Urogenital System Commons^™

Acute Aortic Dissection Masquerading As Testicular Torsion: A Case Report, Bruce M. Lo, Megyn K. Christensen, Coral E. Byrns, Benjamin Chidester

Department of Emergency Medicine Faculty Publications

Introduction: Aortic dissection is a rare but life-threatening condition with a high mortality rate if diagnosis is delayed. Aortic dissection classically presents with sudden-onset, sharp pain in the chest or back. However, atypical presentations can also occur, which could lead to a delay in diagnosis.

Case Report: A patient initially presented to the emergency department (ED) with left testicular pain ongoing for several hours. On examination, he had tenderness in the left lower quadrant abdomen and left testicle. A testicular ultrasound revealed decreased blood flow to the left testicle, raising concern for testicular torsion. The patient was taken to the …

Cervicovaginal Lavage Fluid Iron And Manganese Levels In Women With And Without Vaginitis, Barbara Kozma, David Ratonyi, Bence Kozma, Peter Takacs, Attila G. Sipos

Department of Obstetrics & Gynecology Faculty Publications

Transition metals such as iron and manganese are critical for cellular metabolism, redox balance, and immune function, and they also influence host–pathogen interactions. Vaginitis is characterized by mucosal inflammation that may alter local trace-element homeostasis. We hypothesize that inflammatory conditions such as vaginitis may be associated with altered cervicovaginal iron and manganese levels. We performed a prospective, single-center cohort study at the University of Debrecen (Hungary) between April 2023 and April 2024, enrolling 80 women ≥ 18 years with vulvovaginal complaints. Participants were assessed at baseline and at weeks 4, 8, and 12 with clinical evaluation and cervicovaginal lavage (CVL) …

Neurotensin Drives Theca Cell Migration During Ovulation In Primates, Jessica S. Miller, Megan A. G. Sage, Thomas E. Curry Jr., Diane M. Duffy

Department of Biomedical and Translational Sciences Faculty Publications

Theca cells are a critical steroidogenic cell type of the ovarian follicle and corpus luteum. The ovulatory luteinizing hormone (LH) surge (or human chorionic gonadotropin (hCG)) stimulates theca cell relocation from the stroma surrounding the dominant follicle to full integration into the developing corpus luteum. Luteinizing hormone/human chorionic gonadotropin also stimulates granulosa cells to produce local mediators of ovulation, including the peptide neurotensin (NTS). To determine if hCG-stimulated NTS regulates theca cell relocation within the ovulatory follicle, vehicle or an NTS receptor antagonist was injected into a macaque dominant follicle, and ovaries were removed 48 h after hCG administration. Additional …

Transvascular Endobronchial Ultrasound-Guided Transbronchial Needle Aspirations (Ebus-Tbna) To Confirm Urothelial Carcinoma Metastasis To The Pulmonary Artery, Kyle Admire, Stephen Gegick

Department of Medicine Faculty Publications

Tumours within the pulmonary arteries provide a diagnostic challenge due to their similar appearance to pulmonary emboli. Often, the decision to sample is multidisciplinary and the best approach to take is often unknown. Here we describe a case of urothelial carcinoma which metastasised to the mediastinum with evidence of tumour burden within the pulmonary artery. Sampling of this by endovascular and thoracoscopic means was unsuccessful; however, we were able to provide a diagnosis using direct visualization with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). This report is the first of a central pulmonary artery tumour caused by urothelial carcinoma biopsied by …

Treatment Patterns For Genitourinary Syndrome Of Menopause: A Trinetx Analysis, Anushka Ghosh, Maria D'Amico, Yash B. Shah, Whitney R. Smith, Mihir S. Shah, Costas D. Lallas, Alana M. Murphy

Department of Urology Faculty Papers

BACKGROUND: Genitourinary syndrome of menopause (GSM) is a highly prevalent, underdiagnosed condition that can significantly impair quality of life (QoL). This study evaluates real-world treatment trends for GSM to better understand current management practices and highlight ongoing gaps in care. The background is in a different font than the rest of the abstract.

METHODS: We queried the TriNetX database for patients with a diagnosis of postmenopausal atrophic vaginitis (ICD N95.2) and treatment information from 2004-2024. A combination of RxNorm and International Classification of Diseases-10 (ICD) codes was used to classify disease and treatment type, including topical estrogen (RxNorm 4083, 4099), …

Sensitivity And Specificity Of The Cobas Liat Ct/Ng/Mg Nucleic Acid Test In A Clinical Laboratory Setting And Point-Of-Care Location, B Van Der Pol, R Arcenas, C Boraas, S Chavoustie, L L. Crane, N D'Empaire, A C. Ermel, G Harnett, F Hinestrosa, S House, Rebecca A. Lillis, J Miller, A Mills, R Poblete, S A. Young

School of Medicine Faculty Publications

Sexually transmitted infections, e.g., Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG), present with similar signs/symptoms and are often treated empirically due to delays in receiving diagnostic test results. This study evaluated the clinical performance of the Cobas Liat CT/NG/MG nucleic acid amplification test (NAAT) in detecting these pathogens in a point-of-care (POC) setting. This non-interventional, multicenter study recruited symptomatic/asymptomatic participants from 13 geographically diverse POC sites across the USA. Prospective clinician- and self-collected specimens (urine/vaginal swabs) were used to determine the sensitivity and specificity of the Cobas Liat CT/NG/MG test relative to the composite reference standard (CRS), …

Acute Pancreatitis With Acute Kidney Injury Is Associated With Worse 30 And 90-Day Outcomes: A Multinational Multicenter Analysis, Donghyun Ko, Do Han Kim Md, Pedro Palacios Argueta Md, Wilhelm S. Basegoda Md, Frank J. Lukens Md, Paul T. Kroner Md

Posters

Acute kidney injury (AKI) in patients with acute pancreatitis (AP) has been consistently shown to impact clinical outcomes and is a marker of organ dysfunction, being a primary indicator and driver of disease severity. The cornerstone of management of AP is aggressive intravenous fluid administration, and AKI has traditionally been a surrogate measure of the adequacy of volume repletion and is even recommended by the current ACG guidelines to be monitored in 6-hour intervals for 24-48 hours from presentation. While having been proven to be a factor of paramount importance on prior studies, the aim of our study is to …

Menstruation Cycles And The Impact On A Female Athlete's Performance And Perception Of Performance, Mckenzie Mcaloon

Honors Projects in Biological and Biomedical Sciences

This two-part study investigates the impact of menstrual cycle hormone levels on performances and perception of performance among division I athletes. A survey was given to the captains of all Bryant University female sports teams for the dispersal amongst their teams. Each of the 13 female sports teams participated and contributed. A total of 107 survey responses were collected. Data regarding the perception of menstrual cycle on specific aspects of their athletic lives were collected, as well as whether they were on contraception, their age of menarche and heaviness of flow. The results indicate that 83% of athletes surveyed believe …

Association Of Perioperative Factors With Lymph Node Positivity In Bladder Cancer Following Radical Cystectomy, Alyssa Laguerta, Kimberly Toumazos, Virgil Kevin Demario, Vaishnavi Patel, Balaji Reddy, Mark Quiring, Evan Jones, Young Son, Ronald Clearie, Thomas Mueller

Rowan-Virtua Research Day

Introduction and objectives: The treatment of bladder carcinoma relies on a multimodal approach, including chemotherapy, radical cystectomy, and lymph node dissection, but clear guidelines for the optimal strategy remain ambiguous. Radical cystectomy is complex, with high morbidity and mortality, yet limited research has focused on its short-term implications for lymph node-positive bladder cancer. This study aims to address these gaps by identifying perioperative factors linked to lymph node positivity and comparing outcomes between lymph node-positive and negative patients.

Methods: We conducted a retrospective analysis of 4382 bladder cancer patients who underwent radical cystectomy, collecting comprehensive clinical and surgical data. Clinical …

Case Report: Pigtail Suprapubic Catheter Placement In A Patient With Acute Urinary Retention And Abdominal Mesh, Clara Keum, Zamran Masih, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Acute urinary retention (AUR) is a urological emergency that requires immediate bladder decompression and management of the underlying condition to prevent further complications such as urinary tract infection and renal failure. When standard urethral catheterization is not feasible, a suprapubic catheter can be used to achieve adequate bladder drainage. However, in patients with structural or anatomical challenges, such as the presence of surgical mesh, suprapubic catheter placement can be difficult. This case report presents the successful placement of an 8.5 French pigtail catheter and urinary drainage in an 86-year-old male with abdominal mesh who presented with AUR.

Interactive Module For Medical Student Education In Type I Renal Tubular Acidosis, Het Patel, Emelie-Jo Nappo, Akshata Naik, Suzan Elsayed

Posters

No abstract provided.

Survey Of Medical Student Attitudes Regarding Uterine Transplant For Cisgender And Transgender Women, Oakland University William Beaumont School Of Medicine Medical School Medical Student, Deidre Hurse, Abram Brummett

Posters

No abstract provided.

Sonographic Evaluation Of An Urachal Remnant: A Case Report, Courtney Gushi

SACAD: Scholarly Activities

Urachal anomalies are rare and often identified incidentally during diagnostic imaging studies, such as sonography. These anomalies are being detected with increasing frequency due to advancements in cross-sectional medical imaging. Sonography is a key diagnostic modality due to its lack of radiation, cost-effectiveness, and widespread ability. Urachal anomalies have the potential to undergo pathological changes, leading to inflammation, infection, and even malignancy. Therefore, it is imperative for sonographers to be proficient in identifying and understanding sonographic characteristics of urachal abnormalities.

Nursing Knowledge Regarding Pap Smears For Transgender Men, Caytlin Capulong

Nursing | Student Research Posters

Cervical cancer screening (CCS) is a crucial test used for preventative measures against cervical cancer, yet transgender men (TM) experience significantly lower screening rates in comparison to cisgender women due to pain, anxiety, and systemic healthcare barriers. A major factor for deterrence is pain during speculum insertion, often because of vaginal atrophy related to testosterone usage. Other factors include fear of discrimination, mistreatment, and lack of provider awareness, particularly among nurses who play a pivotal role in patient preparation and care. This research aims to assess the extent of nurses’ knowledge regarding Pap smears for female-to-male (FTM) patients through a …

Nursing Knowledge Regarding Pap Smears For Transgender Men, Caytlin Capulong

Nursing | Senior Theses

Cervical cancer screening (CCS) is a crucial test used for preventative measures against cervical cancer, yet transgender men (TM) experience significantly lower screening rates in comparison to cisgender women due to pain, anxiety, and systemic healthcare barriers. A major factor for deterrence is pain during speculum insertion, often because of vaginal atrophy related to testosterone usage. Other factors include fear of discrimination, mistreatment, and lack of provider awareness, particularly among nurses who play a pivotal role in patient preparation and care. This research aims to assess the extent of nurses’ knowledge regarding Pap smears for female-to-male (FTM) patients through a …

Same Or Different? Resolution Of Diagnostic Difficulty Of Two Mixed Cell-Type Tumors In Ovarian Pathology., Sarah Ingram, Priyanka Raju Md, Wei Shaw Do, Steve Sowers Pa, Kelly Brenan-Rothschild Md

Transformative Medicine

Introduction: When confronted by two disease processes, physicians in all disciplines are faced with the question: Are they manifestations of a common etiology, or distinct entities co-occurring? Inherent in this dilemma is whether an aberration from normal is even a disease process at all. Tissue pathology plays a key role in resolving this conundrum. Although diagnoses can be challenging, there are various methodologies used in the field of pathology to ascertain whether two tumors are of the same or different origins.

Case Description: This case report reviews two patients with large ovarian neoplasms and surgical pathology revealing histopathological features of …

Simple And Epididymal-Sparing Orchiectomy For Surgical Castration In Stage Iv Prostate Cancer, Harrison Travis, Michael Dubic, Joseph Bardot, Blane Edwards, Jessie R. Gills, Scott E. Delacroix, Stephen Lacour, Matthew Mutter, Donald Bell, Mary E. Westerman

School of Medicine Faculty Publications

Background: Androgen deprivation therapy, the mainstay of treatment for patients with advanced prostate cancer, can be either medical or surgical. Surgery has cost benefits compared to medical treatment. In this study, we evaluated the use of simple and epididymal-sparing orchiectomy in 2 different practice settings for the treatment of metastatic prostate cancer. Methods: We reviewed patients who underwent surgical castration for metastatic prostate cancer between 2011 and 2022. The primary outcome was achieving castration-level total testosterone of /dL. We also compared the characteristics of patients who were seen at a public academic teaching hospital vs those who were seen at …

Renal Mass Imaging Modalities: Does Body Mass Index (Bmi) Matter?, Young Son, Mark E Quiring, Raeann M Dalton, Brian Thomas, Noah Davidson, Dayna Devincentz, Collin Payne, Sahil H Parikh, Benjamin A Fink, Thomas Mueller, Gordon Brown

Rowan-Virtua School of Osteopathic Medicine Departmental Research

PURPOSE: Accurate measurement of renal mass size is crucial in the management of renal cancer. With the burdensome cost of imaging yet its need for management, a better understanding of the variability among patients when determining mass size remains of urgent importance. Current guidelines on optimal imaging are limited, especially with respect to body mass index (BMI). The aim of this study is to discern which modalities accurately measure renal mass size and whether BMI influences such accuracy.

METHODS: A multi-institutional chart review was performed for adult patients undergoing partial or radical nephrectomy between 2018 and 2021, with 236 patients …

Improving Fertility: Evaluating The Addition Of Prednisone To Enhance The Effectiveness Of Clomid And Femara In Anovulatory Patients., Jeffrey Bradford

Biological Sciences Undergraduate Honors Theses

Chronic Anovulation and PCOS is a major infertility issue that affects the ability of many female patients to conceive and obtain a pregnancy. General anovulation is influenced by a combination of factors such as hypoandrogenism, hormonal imbalances, and an irregular menstrual cycle. The current methods of treatments include the usage of first-line medications such as Clomid and Femara or more expensive options such as menotropin regimens, Intrauterine Insemination (IUI), or In Vitro Fertilization (IVF). While Clomid and Femara remain the most common and successful method, an estimated 25% of general anovulation patients will fail to ovulate despite a maximum dosage …

Pessary Use In Urology Clinics, Kathy Z. Lu Bs, Emily Brodowsky Md, Alex Stephens Ms, Samantha Raffee Md, Humphrey Atiemo Md

Medical Student Research Symposium

Introduction: Pessaries are a non-invasive treatment option for patients with pelvic organ prolapse (POP) or stress urinary incontinence (SUI). There is currently limited data regarding pessary usage among urology patients. The aim of this study is to determine the patient characteristics that predict long term pessary usage versus surgical intervention.

Methods: A 10-year retrospective review of pessary usage in women with either SUI or POP was performed. Patients were stratified into pessary longevity of less than or greater than one year. Quality of life measures before and after pessary use included pads per day, incontinence symptom index (ISI) scores, and …

Clinical Pathway Using Arabic Written Medical Information To Improve Incontinence Healthcare Utilization, John F. Knapp, Codrut Radoiu, Emma Ross, Jack Vercnocke Md, Aron Liaw Md, Nivedita Dhar

Medical Student Research Symposium

Introduction and Objective: Metro Detroit holds ~13% of all Arabic speakers in the U.S.A. and 91% of those in Michigan. Evidence supports that patients who do not speak the local language have poor access to healthcare. This study describes our preliminary experience of managing Arabic only speaking women with bothersome stress urinary incontinence (SUI) from May 2022 to October 2023. These women routinely request same-sex interpreters, which is not always possible, leading to a lack of detailed translation. A potential solution is to use Arabic written medical information (AWMI). The purpose of the study was to retrospectively look at the …

Antiangiogenic Therapy Combined With Immune Checkpoint Blockade In Urothelial Cancer: Systematic Review And Meta-Analysis, Mohammad Jad Moussa, Iuliia Kovalenko, Emanuele Crupi, Ekaterina Proskuriakova, Yimin Geng, Giuseppe Fallara, Raed Benkhadra, Daniele Raggi, Matthew T. Campbell, Pavlos Msaouel, Omar Alhalabi

Department of Medicine Faculty Publications

Background: Antiangiogenic therapy had been tested in urothelial cancer (UC) without reaching the clinic.

Objective: We provide a systematic review and meta-analysis of trials to assess efficacy of immune checkpoint inhibitors (ICI) combined with antiangiogenic agents in UC.

Methods: Following PRISMA guidelines, we searched for trials with at least one arm of patients with UC treated with ICI plus antiangiogenics. Data were analyzed with the "meta" package from R using a one-staged frequentist meta-analysis.

Results: After screening 13,708 titles and abstracts, 9 studies were selected for analysis with 14 identified cohorts comprising 621 patients: 448 were ICI-naïve (ICI-N) and 173 …

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

Rowan-Virtua 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 …

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

Rowan-Virtua 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 …

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

Rowan-Virtua 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.

Sexual Dimorphism Of Glomerular Capillary Morphology In Rats, Zackarias Coker

Undergraduate Honors Theses

Chronic kidney disease (CKD) progresses faster in males than females; however, the underlying mechanisms remain poorly understood. Sex differences in glomerular capillary morphology has been hypothesized to contribute, in part, to the increased susceptibility to hypertension-induced renal injury and CKD progression in males, but this has not been investigated. The goal of the present study was to assess glomerular capillary morphology in male vs. female rats with intact kidneys and after uninephrectomy (UNX). We hypothesized that glomerular capillary radii (R_CAP) and length (L_CAP) would be greater in male rats.

Male (n=4) and female (n=4) with intact …

Factors Associated With Unplanned Conversion To Open In Nephrectomy For Kidney Cancer, Young Son, Benjamin A. Fink, Justine Garfinkel, Lance Earnshaw, Brian Thomas, Thomas Mueller, David Sussman

Rowan-Virtua Research Day

Minimally invasive surgery (MIS) has been adopted as an approach in kidney surgery. Laparoscopic kidney surgery has been introduced in the 1990s with robotics emerging a decade after. The minimally invasive approach has been technically feasible and has been shown to be noninferior with preserved oncology standards to open surgery. The ubiquitous use of MIS for kidney cancer has been standard of practice; however, unplanned conversion to open kidney surgery has been characterized at 4.9% for laparoscopic radical nephrectomy compared to 6.0% in robotic radical nephrectomy. Another analysis of 54,246 patients undergoing partial nephrectomy for kidney cancer observed an unplanned …

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.

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 …

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 …