Urology Commons^™

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. …

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 beyond protocol, is …

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 …

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 …

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

West Florida Division GME Research Day 2020

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 …

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 …

Kidney Stone Analysis And Spiritual Guides (Pir Faqir): The Known-Unknowns, Lena Jafri, Aysha Habib Khan, Humaira Asif

Department of Pathology and Laboratory Medicine

No abstract provided.

The Financial Burden Of The Urology Match: Room For Improvement, Jinfeng Jiang, Joshua S. Engelsgjerd, Chad A. Lagrange, Christopher M. Deibert

Graduate Medical Education Research Journal

Abstract

Introduction/ Background – The Urology match remains highly competitive, but there is limited published data on the costs of the application process for contemporary applicants. This study aims to determine the financial burden of the Urological match and the effect it has on applicants.

Methods/ Materials – All applicants to the University of Nebraska Medical Center (UNMC) Urology Residency in the 2019 Urology match were invited to complete an anonymous, IRB approved online survey containing 16 questions on interview travel and costs, financial aid, and debt burden.

Results – Thirty-nine out of 183 (21%) applicants responded to the survey. …

Prognostic Nomogram For Bladder Cancer With Brain Metastases: A National Cancer Database Analysis., Zhixian Yao, Zhong Zheng, Wu Ke, Renjie Wang, Xingyu Mu, Feng Sun, Xiang Wang, Shivank Garg, Wenyin Shi, Yinyan He, Zhihong Liu

Department of Radiation Oncology Faculty Papers

BACKGROUND: This study aimed to establish and validate a nomogram for predicting brain metastasis in patients with bladder cancer (BCa) and assess various treatment modalities using a primary cohort comprising 234 patients with clinicopathologically-confirmed BCa from 2004 to 2015 in the National Cancer Database.

METHODS: Machine learning method and Cox model were used for nomogram construction. For BCa patients with brain metastasis, surgery of the primary site, chemotherapy, radiation therapy, palliative care, brain confinement of metastatic sites, and the Charlson/Deyo Score were predictive features identified for building the nomogram.

RESULTS: For the original 169 patients considered in the model, the …

Targeting Dna Repair In Metastatic Castration-Resistant Prostate Cancer (Mcrpc): Genomic Screening For A Clinical Trial Of Rucaparib, Alan Bryce, Mitchell E. Gross, Charles Redfern, Nicholas Vogelzang, Matthew Rettig, Thomas Stanton, Julie N. Graff, Sandhya Srinivas, Andrea Loehr, Wassim Abida

Articles, Abstracts, and Reports

Objectives: The high prevalence of men with mCRPC carrying pathogenic mutations in DNA damage repair (DDR) genes may have implications for clinical treatment, as poly(ADP-ribose) polymerase (PARP) inhibitors, such as rucaparib, have shown preliminary evidence of activity in these patients. The ongoing phase 2 TRITON2 study (NCT02952534) is evaluating rucaparib in mCRPC patients harboring a deleterious germline or somatic mutation in BRCA1, BRCA2, ATM, or other DDR gene. Here we present results from genomic screening of tissue and plasma samples from mCRPC patients.

Methods: Comprehensive genomic profiling was performed by Foundation Medicine, Inc., using FFPE tumor tissue …

Holep Vs Bipolar Turp As Same Day Surgery: Analysis Of Length Of Stay And Costs, Michael Su Ms4, Sarah Azari Ms4, Jacob Rust Md, Alexis R. Brown Pa-C, Clifford Georges Md, James Johannes Md

Department of Medicine

No abstract provided.

Comparison Of Mri- And Trus-Informed Prostate Biopsy For Prostate Cancer Diagnosis In Biopsy-Naive Men: A Systematic Review And Meta-Analysis., Hanan Goldberg, Ardalan E. Ahmad, Thenappan Chandrasekar, Laurence Klotz, Mark Emberton, Masoom A. Haider, Samir S. Taneja, Karan Arora, Neil Fleshner, Antonio Finelli, Nathan Perlis, Mark D. Tyson, Zachary Klaassen, Christopher J.D. Wallis

Department of Urology Faculty Papers

PURPOSE: Multiparametric magnetic resonance imaging (mpMRI) with informed targeted biopsies (TGBX) has changed the paradigm of prostate cancer (PCa) diagnosis. Randomized studies have demonstrated a diagnostic benefit of Clinically significant (CS) for TGBX compared to standard systematic biopsies (SBX). We aimed to evaluate whether mpMRI-informed TGBX has superior diagnosis rates of any-, CS-, high-grade (HG)-, and clinically insignificant (CI)-PCa compared to SBX in biopsy-naive men.

METHODS: Data was searched in Medline, Embase, Web of Science, and Evidence-based medicine reviews-Cochrane Database of systematic reviews from database inception until 2019. Studies were selected by two authors independently, with disagreements resolved by consensus …

Incorporating Mpmri Biopsy Data Into Established Pre-Rp Nomograms: Potential Impact Of An Increasingly Common Clinical Scenario, Joon Yau Leong, Jaime O. Herrera-Caceres, Hanan Goldberg, Elwin Tham, Seth Teplitsky, Leonard G. Gomella, Neil E. Fleshner, Costas D. Lallas, Edouard J. Trabulsi, Thenappan Chandrasekar

Department of Urology Faculty Papers

Background: We examine the practical application of multiparametric MRI (mpMRI) prostate biopsy data using established pre-RP nomograms and its potential implications on RP intraoperative decision-making. We hypothesize that current nomograms are suboptimal in predicting outcomes with mpMRI targeted biopsy (TBx) data.

Materials and methods: Patients who underwent mpMRI-based TBx prior to RP were assessed using the MSKCC and Briganti nomograms with the following iterations: (1) Targeted (T) (targeted only), (2) Targeted and Systematic (TS) and (3) Targeted Augmented (TA) (targeted core data; assumed negative systematic cores for 12 total cores). Nomogram outcomes, lymph node involvement (LNI), extracapsular extension (ECE), organ-confined …

Twitter And Academic Urology In The United States And Canada: A Comprehensive Assessment Of The Twitter-Verse In 2019., Thenappan Chandrasekar, Hanan Goldberg, Zachary Klaassen, Christopher J. Wallis, Joon Yau Leong, Spencer Liem, Seth Teplitsky, Rodrigo Noorani, Stacy Loeb

Department of Urology Faculty Papers

OBJECTIVE: To provide the first comprehensive analysis of the Twitter-verse amongst academic urologists and programs in North America.

METHODS: Using national accreditation and individual program websites, all active urology residency programs (USA & Canada) and academic Urology faculty at these programs were identified. Demographic data for each program (AUA section, resident class size) and physician (title, fellowship training, Scopus H-index and citations) were documented. Twitter metrics (Twitter handle, date joined, # tweets, # followers, # following, likes) for programs and physicians were catalogued (data capture: March-April 2019). Descriptive analyses and temporal trends in Twitter utilization amongst programs and physician were …

Conservative Surgical Treatment In Cervical Dysplastic Lesions Associated With Cystorectocele, Bogdan Marian Puca, Anca D. Braila, Cosmin V. Obleaga, Mihai Braila, Hany Saad, Cristian Lungulescu, Mihai Deca

Journal of Mind and Medical Sciences

The treatment of cervical intraepithelial neoplasia aims at removing the squamocolumnar junction area, including abnormal tissues, up to the healthy tissue. Old postpartum perineal tears associated with cystorectocele, hypertrophic cervical elongation, and first and second degree uterine prolapse are pelvic static disorders. Particular aspects of pelvic-genital static disorder are related to the vulnerability of the pelvic-perineal floor during birth. On the occasion of birth, especially when there are different forms of dystocia during labor, the degradation of soft pelvic, genital, and vaginal-perineal tissues can occur. The objective of this study was to re-evaluate the conservative treatment of cervical dysplasia, depending …

High-Fat Diet Fuels Prostate Cancer Progression By Rewiring The Metabolome And Amplifying The Myc Program., David P. Labbé, Giorgia Zadra, Meng Yang, Jaime M Reyes, Charles Y Lin, Stefano Cacciatore, Ericka M. Ebot, Amanda L. Creech, Francesca Giunchi, Michelangelo Fiorentino, Habiba Elfandy, Sudeepa Syamala, Edward D. Karoly, Mohammed Alshalalfa, Nicholas Erho, Ashley Ross, Edward M. Schaeffer, Ewan A. Gibb, Mandeep Takhar, Robert B. Den, Jonathan Lehrer, R. Jeffrey Karnes, Stephen J. Freedland, Elai Davicioni, Daniel E. Spratt, Leigh Ellis, Jacob D. Jaffe, Anthony V. DʼAmico, Philip W. Kantoff, James E. Bradner, Lorelei A. Mucci, Jorge E. Chavarro, Massimo Loda, Myles Brown

Department of Radiation Oncology Faculty Papers

Systemic metabolic alterations associated with increased consumption of saturated fat and obesity are linked with increased risk of prostate cancer progression and mortality, but the molecular underpinnings of this association are poorly understood. Here, we demonstrate in a murine prostate cancer model, that high-fat diet (HFD) enhances the MYC transcriptional program through metabolic alterations that favour histone H4K20 hypomethylation at the promoter regions of MYC regulated genes, leading to increased cellular proliferation and tumour burden. Saturated fat intake (SFI) is also associated with an enhanced MYC transcriptional signature in prostate cancer patients. The SFI-induced MYC signature independently predicts prostate cancer …

Medical Evaluation And Management Of Male And Female Voiding Dysfunction: A Review., Alana Murphy, Seth Teplitsky, Akhil K. Das, Joon Yau Leong, Andrew Margules, Costas D. Lallas

Department of Urology Faculty Papers

A significant workforce shortage of urologists available to serve the US population has been projected to occur over the next decade. Accordingly, much of the management of urologic patients will need to be assumed by other specialties and practitioners. Since primary care physicians are often first evaluate common urologic complaints, it makes sense that these physicians are in an excellent position to intervene in the management of these patients when appropriate. One of the most common complaints in urology is voiding dysfunction. The incidence of voiding dysfunction increases with age, with conservative estimates showing that over 50% of elderly patients …

Antimicrobial Sensitivity Pattern, Demographic Findings And Risk Factors Amongst Meningitis And Non-Meningitis Invasive Streptococcus Pneumoniae At Aga Khan University Hospital Clinical Laboratory, Karachi, Pakistan, Seema Irfan, Joveria Farooqi, Afia Zafar, Haresh Kumar

Department of Pathology and Laboratory Medicine

Objective: To determine the resistance rate of penicillin and ceftriaxone amongst invasive meningitis and nonmeningitis isolates of streptococcus pneumoniae. Methods: The prospective cross-sectional study was conducted from January 2011 to March 2014 at the Clinical Microbiology Laboratory of Aga Khan University, Karachi, and comprised all invasive strains of streptococcus pneumoniae. Penicillin and ceftriaxone susceptibilities were performed and interpreted based on minimum inhibitory concentration breakpoints recommended by Clinical and Laboratory Standards Institute guidelines. Data was analysed using Stata 12.
Result: There were 163 strains isolated from sterile body fluids of 109 patients. Of the total, 46(28%) samples were meningitic while 117(72%) …

Prevalence Of Suspected Hereditary Cancer Syndromes And Germline Mutations Among A Diverse Cohort Of Probands Reporting A Family History Of Prostate Cancer: Toward Informing Cascade Testing For Men., Thenappan Chandrasekar, Laura Gross, Leonard G. Gomella, Sarah E. Hegarty, Joon Yau Leong, Veda N. Giri

Department of Urology Faculty Papers

BACKGROUND: Prostate cancer (PCa) is increasingly recognized as part of hereditary cancer syndromes (HCSs). HCS prevalence among diverse probands seeking genetic evaluation with PCa family history (FHx) has not been reported and has implications for cascade genetic testing.

OBJECTIVE: To evaluate the rates of HCSs among probands reporting PCa FHx and germline mutations among probands.

DESIGN, SETTING, AND PARTICIPANTS: A prospective genetic testing database queried for individuals with PCa FHx. Pedigrees analyzed for three HCSs: hereditary breast and ovarian cancer (HBOC), hereditary PCa, and Lynch syndrome.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Associations between HCS overall, and with plausible link to …