Urology Commons^™

Gross Hematuria: An Unusual Presenting Symptom Of Systemic Wild-Type Transthyretinamyloidosis., Sage A. Vincent, Daniel Christensen, Perry R. Weiner

Department of Urology Faculty Papers

Amyloidosis of the urinary bladder is a rare cause of gross hematuria. In patients with systemic amyloidosis, identification is nearly always related to cardiac complaints; urologic presenting symptoms are extremely uncommon. We present a 77-year-old male patient with painless gross hematuria ultimately found to be secondary to systemic wild-type transthyretin amyloidosis. He underwent transurethral resection of the bladder lesion and was initiated on transthyretin stabilizing medication. In the 6 months since starting treatment, the patient has had no further episodes of gross hematuria, but will require cystoscopic surveillance for evidence of recurrence or concomittment urothelial carcinoma.

Acute Urinary Retention: Should We Call It A Manifestation Of Appendicitis?, Sadaf Sheikh, Umair Javed, Muhammad Akbar Baig

Department of Emergency Medicine

Acute urinary retention (AUR) is a fairly common presentation in the elderly; but interesting to be noted in a healthy young individual as a manifestation of acute appendicitis. We present a case of a 32-year gentleman with decreased urine output with mild tenderness at the supra-pubic region; which was later on, shifted to the right iliac fossa. Computed tomography of the abdomen showed acute appendicitis. Emergency physicians are challenged to recognize the uncommon presentation of acute appendicitis and need to be reminded of this common complaint as a rare presentation of it. This case also stresses on the repeated abdominal …

Safety, Efficacy And Quality Of Life Improvement In Women With Prior Stress Incontinence Surgery Treated With Autologous Muscle Derived Cells: Experience From Two Double-Blind, Randomized, Placebo-Controlled Trials, R Dmochowski, H Goldman, U Lee, L Carr, Kenneth Peters, K Benson, S Thomas, L Tu, J Bennett, Michael Chancellor

Conference Presentation Abstracts

No abstract provided.

Colonic Migration Of A Nephroureteral Stent Through A Colovesical Fistula, Nicholas Pigg, Kevin Carr, Julio Zayas, Eduardo Franca

HCA Healthcare Journal of Medicine

We describe a case of a patient with a two-year history of prostate cancer who underwent placement of nephroureteral stents. He subsequently presented to the hospital with complications from prolonged retention of the stents, which ultimately lead to a secondary diagnosis of adenocarcinoma of the rectum. A colonoscopy performed approximately two weeks after a bilateral nephroureteral tube exchange demonstrated what was believed to be locoregional metastatic disease and a fistulous connection with the distal nephroureteral stents. Radiographic features of this complication are discussed together with proper management and possible complications of distal nephroureteral stents. Both nephroureteral stents were explanted, and …

External Beam Radiation Therapy Carries Lower Risk Of Sexual Dysfunction As Compared To Radical Prostatectomy In Treatment Of Patients With Localized Prostate Cancer, Aamod S. Dekhne

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising:

Donovan JL, Hamdy FC, Lane JA, et al. Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. N Engl J Med. 2016;375(15):1425-1437. https://doi.org/10.1056/NEJMoa1606221

for a patient with localized prostate cancer and concerns regarding future sexual dysfunction.

Addressing Catheter Associated Uti In The Neuro Icu, Aria Mahtabfar, Md, Giuliana Labella, Msn, Caitlin Harley, Msn, Omar Shah, Md, Mba

Health Equity and Quality Improvement (HEQI) Summit

Increasing systemic pressures have forced clinicians to identify and address a variety of metrics to provide better “quality” care. Catheter associated UTIs (CAUTI) are a common health careassociated infection in the Neuro ICU and are associated with increased LOS and overall mortality.

Aims for Improvement: Improving the incidence of CAUTI at the Gibbon and JHN ICUs on an annual basis after incremental interventions.

Metastatic Renal Cell Carcinoma To Pancreas And Gastrointestinal Tract: A Clinicopathological Study Of 3 Cases And Review Of Literature, Jamshid Abdul Ghafar, Nasir Ud Din, Ramin Saadaat, Zubair Ahmad

Department of Pathology and Laboratory Medicine

Background: Renal Cell Carcinoma (RCC) metastasizes in approximately 20-30% cases. The most common sites for metastases are the lungs, bones, liver, and brain. Metastases of RCC in the gastrointestinal tract (GIT) are very rare. Metastatic RCC has a poor prognosis. We herein present a case series of three patients with metastatic disease in the colon, duodenum, and pancreas following complete resection of RCC.
Methods: Hematoxylin and Eosin and immunohistochemical slides of 3 cases of RCC metastatic to GIT were reviewed. These cases were diagnosed between 2002 and 2019 at French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan, and …

Retrospective Analysis Of Post-Operative Sepsis Rates, Stone Composition, And Ureteral Stent Duration After Ureteroscopy And Laser Lithotripsy During Covid-19, Young Son, Julia T. Scali, Ian Madison, Paul Chialastri, Thomas Mueller

Rowan-Virtua Research Day

Ureteroscopy with laser lithotripsy is routinely used to remove stones but results in manipulation of the genitourinary mucosa and has a well-established relationship with post-operative sepsis under certain conditions. Postoperative sepsis represents a significant morbidity and mortality cost to patients and the healthcare system. Several studies to determine risk factors for sepsis after ureteroscopy have been completed. Such risk factors include positive preoperative urine cultures, female gender, prolonged preoperative stent time > 1 month, and patients with sepsis at the time of initial stenting. To improve sepsis rates, procedural alterations such as the use of disposable ureteroscopes have been introduced, as …

An Unusual Ed Case: Scrotal Edema From A Thoracic Aortic Aneurysm In A 58-Year-Old Male, Yevgeniy Polunin, Emily Nguyen, Bhumi Shah

Rowan-Virtua Research Day

Scrotal edema is not an uncommon presentation in emergency medicine. We describe the case of a 58-year-old male with no prior medical history who presented to the emergency department (ED) due to progressive scrotal edema. The patient noted increased painless testicular enlargement, dry cough, and dyspnea on exertion over the course of several weeks. Scrotal edema was evaluated by an Ultrasound (US), showing bilateral testicular edema with concern for congestive heart failure (CHF). Computed tomography pulmonary angiography (CTPE) scan showed a large 6.51 cm thoracic aortic aneurysm (TAA), cardiomegaly with dilated left sided chambers, and a small pericardial effusion. Subsequently, …

Kidney Rupture: An Unusual Cause Of Abdominal Pain, Flank Pain And Hematuria In A 72-Year-Old Female, Monica Diep, Neelesh Parikh

Rowan-Virtua Research Day

Flank pain, abdominal pain and hematuria are common complaints in emergency medicine. We describe the case of a 72-year-old female who presented to the emergency department for worsening left lower quadrant abdominal pain and left flank pain associated with new-onset hematuria. The patient reports the pain started immediately after she accidentally tripped on a rock while trying to avoid a mailman in an attempt to socially distance due to the COVID-19 pandemic, which resulted in a forceful twist of her body and catching herself with her hands without any direct impact to her body. The patient reports the pain gradually …

Metastatic Adenocarcinoma Of The Prostate To The Brain Initially Diagnosed As Meningioma By Craniotomy: A Case Report, Julia T. Scali, Young Son, Paul Chialastri, Thomas Mueller

Rowan-Virtua Research Day

Prostate cancer is the second leading cause of cancer death in men after lung cancer. The most common site of prostate metastasis is bone (84%), lymph node (10.6%), liver (10.2%), and thorax (9.1%), with 18.4% to multiple metastatic sites [1]. Prostate metastasis to the brain is rare, with less than 1% documented cases from M.D. Anderson Cancer Center [2]. It is estimated that 1%-6% of prostate cancer metastasis is found in post mortem examination [3]. Parenchymal brain metastasis has a mean survival of 9.2 months after discovery of brain metastasis [4]. Acute neurological symptoms of metastatic prostate cancer are observed …

Osteopathic Touch: The Best Diagnostic & Therapeutic Tool - Osteopathic Diagnosis & Treatment For Nephrolithiasis, Bilal Khan, Motasem Abul-Huda, Alexander King

Rowan-Virtua Research Day

Osteopathic Manipulative Therapy (OMT) is a set of osteopathic techniques that involves manipulation of the musculoskeletal system using the hands. It offers a supplement to standard modes of diagnosis and treatment, and is a key component of the osteopathic holistic approach to medicine.

Despite growing numbers of osteopathic physicians in the United States, OMT continues to be an underutilized asset in a plethora of medical conditions. With the merger of osteopathic and allopathic residency programs, restructuring of standardized curricula to a pass/fail format, and further changes uniting the two tracks of physician education, OMT remains one of the few facets …

Evaluation Of Glutaminase Expression In Prostate Adenocarcinoma And Correlation With Clinicopathologic Parameters, Zin W. Myint, Ramon C. Sun, Patrick J. Hensley, Andrew C. James, Peng Wang, Stephen E. Strup, Robert J. Mcdonald, Donglin Yan, William H. St. Clair, Derek B. Allison

Internal Medicine Faculty Publications

High Glutaminase (GLS1) expression may have prognostic implications in colorectal and breast cancers; however, high quality data for expression in prostate cancer (PCa) are lacking. The purpose of this study is to investigate the status of GLS1 expression in PCa and correlated expression levels with clinicopathologic parameters. This study was conducted in two phases: an exploratory cohort analyzing RNA-Seq data for GLS1 from The Cancer Genome Atlas (TCGA) data portal (246 PCa samples) and a GLS1 immunohistochemical protein expression cohort utilizing a tissue microarray (TMA) (154 PCa samples; 41 benign samples) for correlation with clinicopathologic parameters. In the TCGA cohort, …

An Assessment Of The Impact Of Flow Disruptions On Mental Workload And Performance Of Surgeons During Percutaneous Nephrolithotomy, Sana Hussain, Syed Muhammad Nazim, Basit Salam, Nida Zahid, Hammad Ather

Section of Urology

Objective: The aim of this study was to assess the impact of intraoperative disruptions on surgeons’ workload and performance during percutaneous nephrolithotomy (PCNL).
Materials and methods: A structured and standardized tool was used to identify disruptions and interferences that occurred during 33 PCNL procedures. The surgical steps during PCNL were divided into four phases: ureteric catheter placement (phase I), puncture and tract dilation (phase II), intra-calyceal navigation and stone fragmentation (phase III), and tube placement (phase IV). Surgeons’ workload was evaluated using a validated tool: Surgery Task Load Index (SURG-TLX), and correlated with the mean observed intraoperative disruptions. All operating …

Hydronephrosis Classifications: Has Utd Overtaken Apd And Sfu? A Worldwide Survey., Santiago Vallasciani, Anna Bujons Tur, John Gatti, Marcos Machado, Christopher S. Cooper, Marie Klaire Farrugia, Huixia Zhou, Mohammed El Anbari, Pedro-José Lopez

Manuscripts, Articles, Book Chapters and Other Papers

Objective: To collect baseline information on the ultrasonographic reporting preferences.

Method: A 13-multiple choice questionnaire was designed and distributed worldwide among pediatric urologists, pediatric surgeons, and urologists. The statistical analysis of the survey data consisted of 3 steps: a univariate analysis, a bivariate and a multivariate analysis.

Results: Three hundred eighty participants responded from all the continents. The bivariate analysis showed the significant differences in the geographical area, the years of experience and the volume of cases. Most of the physicians prefer the SFU and APD systems because of familiarity and simplicity (37 and 34%, respectively). Respondents noted that their …

Indwelling Urinary Catheter Removal Houdini Protocol, Fatima Villacruz

Student Scholarly Projects

Practice Problem: Catheter-associated urinary tract infections (CAUTIs) in spinal cord injury (SCI) patients have many negative health consequences, including increased cost, increased length of hospital stays, delay in bladder training, increased associated infections, and mortality.

PICOT: The PICOT question that guided this project was: In adult SCI patients (P), does the implementation of a nurse-driven indwelling urinary catheter removal protocol (I), compared to without a nurse-driven protocol (C), decrease the indwelling urinary catheter days and the occurrence of CAUTIs (O) within six weeks (T)? Evidence: Nurse-driven discontinuation protocols are an effective method of decreasing indwelling urinary catheter (IUC) days and …

Modern Approaches For Antiandrogen-Resistant Prostate Cancer Therapy, Felix Voinea, Laura Mazilu, Ioan Sergiu Micu, Adrian Paul Suceveanu, Madalina Iliescu, Andrada Dumitru, Vlad Denis Constantin, Ioana Paunica, Andra Iulia Suceveanu

Journal of Mind and Medical Sciences

Prostate cancer represents the leading malignant tumor in men over 50 years of age with 400,000 new cases being diagnosed yearly in Europe. Even if the incidence rate is higher than the mortality rate, still there is an increasing trend when speaking of its mortality. The increasing incidence of the metabolic syndrome, the unhealthy lifestyle, the high lipid and Calcium intake, the high spread of infections with Human Papilloma Virus, Human Herpes Virus, the excess of androgen consumption and the longer life expectancy, are few of the main causes of prostate cancer increasing incidence. The new systemic therapies such as …

The Analysis Of Risk Factors Associated With Women's Urinary Incontinence; Literature Review, Denisa Oana Balalau, Octavian Gabriel Olaru, Nicolae Bacalbasa, Stana Paunica, Daniela Gabriela Balan, Anca Daniela Stanescu

Journal of Mind and Medical Sciences

Urinary incontinence (UI) is a common condition among women. Approximately 50% of them had an involuntary loss of urine at least once in their lifetime. It can be present during sexual activity, contributing to sexual dysfunction and often associated with anxiety or even depression, thus having a negative impact on the quality of life. The incidence of UI is related to the existence of predisposing factors. The best known are: age, weight, family history, race/ ethnicity, number of pregnancies and mode of birth, history of genitourinary interventions and factors related to ordinary habits: smoking, caffeine consumption, oral contraceptives. Studies on …

Determination Of Reference Interval (Ri) Of Spot Urinary Oxalate To Creatinine Ratio In Children Of Pakistani Origin Under Six Years Of Age: A Cross-Sectional Study, Syed Bilal Hashmi, Lena Jafri, Jamsheer Jehangir Talati, Hafsa Majid, Saqib Hamid Qazi, Aysha Habib Khan

Department of Pathology and Laboratory Medicine

Background: The gold standard screening method of hyperoxaluria in children is using 24-hour urine collection. Urine collection may be cumbersome and challenging for children. Reference intervals (RI) of oxalate for the Pakistani population are not readily available. Therefore we aimed to determine the oxalate to creatinine ratio (Ox: Cr) for Pakistani children <6 years of age.
Materials and methods: A cross-sectional study was conducted at Aga Khan University from June 2018 to October 2019. Random urine samples from apparently healthy children < 6 years were collected and stored at -30°C until analysis after adding 6M HCl. Oxalate was measured on Micro lab 300 using a kit based on oxalate oxidase principle, while creatinine was measured by kinetic Jaffe reaction. Data was analyzed by EP evaluator and SPSS 23. Ox: Cr ratio was calculated and reported with 90% confidence interval (CI) and interquartile range (IQR).
Results: The mean age of study subjects (n=120) was 29 ±22.3 months with an M: F ratio of 1:1. Children of various ethnicities …

Expression And Function Of Transcription Factors Foxa1, Hoxb13 And Cdx2 In Prostate Cancer, Hamsat B. Anwar

University Honors Theses

Prostate cancer (PC) is the second leading cause of death in men, affecting around 190 thousand patients in 2020 alone (National Institute of Cancer, 2020). Much of the current research focuses on treatments for advanced PC, which is problematic due to the rapid evolution of tumors and development of treatment resistance. Cancer early detection presents a better approach to control and treat patients before they acquire an incurable disease. Earlier diagnosis of patients leads to better prognosis and a more comfortable treatment process (Etzioni et al., 2003). However, we currently lack molecular markers to stratify PC during its early stages. …

Analysis Of 114 Pedigrees Of Renal Stone Patients: A Retrospective Review, Syed Raziuddin Biyabani, Jamsheer Jehangir Talati, Daniya Umer, Zehra Kazmi, Hussam Uddin Soomro, Rubab Mansoor

Section of Urology

Background: Renal and ureteric stones (RS) can form due to genetic, metabolic, environmental, and diet-hydration related factors. Studies have shown that patients with family history (FH) of RS have higher likelihood of recurrence.
Materials and methods: We conducted a retrospective cross-sectional study on 114 pedigrees to investigate the impact of FH on recurrence of RS and examine patterns of inheritance. Results: Family history of renal stone disease was found in 42% of all patients. There was a significant increase of stone recurrence in RS patients with a positive FH (p=0.001). Seventy-one percent of patients with recurrent stones had at least …

Non-Invasive Predictors Of Response To Tamsulosin For Benign Prostatic Obstruction, Mohammad Shoaib, Muhibullah Bangash, Wajahat Aziz, Hammad Ather

Section of Urology

Objectives: To identify non-invasive predictors of response to tamsulosin 0.4 mg in patients with benign prostatic obstruction (BPO).
Methods: Males ≥ 50 years of age with lower urinary tract symptoms (LUTS) suggestive of BPO for over three months were included in the study. We assessed change in the mean International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax) after six weeks of medical therapy. Clinical and uroflowmetry parameters were compared between two groups of patients with >25% vs. <25% change in the IPSS after treatment. Pre- and post-treatment post-void residue (PVR), Qmax, and IPSS were compared by independent t-test, univariate/multivariate regression analysis.
Results: A total of 121 patients were included. At presentation, the mean prostate size was 35.7±12.2 grams and the mean IPSS …

Collaborative Review: Factors Influencing Treatment Decisions For Patients With A Localized Solid Renal Mass., Thenappan Chandrasekar, Stephen A. Boorjian, Umberto Capitanio, Boris Gershman, Maria Carmen Mir, Alexander Kutikov

Department of Urology Faculty Papers

CONTEXT: With the addition of active surveillance and thermal ablation (TA) to the urologist's established repertoire of partial (PN) and radical nephrectomy (RN) as first-line management options for localized renal cell carcinoma (RCC), appropriate treatment decision-making has become increasingly nuanced.

OBJECTIVE: To critically review the treatment options for localized, nonrecurrent RCC; to highlight the patient, renal function, tumor, and provider factors that influence treatment decisions; and to provide a framework to conceptualize that decision-making process.

EVIDENCE ACQUISITION: A collaborative critical review of the medical literature was conducted.

EVIDENCE SYNTHESIS: We identify three key decision points when managing localized RCC: (1) …

Testicular Dislocation After Unstable Pelvic Ring Injury., Zachary Bernhard, Devon Myers, Braden J Passias, Benjamin C Taylor, Joaquin Castaneda

Trauma and Acute Care Articles

Reproductive and genitourinary complications following pelvic ring injuries have been described; however, testicular dislocation is rare and can cause significant morbidity if not managed appropriately. We describe a case of testicular dislocation after pelvic ring injury and outline the subsequent management and outcome, and seek to identify areas of improvement to ensure expedient and appropriate care in the setting of these injuries. Our case describes a 29-year-old male who presented to a level-one trauma center following a motorcycle collision. An anteroposterior compression type II rotationally unstable pelvic ring was identified on imaging. He was hemodynamically unstable and computed tomography (CT) …

Urosim, Robert Abishek, Bryan Nardone, Jasmine Wang, Christopher Wetzel, Rob Pugliese

Phase 1

Designing a more cost-efficient method for ureteroscopy simulation training that involves 3D printing an anatomically-accurate model of a patient’s renal pelvicalyceal system.

Two-Year Outcomes Of The Artisan-Snm Study For The Treatment Of Urinary Urgency Incontinence With The Axonics Rechargeable Sacral Neuromodulation System, Andrea Pezzella, Rebecca Mccrery, Felicia Lane, Kevin Benson, Chris Taylor, Kenneth M. Peters

Conference Presentation Abstracts

Introduction: Sacral neuromodulation is a guideline-recommended therapy for treatment of urinary urgency incontinence (UUI) patients [1]. The Axonics® System is the first FDA-approved rechargeable SNM system that is qualified to delivery therapy for at least 15 years. The ARTISAN-SNM study is a prospective, pivotal study, designed to evaluate the safety and effectiveness of the Axonics System for UUI treatment. Clinical outcomes at 2 years are presented. Methods: 129 UUI participants across 19 centers in the US and Europe were implanted with the Axonics System in a single, non-staged procedure. Clinical outcomes were reported from 3-day bladder diaries, a validated quality …

Changes In Patient Reported Outcome Measures After Treatment Of Female Urethral Stricture, Alyssa Gracely, Giulia I. Lane, Pansy Uberoi, Una Lee, Ariana Smith, Priya Padmanabhan

Conference Presentation Abstracts

Introduction: There is a paucity of patient reported outcome measures (PROM) data for women with urethral strictures. Prior literature focuses on anatomic success, with almost no data describing patient centered outcomes. To fill this critical gap, we aim to evaluate change in PROM among women who underwent surgery for stricture. Methods: Data were collected as part of a multiinstitutional retrospective cohort study of women treated for urethral stricture between 2010-19. Median change between baseline and postoperative follow-up on the American Urological Association Symptom Index (AUA-SI) and Urinary Distress Inventory (UDI-6) were assessed using paired Wilcoxon signed-rank tests. Results: Of the …

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: Previous studies have shown that the fractional carbon dioxide (fCO2) vaginal laser improves genitourinary symptoms of menopause. It has been proposed that 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 patient complaining of SUI. Methods: Women over 18 years old with complaints of urogenital symptoms who had been off vaginal estrogen for at least three months were enrolled in this open-label prospective trial. Participants received 3 laser treatments approximately 6 weeks apart. Stress test was performed on …

Are Consortia Polymicrobial Urinary Tract Infections More Symptomatic Than Monomicrobial? Results From A Multi-Institutional Study, Annah Vollstedt, Dakun Wang, Natalie Luke, David Baunoch, Kirk J. Wojno, Kevin Cline, Natalie Gaines, Howard Korman, S Mohammad Jafri, David Wenzler, Frank Burks, Larry Sirls

Conference Presentation Abstracts

Introduction: Polymerase chain reaction (PCR) has been shown to be more sensitive in the detection of polymicrobial infections in patients with urinary tract infection (UTI). Bacterial consortia are non-random communities of microbes that may act synergistically to provide growth and survival advantages. We aim to investigate the relationship between bacteria detected by PCR, and the presence of consortia, with clinical findings in patients with symptomatic UTI. Methods: We performed a retrospective analysis of 2493 UTI-symptomatic patients over the age of 60 from 37 geographically disparate urology clinics in the U.S. from July 2018 to February 2019. Clinical findings, including UA …

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

Conference Presentation Abstracts

Introduction: Pudendal neuralgia is a chronic and debilitating condition with 10- 25% of patients refractory to traditional therapies including sacral neuromodulation. Prior studies have shown chronic pudendal nerve stimulation with Interstim® (Medtronic, Inc., Minneapolis, MN) is effective for this patient population. 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 pudendal neuralgia who had a lead placed at the pudendal nerve and powered wirelessly according to patient need. Clinical outcomes were assessed at post-operative visits as well as phone calls. Non-validated …