Of Urinary Modulators In The Development Of Infectious Kidney Stones, Brendan Wallace

Electronic Thesis and Dissertation Repository

The pathogenesis of infectious kidney stones is poorly understood, while equally unclear is the role of urinary modulators and bacteria. An experimental model was created and utilized to test a variety of urinary modulators and bacterial strains commonly associated with struvite and calcium phosphate stones to evaluate their potential roles in influencing crystal formation. Modulators such as acids, citrate, and osteopontin had strong inhibitory effects on infectious crystal formation while the remaining modulators had neutral, mixed, or positive effects. Lastly, it was determined that the presence of urease may not directly lead to calcium phosphate and struvite stones in all …

Factors And Outcomes Contributing To Pelvic Lymph Node Dissection In Non-Muscle Invasive Bladder Cancer, Young Son, Brian Thomas, Lance Earnshaw, Mark Quiring, Erica Martel, Benjamin Fink, Raeann Dalton, Thomas Mueller, Philip Dorsey

Rowan-Virtua Research Day

Bladder cancer represents the 6th most common for men and is classified into muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC). NMIBC (T1, Ta, Tis), accounting for approximately 75% of new bladder cancer diagnoses, is limited to the mucosa, submucosa, and lamina propria. Studies have approximated the rate of recurrence in NMIBC between 50 - 70%, which sometimes progresses to muscle invasive disease. Management of NMIBC ranges from surveillance, intravesical chemotherapy to radical cystectomy (RC) and is dependent upon the TNM staging and grading of the tumor. Clinically, staging is determined via imaging, physical exam, and histology on transurethral …

Spontaneous Extraperitoneal Hematoma: An Unexpected Case Of Dysuria And Urinary Retention In A 77-Year-Old Male, Monica Diep, James Lee, James Espinosa, Joseph Pagano, Alan Lucerna

Rowan-Virtua Research Day

Urinary problems are common complaints in the Emergency Department and can present with any combination of lower urinary tract symptoms such as dysuria, hematuria, urgency, frequency, incontinence, or retention. We describe the case of a 77-year-old male who presented to the Emergency Department for five days of worsening dysuria. Two days prior, the patient was seen and evaluated for the same chief complaint, where he received intravenous antibiotics and was admitted to the hospital overnight for observation. The following day, the patient’s urinalysis and cultures were not consistent with a urinary tract infection (UTI) and was subsequently discharged without antibiotics. …

The Impact Of Racial Disparities And Outcomes On Urinary Anastomotic Leak In Radical Prostatectomy, Young Son, Benjamin A. Fink, Lance Earnshaw, Brian Thomas, Fred Okoye, Ryan Moriarty, Kathryn Goettle, Thomas Mueller

Rowan-Virtua Research Day

Prostate cancer is the leading malignancy and third most common cause of cancer death among men. In the United States, racial disparities exist in prostate cancer incidence and mortality rates. According to the National Cancer Institute, African American (AA) men have a significantly increased incidence of prostate cancer compared to Caucasians or Asians. Urinary leak at the urethrovesical anastomosis has been cited as a complication of radical prostatectomy (RP), with incidence rates as high as 23%. Urinary anastomotic leak is associated with increased rates of ileus, prolonged hospitalization rates, and longer time to achieve continence. The etiology of risk factors …

Case Report: Segmental Testicular Infarction, Nicholas Coan, Ronald Clearie, Amanda Maciag, Joseph Pagano, James Espinosa, Alan Lucerna, Neelesh Parikh

Rowan-Virtua Research Day

We report a case of a 45-year-old male who presented to the Emergency Department with acute onset left testicular pain and was diagnosed with left sided segmental testicular infarction. The differential diagnosis of acute onset testicular/scrotal pain can include critical urological diagnoses such as testicular torsion and testicular tumors. In the absence of global flow disruption on ultrasound Doppler, emergent surgical intervention is not needed. While ultrasound aids in the Emergency Department’s management of acute testicular pain, it does not rule out the need for an additional outpatient work-up or imaging. Conservative management with pain control, outpatient scrotal MRI, and …

Incidental Finding Of Unusually Large Renal Cyst During Point Of Care Ultrasound, David Ho, Jeffrey Gardecki

Rowan-Virtua Research Day

Renal cysts are common, and their frequency and size increase as patients age. Renal cysts are derived primarily from tubules and can occur anywhere between Bowman’s capsule to the renal papilla. The cysts are composed of abnormally differentiated epithelial cells encapsulating a cavity of fluid. These abnormally differentiated cells are due to defects in the structure and function of cilia, the structures responsible for detecting urine flow as well as the epithelial composition of the epithelial architecture and repair. According to Campbell Urology, there are three processes in which renal cysts increase in their size – proliferation of epithelial cells …

Neoadjuvant Chemotherapy As A Risk Factor For Urinary Anastomotic Leak In Patients Undergoing Radical Cystectomy, Young Son, Katelyn Klimowich, Joseph Flemming, Lance Earnshaw, Benjamin Fink, Brian Thomas, Thomas Mueller

Rowan-Virtua Research Day

Muscle-invasive bladder cancer (MIBC) represents approximately 25% of all bladder cancer and carries a significant risk of mortality. Neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) is the standard of care for MIBC. One complication associated with RC is ureteral anastomotic leak with a predicted rate of 3%. The objective of this National Surgical Quality Improvement Project (NSQIP) database analysis is to determine if correlations exist between radiation (RAD) and/or NAC before RC and anastomotic leak in the treatment of MIBC.

Case Study Of Metformin-Induced Lactic Acidosis, Kajel Patel, Kishan Patel

Rowan-Virtua Research Day

Metformin induced lactic acidosis is when high levels of metformin cause dangerously high levels of lactic acid. Here is a case report of a 72-year-old female who came in for nausea, vomiting, and diarrhea found to have a high suspicion for metformin induced lactic acidosis. She stabilized in the emergency department, nephrology and ICU was contacted, and she went for emergent dialysis. For many patients the prognosis of metformin induced lactic acidosis is poor. This patient was made comfort care by her family.

Assessing The Prevalence Of Sport-Induced Urinary Incontinence And Its Emotional Impact On Female Gymnasts, Nikta Rezakahn Khajeh, Kenneth M. Peters

Posters

INTRODUCTION
Female gymnasts put strain on their pelvic floor muscles with high impact exercises that increase their susceptibility for stress urinary incontinence (SUI). Moreover, they refrain from seeking medical attention because of embarrassment. This project seeks to quantify the prevalence of SUI in female gymnasts while also influencing conversation about SUI in the gymnastics community to alleviate its stigma. We hypothesize there to be a high prevalence of SUI in young female gymnasts compared to nonathletic females.

Elimination Of Postoperative Narcotics In Infant Robotic Pyeloplasty Using Caudal Anesthesia And A Non-Narcotic Pain Pathway, Kwesi Asantey, Kristen Meier, Zachary Rollins, Andrew B. Banooni, Zachary J. Liss

Posters

INTRODUCTION
Research suggests that narcotic pain medications are dramatically overprescribed. We hypothesize that narcotics are unnecessary in the majority of infants for postoperative pain control. In this series, we report our experience combining caudal blocks with a non-narcotic postoperative pathway as a means of completely eliminating postoperative narcotics following infant robotic pyeloplasty.

Evaluation Of Trenguard Patient Positioning System, Joshua Volin, Patrick Herndon, Michelle Jankowski, Deborah Hasenau, Jason Hafron

Posters

INTRODUCTION
The TrenGuard™ patient positioning device is a comprehensive patient restraint system for patient positioning when in Trendelenburg position during robotic surgery. This study aims to compare patient migration with the TrenGuard™ patient restraint system (TGPRS) to traditional patient restraint with surgical tape and egg crate foam bolsters (STECFB).

Testicular Torsion Education: Improving Awareness Among Boys And Their Caregivers Regarding The Urgency Of Evaluating Scrotal Pain, Abby Taylor

Capstone Experience

Introduction: Testicular torsion is a urologic emergency that requires prompt medical evaluation and surgical intervention. The length of time from onset of the torsion to evaluation in the emergency department is often delayed due to lack of knowledge of the urgency of the situation amongst boys and their caregivers. We hypothesize that an animated educational video will increase awareness of the condition and prompt urgent evaluation in the emergency department.

Methods: A 5-minute animated educational video was created following a boy, Danny, as he develops testicular torsion. Four population groups: boys, parents, school nurses, and pediatricians, completed group-specific pre- and …