Urology

OBJECTIVE: To analyze whether urethral catheter-free anastomosis during retzius-sparing radical prostatectomy results in worsening immediate perioperative and postoperative complications. METHODS: We retrospectively reviewed records of patients undergoing robotic-assisted radical prostatectomy with or without indwelling urethral catheter placement by a single surgeon between January 2020 and March 2022. Clinical and pathological characteristics were evaluated. An independent t-test was used to compare continuous variables, and Pearson's chi-square test or Fisher's exact test was used to compare categorical variables...

OBJECTIVES: To report incidence of acute kidney injury (AKI) following radical cystectomy (RC) for bladder cancer and evaluate risk factors for AKI as well as the impact of AKI on development of long-term renal insufficiency. METHODS: A retrospective analysis of patients undergoing RC between 2010-2020 at a high-volume tertiary referral center. AKI was graded according to the KDIGO criteria within 90 days of surgery. Long-term renal insufficiency was defined as estimated glomerular function < 45 ml/min...

OBJECTIVES: To report microbial pathogens detected at infection-related readmissions, including their susceptibility to antimicrobials. MATERIAL AND METHODS: A retrospective review of 785 patients who underwent RC for bladder cancer at a tertiary centre in Denmark between 2009 and 2019. All patients received prophylactic cefuroxime preoperatively and pivmecillinam at stent- or catheter removal. Data was collected through the national medical records and microbiology database...

OBJECTIVE: To report the outcomes of performing transperineal prostate biopsy in the office setting using the novel anesthetic technique of tumescent local anesthesia. We report anxiety, pain, and embarrassment of patients who underwent this procedure compared to patients who underwent a transrectal prostate biopsy using standard local anesthesia. MATERIALS/METHODS: Consecutive patients undergoing either a transperineal prostate biopsy under tumescent local anesthesia or a transrectal prostate biopsy with standard local anesthetic technique were prospectively enrolled...

OBJECTIVES: To explore the efficacy, in terms of sensitivity and specificity, of EHS applied to masturbation in diagnosing predominantly organic ED, compared to the actual standard, which is NPTR. MATERIALS AND METHODS: A total of 189 consecutive patients who came to our outpatient clinic from October 2019 to October 2020, reporting ED and an abridged International Index of Erectile Function (IIEF-6) score <26 were enrolled. Patients filled out two psychometric questionnaires: the IIEF-6 applied to partnered intercourse and the EHS applied to masturbation, then they underwent the NPTR test with Rigiscan for 2 consecutive nights in good sleep condition...

OBJECTIVE: The artificial urethral sphincter (AUS) is the gold standard treatment for male stress urinary incontinence which commonly results from prostatectomy or pelvic radiation for prostate cancer. Patients with prior pelvic radiation history experience increased risk of developing urethral erosion. Transcorporal AUS (TAUS) placement can be used as an alternative for compromised urethras to incorporate a small portion of the corporal bodies for additional support. The inclusion of an additional tissue barrier has been shown to improve outcomes...

OBJECTIVE: To explore the effect of Agent Orange (AO) exposure on BCa outcomes in patients receiving Bacillus Calmette-Guerin (BCG) for non-muscle invasive BCa (NMIBC). METHODS: We retrospectively examined the association between AO exposure in patients with NMIBC in national VA databases who were being treated with BCG. Patients were diagnosed with NMIBC from 2000-2010 with follow-up through 2018. Clinical, pathological, and demographic variables were compared by AO exposure...

OBJECTIVE: To utilize a large cohort of healthy sperm bank donors to evaluate the association between body mass index (BMI) and individual sperm parameters. METHODS: Sperm parameters from donors across the United States were obtained between 2013-2022. Donors were healthy men aged 18-46 years old. Semen samples were analyzed in a certified lab following guidelines by the World Health Organization. A multivariable interaction model between age, BMI, and sperm parameters was conducted...

OBJECTIVE: To qualitatively analyze the knowledge, attitudes, and beliefs of women regarding genitourinary syndrome of menopause (GSM) and vaginal estrogen therapy as expressed on Reddit, a public, anonymous internet forum for discussion and information sharing. METHODS: "r/menopause," a Subreddit with >30,000 subscribers, was queried for "vaginal estrogen" to collect postings related to vaginal estrogen in October 2022. Posts were analyzed qualitatively by two independent researchers...

OBJECTIVE: To assess the outcomes of Holmium Laser Enucleation of the Prostate (HoLEP) at the extremes of the size spectrum, comparing whether the results are consistent for very large and small prostates. METHODS: A retrospective review of 402 patient charts was conducted to compare the outcomes of HoLEP in patients with prostate size < 40 g (Group 1), 41-200 g (Group 2), and > 200 g (Group 3). Various preoperative, perioperative, and postoperative variables were collected...

OBJECTIVE: To investigate the prevalence and treatment rates of low testosterone (T) in men with Cystic Fibrosis (CF). CF is a genetic disease with highly variable presentation that results from a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Phenotypic manifestations of CF include alterations in function of the lungs, liver, pancreas, and reproductive system. Despite the well-described association between CF and infertility secondary to congenital bilateral absence of the vas deferens (CBAVD), men with CF report further sexual and reproductive health concerns, many of which are often associated with low testosterone...

PURPOSE: To characterize training program and early career factors that impact decision making and job retention following graduation in a diverse population of urologists. MATERIALS AND METHODS: We performed a computer-based survey distributed to residency graduates from 25 urology training programs. Five focus institutions were identified with a goal >30% response rate. The survey included questions about training program specifics and post-training employment characteristics...

OBJECTIVE: To evaluate the number of dimensions of obstructing ureteral stones in the emergency department (ED) described in present-day radiology computed tomography (CT) reports and assess for measurement discrepancies between radiologist and urologist review. METHODS: We conducted a single-center retrospective study of patients who presented to the ED with unilateral, solitary, obstructing ureteral stones from March 2018 to March 2021. Stone size in each reported dimension recorded by the radiologist was extracted from the chart and then compared to size independently measured by one of our urologists for all 3 stone dimensions...

OBJECTIVE: There has been a widely reported decline in both semen quality and fertility rate, however to date these studies have not looked at a decline of both in the same time period within the same geographical area. The objective of this study was to determine if there existed a temporal trend in both semen parameters and fertility rates for the same geographic area (King County, WA) over time. MATERIALS AND METHODS: Semen parameters from sperm donors at Seattle sperm bank were obtained from 2008 to 2021...

OBJECTIVE: To describe the surgical technique and evaluate the safety, feasibility and preliminary outcomes of perineal closure with fasciocutaneous flaps as an alternative to scrotoplasty for large genital wounds. METHODS: Cases of perineal closure with fasciocutaneous flaps and thigh pouch creation for patients having undergone scrotectomy from January 2015 until August 2022 were reviewed for operative details and surgical outcomes. RESULTS: 20 patients were identified undergoing this procedure...

OBJECTIVE: To examine the effect of virtual care on urine testing, antibiotic prescription patterns, and outcomes of care in UTI management. METHODS: We conducted retrospective analysis of adults treated for UTI in an ambulatory setting across a large health system from March 2020-2021. Outcomes included urine testing, antibiotic prescription, and retreatment or hospitalization, stratified by in-person versus virtual visit. Multivariable logistic regression was performed to examine factors contributing to outcomes...

OBJECTIVE: To study whether varicocele repair would improve sperm capacitation and probability of generating a pregnancy. METHODS: Data were collected prospectively of 40 consecutive adult men who presented with infertility confirmed by semen analysis and found to have a varicocele on exam or ultrasound who underwent unilateral or bilateral subinguinal microscopic varicocelectomy. We recorded pre and post-operative SA, Cap-Score, and PGP with a 3-month follow up...

PURPOSE: To assess the impact of total laser energy applied, as well as enucleation efficiency on short term functional outcomes for patients treated for lower urinary tract symptoms (LUTS) with Holmium laser enucleation of the prostate (HoLEP). METHODS: A retrospective analysis of 1593 consecutive patients who underwent HoLEP for LUTS due to BPO in a tertiary care centre between January 2018 and January 2021was performed. Perioperative parameters and short-term functional outcome were evaluated...

OBJECTIVES: To prospectively investigate the nocturnal bladder function and sleep in children with refractory primary monosymptomatic nocturnal enuresis (RPMNE). MATERIALS AND METHODS: 53 children diagnosed with RPMNE and 30 controls who had upper urinary tract abnormality but without any voiding problems were included in the study. RPMNE patients underwent a standardized investigation protocol, including the Pittsburgh Sleep Quality Index (PSQI)questionnaire, a 7-day bladder diary, and the simultaneous ambulatory urodynamic monitoring (AUM) and polysomnography (PSG); controls were evaluated using the PSQI questionnaire and PSG...

OBJECTIVE: To assess the risk of persistent opioid use following various urologic procedures in adolescents and young adults. MATERIALS AND METHODS: The TriNetX LLC Diamond Network was queried for patients aged 13 to 21 years who underwent pyeloplasty, hypospadias repair, inguinal hernia repair, inguinal orchiopexy, hydrocelectomy, or circumcision. Cohorts of patients prescribed and not prescribed postoperative opioids were created and propensity-matched for age, race/ethnicity, psychiatric diagnoses, and preoperative pain diagnoses...