Urology Commons^™

Reimbursement Incentive Associated With Decreased Inpatient Opioid Prescribing Following Robotic Radical Prostatectomy, Brett Watson, Ross Touriel, Joshua Volin, Frank Burks

Conference Presentation Abstracts

Introduction: Various strategies have been explored to decrease the quantity of opioids prescribed for post-operative pain. The Michigan Opioid Prescribing Engagement Network, in partnership with BCBS-Michigan, has developed a pain optimization pathway for several surgical procedures, including prostatectomy. Urologists who follow the pain optimization pathway, which includes pre-operative patient education and limiting discharge opioids to 6 tablets of oxycodone 5 mg, can report a modifier for additional reimbursement. We explored the impact of this incentive on inpatient opioid prescribing practices following robotic assisted radical prostatectomy (RARP). Methods: Patients undergoing RARP between January 2017 and August 2019 at a single institution …

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: It has been proposed that fractional carbon dioxide (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 patients complaining of SUI. Methods: This is a prospective, open-label study of women over 18 years old with complaints of urogenital symptoms. Women with a history of vaginal estrogen use within the last 3 months were excluded. Participants received 3 laser treatments 6 weeks apart. Cough stress test (CST) was performed at each visit. Incontinence-Quality of Life (I-QOL), Questionnaire for Urinary …

A Comparative Analysis Of Pelvic Fracture Urethral Injury Repairs In U.S. And Third World Country Patients, Jacob Stephens, Daniel Rosenstein, Frank Burks

Conference Presentation Abstracts

Introduction: Pelvic fracture urethral injury (PFUI) often results from significant, high energy trauma such as motor vehicle accidents or crush injuries. PFUI doesn’t spare those in third-world countries who may not have access to reliable healthcare. We aim to compare outcomes of PFUI repair in the US and third-world countries. Methods: A retrospective chart review and comparative analysis were performed on patients who had a PFUI repair during international trips to Haiti and Rwanda and a cohort of US patients from 2014-2020. FNB performed all US repairs while FB and DR collaborated internationally with local urologists. Results: A total of …

Acute Segmental Testicular Infarction Resulting From Illicit Anabolic Steroid Use, Jacob Stephens, Frank Burks

Conference Presentation Abstracts

Introduction: Segmental testicular infarction (STI) is a rare cause of acute scrotum of unknown etiology. The diagnosis is often made by color Doppler ultrasonography (CDUS) demonstrating absent perfusion in a well-defined testicular region. Previously patients underwent surgical exploration, but currently conservative therapy is recommended. Methods: We report a case of STI related to anabolic steroid use. Results: A 44-year-old male with a history of hypertension presented to the emergency room with acute, severe right testicular pain which was unprovoked and constant. Physical exam was notable only for tenderness at the inferior right testicle. CDUS showed small bilateral hydroceles but preserved …

Metastatic Crohn's Disease: A Case Of Genital Cutaneous Crohn's Disease Involving The Penis And Scrotum, Zubin Shetty, Megen Schober

Conference Presentation Abstracts

Introduction: Crohn’s disease is an autoimmune inflammatory disorder affecting the gastrointestinal tract. Rarely, Crohn’s disease can cause cutaneous manifestations that are non-contiguous with the GI tract or “metastatic.” Genital Cutaneous Crohn’s Disease (CCD) is the most frequent presentation of CCD in the pediatric population and has shown to be difficult to manage. Case: A 13-year-old boy with a history of fistulizing Crohn’s disease presented with severe penile and scrotal edema for the previous 4 years. While his gastrointestinal symptoms were responsive to Adalimumab, his genital swelling only minimally and temporarily improved between treatments. He was referred to pediatric urology for …

The Altis Mid-Urethral Sling: One Surgeon's Experience With Immediate Post-Operative Adjustment, Jennifer Nguyen, Brett Friedman, Annah Vollstedt, Mireya Diaz, Ly Hoang Roberts, Larry Sirls

Conference Presentation Abstracts

Introduction: The Altis® transobturator sling uses a dynamic anchor on a pulley suture for intraoperative tension adjustment. Given the potential for over-tensioning seen with any sling, we have adopted a technique using the pulley suture that allows for sling tightening should stress urinary incontinence (SUI) persist in the immediate post-operative period or sling loosening if there is bladder outlet obstruction. Our objective is to describe our technique and rate of post-operative adjustment. Methods: In this single-surgeon experience, retrospective chart review, demographic and clinical data were collected on patients who had received the Altis® sling between 2014 and 2020. Descriptive statistics …

Patient Reported Outcomes Of Urinary Incontinence Rates Using Viable Cryopreserved Umbilical Tissue Over Neurovascular Bundles During Robotic Assisted Radical Prostatectomy, Samantha Kraemer, Mit Shah, Chirag Dave, Ji Qi, Fionna Sun, Sugandh Shetty, Brian Seifman, Jason Hafron

Conference Presentation Abstracts

Introduction: Incontinence remains a side effect from robotic assisted radical prostatectomy (RAP) for prostate cancer despite nerve sparing (NS) techniques. Use of growth factors and anti-inflammatory substances over neurovascular bundles is an emerging technique to enhance recovery of continence and potency. Viable cryopreserved umbilical tissue (vCUT) is FDA approved for homologous use in surgery. The objective is to determine if vCUT use in NS-RAP accelerates return to continence. Methods: Retrospective review of 176 patients who underwent NS-RAPs from October 2015 through July 2020 were identified through the Michigan Urological Surgery Improvement Collaborative (MUSIC). Return to social urinary continence (0-1 pads …

A Novel Approach To Short Bulbar Urethral Strictures: Ventral Urethrotomy For A Non-Transection Excision And Primary Anastomosis, Alexander Geisenhoff, Samantha Kraemer, Frank Burks

Conference Presentation Abstracts

Introduction: Excision and primary anastomosis (EPA) has been the gold standard procedure for definitively managing short bulbar urethral strictures. A non-transecting approach was developed to help preserve proximal blood supply of the urethra. The previously described technique involves a dorsal urethrotomy and excision of the stricture without disrupting the anterior spongiosum. We describe a novel approach by performing a ventral urethrotomy leaving the posterior spongiosum intact. By not requiring urethral rotation, we believe this technique is simpler and does not compromise outcomes. Methods: Retrospective chart review was performed on 8 consecutive patients from April 2019 to February 2021 who underwent …

A Rare Case Of Pure N4-Acetyl-Sulfaethoxazole Nephrolithiasis Associated With Trimethoprim-Sulfamethoxazole Treatment Of Pulmonary Nocardiosis, Alexander Geisenhoff, Sugandh Shetty

Conference Presentation Abstracts

Introduction: Trimethoprim-sulfamethoxazole is a commonly used antibiotic for treatment of urinary tract infections (UTIs). It is also commonly used to treat nocardia infections. Less common are reports of nephrolithiasis consisting purely of N4-acetyl-sulfamethoxazole, the primary metabolite of trimethoprim-sulfamethoxazole. Case: A 70-year-old male with history of mantle cell lymphoma and T-cell leukemia treated with bone marrow transplant now with nocardia lung infection receiving trimethoprimsulfamethoxazole for the past 6 months who presented to the emergency room with confusion and a fall. He had no prior history of nephrolithiasis, but during hospitalization developed renal colic and was found to have obstructing right proximal …

Multi-Institutional Outcomes Of A One-Sided Dorsal Onlay Buccal Mucosal Urethroplasty For Penile Urethral Strictures Accessed Via A Penoscrotal Incision, David Abramowitz, Felicia Balzano, Jay Simhan, Frank Burks, Dmitriy Nikolavsky, Stephen Blakely

Conference Presentation Abstracts

Introduction: Optimal surgical management of penile urethral strictures remains unclear. Herein, we report our multi-institutional series of patients undergoing a one-sided dorsal onlay buccal mucosal urethropalsty for penile urethral strictures accessed via a penoscrotal invagination technique. Methods: We retrospectively reviewed consecutively treated penile urethral stricture patients who underwent a one-sided dorsal onlay buccal mucosal urethroplasty accessed via a penoscrotal incision and penile invagination across 7 institutions. This technique is a modification of the Kulkarni invagination technique to include penoscrotal rather than perineal incision for penile strictures. Thus, allowing for supine positioning, and less dissection to reach the stricture location. Minimum …

Concordance Between Antibiotic Resistance Genes By Multiplex Polymerase Chain Reaction And Antibiotic Susceptibility By Pooled Antibiotic Sensitivity Testing In Symptomatic Patients With Urinary Tract Infection, Annah Vollstedt, Dakun Wang, Natalie Luke, David Baunoch, Kirk J. Wojno, Howard Korman, Natalie Gaines, Shuguang Huang, S Mohammad Jafri, David Wenzler, Patrick Cacdac, Frank Burks, Larry Sirls

Conference Presentation Abstracts

Introduction: Studies have shown many genes influence antibiotic resistance, and the relationship between genotypic and phenotypic antibiotic resistance is unclear. We sought to analyze the concordance between the presence of antibiotic resistance (ABR) genes and antibiotic susceptibility results. Methods: Urine samples were collected from patients presenting with possible UTI to 37 Urology clinics from July 2018 to February 2019. Multiplex polymerase chain reaction (M-PCR) was used to test for 33 ABR genes. Pooled Antibiotic Susceptibility Testing (P-AST) was performed against 14 different antibiotics. The concordance rate between the ABR genes and P-AST results was generated. The concordance rates for each …

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

Conference Presentation Abstracts

Introduction: In patients with pudendal neuralgia refractory to traditional therapies, prior studies have shown efficacy in chronic stimulation with Interstim® (Medtronic, Inc., Minneapolis, MN). 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 a lead placed at the pudendal nerve for neuralgia and powered wirelessly. Clinical outcomes were assessed at postoperative visits and phone calls. Administered non-validated follow-up questionnaire evaluated the GRA, percentage of pain improvement, satisfaction with device, and initial and current settings of the device (hours/day of stimulation). Results: …

A Unique Case Of Renal Pelvic Urothelial Carcinoma With Extensive Small Round Cell Sarcoma Differentiation Showing Swsr1 Gene Rearrangement, Zubin Shetty, Mitual Amin, Savitha Balaraman, Sugandh Shetty

Conference Presentation Abstracts

Introduction: Ewings-like sarcoma is a rare subgroup of small round cell sarcoma with immunohistochemistry and morphological similarities to Ewing Sarcoma. We report a rare case of renal pelvis invasive urothelial carcinoma with small round cell sarcoma differentiation showing EWSR1 gene rearrangement. Case: An 84-year-old male presented with 6 months of intermittent painless gross hematuria. Workup revealed a 5.4cm left renal pelvicalyceal mass suspicious for transitional cell carcinoma and a 2.5cm enhancing left renal cortical lesion. The patient underwent an uncomplicated robotic left nephroureterectomy. Pathology revealed small round cell sarcoma composing greater than 80% of the renal pelvis tumor with the …

A Case Report Of Metastatic Castration-Resistant Prostate Cancer Harboring A Pten Loss, Zin W. Myint, Derek B. Allison, Carleton S. Ellis

Internal Medicine Faculty Publications

The treatment landscape of metastatic castration-resistant prostate cancer (mCRPC) has dramatically improved over the last decade; however, patients with visceral metastases are still faced with poor outcomes. Phosphatase and tensin homolog (PTEN) loss is observed in 40%–60% of mCRPC patients and is also associated with a poor prognosis. Several PI3K/AKT/mTOR pathway inhibitors have been studied, with disappointing anti-tumor activity. Here, we present a case of a patient with heavily treated mCRPC who had a modest tumor response to concurrent carboplatin, abiraterone acetate/prednisone, and liver-directed radiation therapy. We discuss the potential rationale supporting the use of this combination therapy …

Gaps In Public Awareness About Brca And Genetic Testing In Prostate Cancer: Social Media Landscape Analysis, Stacy Loeb, Philip Massey, Amy Leader, Sameer Thakker, Emily Falge, Sabina Taneja, Nataliya Byrne, Meredith Rose, Matthew Joy, Dawn Walter, Matthew S Katz, Risa L Wong, Preethi Selvan, Scott W Keith, Veda N. Giri

Department of Medical Oncology Faculty Papers

BACKGROUND: Genetic testing, particularly for BRCA1/2, is increasingly important in prostate cancer (PCa) care, with impact on PCa management and hereditary cancer risk. However, the extent of public awareness and online discourse on social media is unknown, and presents opportunities to identify gaps and enhance population awareness and uptake of advances in PCa precision medicine.

OBJECTIVE: The objective of this study was to characterize activity and engagement across multiple social media platforms (Twitter, Facebook, and YouTube) regarding BRCA and genetic testing for PCa compared with breast cancer, which has a long history of public awareness, advocacy, and prominent social media …

Gaps In Public Awareness About Brca And Genetic Testing In Prostate Cancer: Social Media Landscape Analysis., Stacy Loeb, Philip Massey, Amy E. Leader, Sameer Thakker, Emily Falge, Sabina Taneja, Nataliya Byrne, Meredith Rose, Matthew Joy, Dawn Walter, Matthew S. Katz, Risa L. Wong, Preethi Selvan, Scott W. Keith, Veda N. Giri

Department of Medical Oncology Faculty Papers

BACKGROUND: Genetic testing, particularly for BRCA1/2, is increasingly important in prostate cancer (PCa) care, with impact on PCa management and hereditary cancer risk. However, the extent of public awareness and online discourse on social media is unknown, and presents opportunities to identify gaps and enhance population awareness and uptake of advances in PCa precision medicine.

OBJECTIVE: The objective of this study was to characterize activity and engagement across multiple social media platforms (Twitter, Facebook, and YouTube) regarding BRCA and genetic testing for PCa compared with breast cancer, which has a long history of public awareness, advocacy, and prominent social media …

Crossfire: Controversies In Urology Debate: Prophylactic Suburethral Sling At Time Of Prolapse Sling In Era Of Mesh Controversy, Eric Scott Rovner, Alexander Gomelsky, Ariana L. Smith, Leslie Minor Rickey, Jason P. Gilleran

Conference Presentation Abstracts

No abstract provided.

Is There An Increased Risk Of Delirium Among Patients With Overactive Bladder Treated With Newer Anticholinergic Medication Compared To A Beta-3 Agonist?, Khaled Ashraf Etaby

Electronic Thesis and Dissertation Repository

ABSTRACT

Objective

To determine if there is an increased risk of delirium among patients with overactive bladder (OAB) started on anticholinergic medication compared to beta-3 agonist.

Methods

We conducted a population-based, retrospective, matched weight cohort study using administrative data from Ontario, Canada from January 2016 until March 2020. We matched 13865 new users of Oxybutynin to 33097 new users of newer anticholinergic medications (Solifenacin, Tolterodine, Trospium, Darifenacin and Fesoterodine), and to 56062 new users of beta-3 agonist medication (Mirabegron); all of the included medications are only for the treatment of OAB. Matching weights (an extension of the propensity score weighting) …

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 …