Urology Commons^™

Catheter-Associated Urinary Tract Infections: Patient Characteristics, Treatment, And Clinical Outcomes In One South Texas Acute Care Hospital, Kimberly A. Ambrosini, Jose Campo Maldonado

Research Colloquium

Background: Catheter-associated urinary tract infections (CA-UTIs) account for 40 percent of nosocomial infections worldwide. Their elimination is at the forefront of quality improvement in one South Texas acute care hospital.

Methods: Over a period of 6 months, five CA-UTIs occurred in one South Texas acute care hospital. These cases were identified via regular surveillance by Infection Prevention staff and the Laboratory Department of the hospital. This research reviews patient age, sex, length of stay, bacteria contracted, appropriate antibiotic use, patient characteristics, and overall outcomes.

Results: Between the months of July and December 2021, 5 CAUTIs were contracted. Patients ranged in …

Penile Calciphylaxis In An End Stage Renal Disease Patient., Juan Enrique Garcia Lopez, Alain Velazquez Blanco, Aileen Aguilar, Sareena Siyas, Daniel Ibarias Paz, Mays Abdulazeez, Jesus Garza-Tamez, Desmond Adamu

Research Colloquium

Background: Penile Calciphylaxis occurs in about 1–4% of hemodialysis patients worldwide. Associated mortality rates are very high, and hyperparathyroidism is the second most frequently associated disorder. Addressing the resulting metabolic imbalance, and surgical intervention guided by findings of radiological studies may improve quality of life. The pathogenesis is thought to be mediated by vascular smooth muscle cells which differentiate into osteoblast-like cells. Decrease in vascular calcification inhibitory proteins fetuin-A and matrix Gla is found in patients on dialysis causing systemic medial calcification of arterioles, leading to epidermal ischemia, tissue infarction, and ulceration.

Case presentation: 47-year-old male with history of coronary …

Characterization Of Prostate Cancer In Transgender Women, Simita Gaglani, Rajveer Purohit, Ashutosh Tewari, Dara Lundon, Natasha Kyprianou

Research Symposium

Background: The risk of developing prostate cancer (PC) in transgender women is unknown. Many patients are unaware that the prostate is not removed during male-to-female surgical transition. It is unclear what the exposure of estrogens and androgen blockers in these transgender patients has on the prostate. Our aim was to examine and characterize the different presentations of PC in published cases and augment this with an additional case series from one institute.

Methods: A retrospective review of prospectively maintained medical records was performed identifying features of PC diagnoses in transgender women. These included age, duration of feminizing hormone therapy, PSA …

The Association Between Level Of Education And The Propensity To Get A Prostate Specific Antigen Test, Sophia Artamendi, Julia Steger, Sofia Steger

AMNET XX Conferencia Internacional

No abstract provided.

A Comparison Of The Thulium Fiber Laser Versus Holmium:Yag Laser Lithotripsy Of Upper Urinary Tract Calculi: Preliminary Results Of A Randomized Prospective Clinical Trial, Eduardo Gonzalez Cuenca

Electronic Thesis and Dissertation Repository

The Holmium:yttrium-aluminium-garnet (Ho:YAG) laser has become an indispensable tool in Endourology since its introduction in 1995, due to its safe and efficient urinary stone fragmentation capabilities. The Thulium Fiber Laser (TFL), is the latest innovation with early clinical experience suggesting improvements over the Ho:YAG. This prospective, randomized controlled study aims to compare clinical outcomes of Ho:YAG versus TFL lithotripsy for upper urinary tract calculi. Patients undergoing ureteroscopy for renal stones (size 8-20mm, density >600 HU) from a single institution were prospectively recruited.

Thirty-eight patients have been recruited (Ho:YAG=20, TFL=18). The laser-on time (p=.330), total operative time (p …

Penile Prosthesis Implantation After Radiation Therapy For Prostate Cancer, Joon Yau Leong, Paul Chung

Department of Urology Faculty Papers

No abstract provided.

The Role Of Salvage Radical Prostatectomy In Patients With Radiation-Resistant Prostate Cancer, Jake Drobner, Alain Kaldany, Mihir S. Shah, Saum Ghodoussipour

Department of Urology Faculty Papers

There are multiple treatment strategies for patients with localized prostate adenocarcinoma. In intermediate- and high-risk patients, external beam radiation therapy demonstrates effective long-term cancer control rates comparable to radical prostatectomy. In patients who opt for initial radiotherapy but have a local recurrence of their cancer, there is no unanimity on the optimal salvage approach. The lack of randomized trials comparing surgery to other local salvage therapy or observation makes it difficult to ascertain the ideal management. A narrative review of existing prospective and retrospective data related to salvage radical prostatectomy after radiation therapy was undertaken. Based on retrospective and prospective …

Impact Of An Expanded Definition Of Family History On Outcomes Of Active Surveillance For Prostate Cancer, Adam C. Schneider, Thenappan Chandrasekar, Nicholas Bowler, Ryan Fogg, Joon Yau Leong, Andrew Gusev, Linda H. Rodgers, Shelley R. Mccormick, Douglas M. Dahl, Jason A. Efstathiou, Michael L. Blute, Anthony L. Zietman, Chin-Lee Wu, Matthew R. Smith, Eliezer M. Van Allen, Adam S. Feldman, Keyan Salari

Department of Urology Faculty Papers

PURPOSE: Despite family history being an established risk factor for prostate cancer, the role of a broader definition of family history inclusive of not just prostate cancer but other genetically related malignancies has not been investigated in the active surveillance population. Here, we evaluate the impact of an expanded definition of family history on active surveillance outcomes.

MATERIALS AND METHODS: Patients undergoing active surveillance for prostate cancer at Massachusetts General Hospital from 1997-2019 with detailed data available on family cancer history were identified. Primary outcome was biopsy progression-free survival, and secondary outcomes were treatment-free survival, adverse pathological features at prostatectomy, …

Elevated Inos And 3'-Nitrotyrosine In Kaposi's Sarcoma Tumors And Mouse Model, Olga Vladimirova, Samantha Soldan, Chenhe Su, Andrew Kossenkov, Owen Ngalamika, For Yue Tso, John T. West, Charles Wood, Paul M. Lieberman

LSU-LCMC Cancer Center Faculty Publications

Kaposi's Sarcoma (KS) is a heterogenous, multifocal vascular malignancy caused by the human herpesvirus 8 (HHV8), also known as Kaposi's Sarcoma-Associated Herpesvirus (KSHV). Here, we show that KS lesions express iNOS/NOS2 broadly throughout KS lesions, with enrichment in LANA positive spindle cells. The iNOS byproduct 3-nitrotyrosine is also enriched in LANA positive tumor cells and colocalizes with a fraction of LANA-nuclear bodies. We show that iNOS is highly expressed in the L1T3/mSLK tumor model of KS. iNOS expression correlated with KSHV lytic cycle gene expression, which was elevated in late-stage tumors (>4 weeks) but to a lesser degree in …

Protocol Of A Multicentre Randomised Controlled Trial Assessing Transperineal Prostate Biopsy To Reduce Infectiouscomplications, Jim Hu, Alec Zhu, Andrew Vickers, Mohamad Ezzeddine Allaf, Behfar Ehdaie, Anthony Schaeffer, Christian Pavlovich, Ashley E. Ross, David A. Green, Gerald Wang, Serge Ginzburg, Jeffrey S. Montgomery, Arvin George, John N. Graham, Benjamin T. Ristau, Andres Correa, Jonathan E. Shoag, Keith J. Kowalczyk, Tenny R. Zhang, E.M. Schaeffer

Einstein Health Papers

Introduction Approximately one million prostate biopsies are performed annually in the USA, and most are performed using a transrectal approach under local anaesthesia. The risk of postbiopsy infection is increasing due to increasing antibiotic resistance of rectal flora. Single-centre studies suggest that a clean, percutaneous transperineal approach to prostate biopsy may have a lower risk of infection. To date, there is no high-level evidence comparing transperineal versus transrectal prostate biopsy. We hypothesise that transperineal versus transrectal prostate biopsy under local anaesthesia has a significantly lower risk of infection, similar pain/discomfort levels and comparable detection of non-low-grade prostate cancer.

Methods and …

Evaluating The Baseline Hemoglobin, Albumin, Lymphocyte, And Platelet (Halp) Score In The United States Adult Population And Comorbidities: An Analysis Of The Nhanes, Ryan Antar, Christian Farag, Vincent Xu, Arthur Drouaud, Olivia Gordon, Michael J. Whalen

Urology Faculty Publications

Introduction: As a composite immunonutritional biomarker, the Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) score has shown promise in assessing a patient's overall health status by integrating several routinely collected laboratory indicators. This biomarker has been examined in many different populations of patients and disease states (i.e., cancer), but an integrated, universal rubric using standardized thresholds has not thus far been developed. Pre-existing large population-based databases represent an ideal source to examine the distribution of HALP and the influence of diverse health statuses on this score.

Methods: We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey …

Silicone Stenting For Chronic Ureteral Obstruction Improves Stent Exchange Frequency, Bebe Eke, Noah Canvasser

Research Day

Introduction and Objective

Chronic ureter stenting is recommended for patients with malignant ureteral obstruction, or with benign ureteral obstruction that cannot tolerate or do not want definitive surgical management. Stents are exchanged at time intervals often limited by stent encrustation. Prior in vitro studies have demonstrated that silicone stents have less encrustation. Our objective was to compare patients undergoing chronic exchanges with polymer-based and silicone stents.

Methods

This IRB-approved retrospective study included all adult patients who underwent chronic ureter stent exchange from August 2017 through August 2022. Patients were stented with either a Boston Scientific PercuflexTM Plus or a Cook …

A Seemingly Low Risk Patient Develops Urosepsis As A Complication Of Transrectal Prostate Biopsy: A Case Study, Nicole Peritz, Gabrielle Oquendo, Yuhyun Kang, Elijah Humphries, Joy Zarandy

Research Day

Background:

Prostate cancer (PCa) is the most common cancer in men, and the second most common cause of cancer deaths in the United States. Approximately 1 million Americans undergo prostate biopsies annually, with 97% undergoing the transrectal prostate biopsy (TRPB). While TRPB is reliable and relatively low risk, nearly 7% of patients develop infectious complications, with 3% requiring hospitalization due to sepsis. Risk factors for developing infection post-TRPB include antibiotic resistance, >10 biopsy cores, diabetes mellitus, indwelling catheter, and African-American ethnicity. Identifying risk factors, considering a transperineal biopsy approach, and utilizing pre-procedural practices like rectal sterilization, screening urinalysis, prophylactic antibiotics, …

Foley Catheter Algorithm, Chary Mathew

Doctor of Nursing Practice Projects

Urinary catheterization, indwelling and intermittent are simple and common procedures performed in hospitals, emergency rooms, nursing homes, and clinics to ensure adequate urinary output in patients who cannot void efficiently or closely monitor fluid intake and output. Though simple and straightforward in most cases, catheterization can become a challenging procedure with complications in the absence of a standardized protocol for difficult catheterization (Ghaffary et al., 2013). This Quality Improvement Project aimed to develop a standardized Foley catheter algorithm/ flow chart available in our institution's intranet and laminated charts in nursing stations and procedure rooms with Foley catheter insertion indications, types, …

Pathophysiology, Presentation, And Management Of Interstitial Cystitis In The Acute Setting, David Koziel

Stratford Campus Research Day

Interstitial cystitis (IC) also known as bladder pain syndrome (BPS) and more infrequently by other monikers represents a debilitating disease with a poorly understood pathophysiology. According to the Centers for Disease Control the incidence of IC ranges from 1 to 5.1 cases per 100,000 individuals. While a relatively rare condition, it is common enough that the provider in the acute setting recognizes the pathophysiology and is familiar with the management of this condition. It is a disease that is more prevalent in women, however men can also be affected. Due to the significant overlap with more common conditions, it is …

Purple Urine Bag Syndrome (Pubs) In A Patient With A Chronic Indwelling Foley, Kelsey Murray, Kishan Patel

Stratford Campus Research Day

Purple urine bag syndrome (PUBS) is a rare medical condition characterized by the appearance of purple discoloration in the urine collection bag of patients who use catheters for urinary drainage. PUBS is primarily seen in elderly, female, and institutionalized patients who have chronic indwelling catheters. The discoloration occurs due to the presence of certain bacteria that produce pigments, which react with the plastic materials of the catheter and urine collection bag, leading to the formation of a purple color. In addition to the aesthetic concerns, PUBS may also indicate an underlying urinary tract infection or other medical conditions that require …

Association Of Prematurity And Urogenital Comorbidities With Postoperative Outcomes Of Ureteroneocystostomy For Vesicoureteral Reflux, Raeann Dalton, Young Son, Edward Wu, Leah Anderton, Matthew Eximond, Lance Earnshaw, Katelyn Klimowich, Gregory Dean

Stratford Campus Research Day

Background: It is estimated that 20-30% of congenital anomalies involve the kidney and ureter, and these rates are even higher in infants with low birth weights. Vesicoureteral reflux (VUR) occurs when there is a backflow of urine from the bladder to the kidney. Depending on severity, this condition may require surgical correction with ureteroneocystostomy (UNC). The impact of premature birth and presence of urogenital comorbidities on outcomes of UNC is not known. The objective of this study is to determine the relationship between premature birth and urogenital comorbidities with operative outcomes of UNC for VUR.

Methods: The 2020 American College …

Ureterocutaneous Fistula In Setting Of Recurrent Gluteal Abscesses: A Case Report, Catherine Alapatt, Young Son, Benjamin Fink, Brian Thomas, Sean Coulson, Shawon Akanda, Jacob Thatcher, Thomas Mueller

Stratford Campus Research Day

Ureteral fistulas are a rare occurrence that can arise from iatrogenic trauma, radiation, malignancy, and inflammation. Treatment options of urinary tract fistulas are handled on a case-by-case basis and can necessitate a surgical approach. We present the case of an 85-year-old patient with a ureterocutaneous fistula where conservative management with PCN is a viable alternative to surgical intervention.

The Vaginal Microbiome Post-Menopause And Urinary Tract Infections, Rifke Anolik, Julia Kiffel, Venkateswar Venkataman

Stratford Campus Research Day

Background: Urinary Tract Infection (UTI) is a condition where pathogens invade the urinary tract and can travel up the urethra and into the bladder. UTIs occur more commonly in females compared to males and in the post-menopausal population this rate increases significantly. While these infections may be asymptomatic, they can also cause severe discomfort and lead to serious and even life threatening complications. Recent investigation into the vaginal microbiome has opened the doors to a possible mechanism behind the increased incidence of UTIs after menopause. Understanding the pathogenesis behind the increased risk of UTIs in the postmenopausal state will allow …

Prolonged Length Of Stay In Illeal Conduit Compared To Neobladder Diversion In Radical Cystectomy Patients For Bladder Cancer, Ryan J. Moriarty, Young Son, Brian Thomas, Ronald Clearie, Lance Earnshaw, Dayna Devincentz, Thomas Mueller

Research Day

Background:

Radical cystectomy and urinary diversion has become the standard treatment for invasive and complicated malignancies of the bladder, urethra, and ureters. [1] Robotic-assisted radical cystectomy (RARC), introduced in the last decade, has been associated with favorable perioperative outcomes when compared to open radical cystectomy. Yet little is known about how different urinary diversion types compare in regards to length of hospital stay, readmission rates, and perioperative course. This data analysis seeks to identify the statistically significant differences in postoperative course of ileal conduit versus neobladder among patients with staged bladder cancer.

Methods:

The American College of Surgeons National Surgical …