Urology Commons^™

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 ...

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 ...

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

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 ...

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 ...

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?

Methylation Of Srd5a2 Promoter Predicts A Better Outcome For Castration-Resistant Prostate Cancer Patients Undergoing Androgen Deprivation Therapy, Zongwei Wang, Tuo Deng, Xingbo Long, Xueming Lin, Shulin Wu, Hongbo Wang, Rongbin Ge, Zhenwei Zhang, Chin-Lee Wu, Mary-Ellen Taplin, Aria F. Olumi

Open Access Articles

PURPOSE: To determine whether SRD5A2 promoter methylation is associated with cancer progression during androgen deprivation therapy (ADT) in CRPC.

PATIENTS AND METHODS: In a Local CRPC cohort, 42 prostatic specimens were collected from patients who were diagnosed as CRPC and underwent transurethral resection of the prostate (TURP) at Massachusetts General Hospital (MGH). In a metastatic CRPC (Met CRPC) cohort, 12 metastatic biopsies were collected from CRPC patients who would be treated with abiraterone plus dutasteride (Clinical Trial NCT01393730). As controls, 36 benign prostatic specimens were collected from patients undergoing prostate reduction surgery for symptoms of bladder outlet obstruction secondary to ...

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

Characterizing Patients With Recurrent Urinary Tract Infections In Vesicoureteral Reflux: A Pilot Study Of The Urinary Proteome, Dijana Vitko, Patricia Cho, Stephen A. Kostel, Shannon E. Dimartino, Lily D. Cabour, Matthew A. Migliozzi, Tanya Logvinenko, Peter G. Warren, John W. Froehlich, Richard S. Lee

Open Access Articles

Recurrent urinary tract infections (UTIs) pose a significant burden on the health care system. Underlying mechanisms predisposing children to UTIs and associated changes in the urinary proteome are not well understood. We aimed to investigate the urinary proteome of a subset of children who have vesicoureteral reflux (VUR) and recurrent UTIs because of their risk of developing infection-related renal damage. Improving diagnostic modalities to identify UTI risk factors would significantly alter the clinical management of children with VUR. We profiled the urinary proteomes of 22 VUR patients with low grade VUR (1-3 out of 5), a history of recurrent UTIs ...

Angiogenin Mrna Expression Levels In Prostate Cancer Tissue, Bowen Yao, Megumi Shigematsu, Phd, Kamlesh Ganesh Pawar, Phd, Venetia Pliatsika, Ms, Yohei Kirino, Phd

Phase 1

Introduction: Prostate cancer is the most commonly diagnosed cancer in men and second leading cause of cancer deaths. Studies have shown that tRNA fragments are upregulated in prostate cancers and play important roles in carcinogenesis. This project looks at how tRNA cleaving enzyme angiogenin expression is regulated in prostate cancer tissues.

Methods: Clinical data and mRNA expression levels of selected tRNA cleaving enzymes were extracted from the TCGA website. mRNAs were sequenced using IlluminaGA_RNASeqV2 at University of North Carolina.

Results: 546 samples from 494 patients, with normal tissue from 53 patients were collected. ANG mRNA levels were lower in patients ...

Comparison Of Patient Satisfaction With Telehealth And In-Clinic Post-Operative Visits, Lillian Matthews, Bryan Renslo, Deborah T. Glassman, Md

Phase 1

Introduction: Telehealth has grown rapidly in the healthcare industry as a time efficient, affordable, and accessible means to provide care. Jefferson’s Department of Urology currently employs telehealth for post-operative visits but its efficacy in post-nephrectomy patients has not been well studied. We aim to demonstrate that patient satisfaction is the same for telehealth versus in-clinic post-operative visits in nephrectomy patients. Secondarily we will examine distance saved for telehealth patients.

Methods: We will administer an IRB approved questionnaire to all nephrectomy patients via the EPIC^® EMR platform after their post-operative visit. Each questionnaire will be specific to telehealth or in-clinic ...

Comparison Of Patient Satisfaction Between Telehealth And In-Clinic Post-Operative Visits, Bryan Renslo, Lillian Matthews, Deborah T. Glassman, Md

Phase 1

Introduction: Telehealth has the potential to be an efficient, affordable, and accessible means to give care. In the field of Urology, its use has large potential but has not been well studied. We hypothesize that the use of telehealth for post-op nephrectomy patients will maintain the same level of patient satisfaction. We also hypothesize that telehealth visits will take less time and save patients money by eliminating the need to travel.

Methods: From May through July 2019, post-nephrectomy patients who consented to the study were given either a telehealth or in-clinic post-operative visit. Outcome metrics and demographics information were obtained ...

Color-Changing Device To Improve Adherence To Foley Catheter Replacement Protocols And Reduce Urinary Tract Infection Frequency, Alexander Straus, Ms, Kurt Hill, Bryn Cross, Jason M. Fields, Md

Phase 1

Background: Catheter associated urinary tract infections (CAUTI) are a major source of patient morbidity and mortality in healthcare settings and have a significant financial impact on the healthcare system. Many hospitals have clinical protocols in place to continually reassess the necessity of indwelling foley catheters and remove them if their use is no longer warranted. However, it is still common for indwelling foley catheters to be overlooked and remain in place, even after meeting criteria for removal. A design project was conducted that sought to improve adherence to clinical protocols, and reduce frequency of CAUTIs, by creating a color-changing device ...

Color-Changing Device To Improve Adherence To Foley Catheter Replacement Protocols And Reduce Urinary Tract Infection Frequency, Kurt Hill, Alexander Straus, Ms, Bryn Cross, Jason M. Fields, Md

Phase 1

Background: Foley catheter-associated UTI’s (CAUTI’s) represent a driving cause of cystitis, bacteremia and sepsis in the hospital setting. Accordingly, the CDC has identified prolonged indwelling time as the foremost risk factor for CAUTI’s. However, the fundamental design of the Foley has remained unchanged for over eighty years. Hospital-specific protocols do currently exist for the removal of infection-prone catheters; however, in practice it remains commonplace for catheters to be ignored, increasing the risk of life-threatening infection. Our design process addressed this by creating a color-changing alarm device that would alert providers when a catheter has been left in ...

Chronic Recurrent Priapism: A High Flow State Secondary To An Arteriovenous Fistula Of The Corpus Cavernosum, Catherine M. Fiore, Melissa L. Pellegrino, Meghna C. Trivedi

Open Access Articles

Priapism is clinically defined as an erect penis for more than 4h unrelated to sexual stimulation. There are two main types of priapism-high flow and low flow, based on the pathophysiology. In this case report we will mainly focus on high flow, non-ischemic priapism, which is the less common form. High flow priapism occurs secondary to congenital malformation or from the development of arteriovenous malformation from genital trauma. This case highlights the importance of differentiation and recognition of posttraumatic high flow priapism and unveils the role of selective internal pudendal artery angiography and embolization in its management.

Manipulation Of Ar-V7 In Castrate Resistant Prostate Cancer, Sean Simpson

Capstone Showcase

Abstract

Introduction: Prostate cancer is the leading cancer affecting men of all races in the United States, and the second leading cause of cancer death in men. If caught early, many have had success in combating the disease, but if the cancer metastasizes, the 5-year survival rate drops to only 30%. Current treatment options heavily involve hormone therapy, radiation therapy, chemotherapy, and surgery. While these treatments can be effective for early stage prostate cancer, they can fall short in preventing the spread of the cancer to other parts of the body. This review analyzes a new potential way of preventing ...

Robot-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection: A Minimally Invasive Surgical Approach For Testicular Cancer., Harsha R Mittakanti, James R Porter

Articles, Abstracts, and Reports

Retroperitoneal lymph node dissection (RPLND) can been employed as primary treatment for stage I non-seminomatous germ cell tumor (NSGCT) as well as for treatment of post-chemotherapy masses. Open RPLND (O-RPLND) has long been the standard approach for lymphadenectomy, but is associated with significant morbidity. Laparoscopic RPLND (L-RPLND) was developed to mitigate the morbidity associated with O-RPLND, but is a technically challenging procedure requiring significant experience with laparoscopic dissection and suturing to remove lymph nodes behind the great vessels and to control vascular injury. Robotic RPLND (R-RPLND) has gained traction in recent years as an alternative to both O-RPLND and L-RPLND ...

Corpus Cavernosum Abscess Secondary To Traumatic Perforation Of Urethral Diverticulum, Thomas C. Gore Do, Anna Schepcoff Do, Domenick Sorresso Md

West Florida Division Virtual Research Day

A corpus cavernosum abscess is a rare condition. Usual etiologies include penile injection of erectile dysfunction medications or illicit drugs, priapism, sexually transmitted infections, and trauma; however, there have been reported cases of idiopathic etiology. The most common causative organisms include Staphylococcus aureus, Streptococci, and Bacteroides [1]. Diagnosis is typically made clinically and through imaging (computed tomography [CT] and ultrasound). The first-line treatment is the use of intravenous (IV) antibiotics and surgical drainage. More conservative treatment, however, includes aspiration in conjunction with IV antibiotics [2-3]. Urethral diverticulum (UD) is the formation of a saccular outpouching of the urethral lumen. Symptoms ...