Imaging Findings Associated With Failure of Conservative Management After Blunt Extraperitoneal Bladder Injury.

Objective: To identify risk factors for failure of conservative management (CM) for uncomplicated extraperitoneal bladder injuries (EBI).

Methods: The trauma registry at a single Level 1 trauma center was queried for patients presenting with a blunt EBI between 2004 and 2022. Patients with CM and follow-up through at least 1 postoperative cystogram or catheter removal were included.

Conscientious Objection to Gender-Affirming Surgery: A Cross-Sectional Analysis of Plastic Surgery and Urology Residency Programs.

Objective: Medical conscientious objection is a federally protected right of physicians to refuse participation in medically indicated services or research activities that are incompatible with their ethical, moral, or religious beliefs. Individual provider objections to gender-affirming surgery have been documented, however the prevalence of such objections is unknown. Our study aimed to characterize physician objections to gender-affirming surgery in plastic surgery and urology residencies and to assess related institutional policies.

Management of long-term functional sequelae of pelvic fracture urethral injury.

Pelvic fracture (PF) is a rare emergency, which led to pelvic fracture urethral injury (PFUI) in 1.6% to 25% of cases. Urethral injury assessment requires a thorough analysis of the initial injury history and imaging that combine cystourethrography acutely, repeat urethral imaging as well as adjunctive use of MRI in the follow-up period.

Sexual health in transgender and gender diverse people.

Purpose Of Review: Sexual health and sexual function are critical to the wellbeing of cisgender, transgender, and gender diverse populations. To date, there has been only limited patient-focused evaluation of sexual function in transgender and gender diverse patients at several stages in their gender-affirming medical care. There remains a need to better understand the impact of gender affirming medical and surgical therapy on sexual health, and to develop evidence-based treatments to address sexual dysfunction when present.

Oncologic control and predictors of urologic reconstruction after Mohs micrographic surgery for low-risk penile malignancy.

Purpose: Mohs micrographic surgery (MMS) is a low-risk penile cancer management option. However, contemporary patients' short-term oncologic control and preoperative characteristics predicting reconstruction needs are undefined. This study assesses MMS's oncologic efficacy for low-risk penile cancer and identifies baseline predictors of post-resection reconstruction referral.

Making a Statement: Positions of Professional Medical Organizations Towards Gender-Affirming Care.

Objective: Despite politically charged media coverage and legislation surrounding gender affirming care (GAC), many organizations have released position statements to provide scientifically backed clinical practice standards, combat misinformation, and inform medicolegal policies. The purpose of this study is to objectively assess the availability and the content of the official position statements of relevant medical professional organizations regarding GAC.

Summary Background Data: A list of U.

Semiquantitative Tissue Perfusion Assessment Using Indocyanine Green in Complex Open Urethral Reconstruction.

Objective: Current assessment of critical tissue in genitourinary reconstruction, including graft beds and tissue flaps, primarily relies upon qualitative visual and tactile assessment by experienced surgeons. Here we explore the feasibility of using intravenous indocyanine green (ICG) for semiquantitative assessment of perfusion in complex open urethral reconstruction.

Methods: A standardized protocol for intravenous use of ICG and near-infrared fluorescence was established.

Evaluating Adherence to Guideline-based Injury Grading in Pediatric Renal Trauma: How Are Patients Being Worked Up Prior to Transfer to a Level 1 Trauma Center?

Objective: To determine whether children with renal trauma who are transferred to a level I trauma center (TC) receive appropriate imaging studies before transfer and whether this impacts care. The American Urologic Association (AUA) Urotrauma guidelines state clinicians should perform IV contrast-enhanced CT with immediate and delayed images when renal trauma is suspected. Adherence to these guidelines in pediatric patients is unknown.

Management of male stress urinary incontinence in high-risk patients: a narrative review.

Background And Objective: The artificial urinary sphincter (AUS) remains the gold standard for treatment of stress urinary incontinence (SUI). However, highly complex patients such as those with bulbar urethral compromise, bladder pathology, and lower urinary complications pose a particular challenge for the surgeon. In this article, we will address critical risk factors and synthesize existent data across relevant disease states to support surgeons in successful management of SUI in high-risk patients.

Blunt traumatic female urethral and bladder neck injuries: a 15-year single-institution experience.

Purpose: To describe our experience in the management and outcomes of female patients with urethral or bladder neck (BN) injury at a high-volume Level 1 trauma center.

Methods: A retrospective chart review of all female patients with urethral or BN injury by blunt trauma mechanism admitted to a Level 1 trauma center between 2005 and 2019 was performed.

Results: Ten patients met study criteria with median age 36.

Managing Thermal Injuries of the Penis and Scrotum: A Narrative Review.

While thermal injuries to the external genitalia occur less often than burns to the trunk and extremities, such injuries can potentially leave patients with devastating lifelong sequelae. Though much is known about treating burns in commonly exposed areas of the body, there is a lack of agreement concerning the management of genital thermal injuries. In this review, we seek to synthesize the past and existing literature into a clear analysis while reviewing current recommendations and new developments in the management of genital thermal injuries of the penis and scrotum.

Functional outcomes of Fournier's gangrene: a multi-institutional experience.

Introduction: Fournier's gangrene (FG), is a progressive, necrotizing soft tissue infection of the external genitalia, perineum, and/or anorectal region. How treatment and recovery from FG impacts quality of life related to sexual and general health is poorly characterized. Our purpose is to evaluate the long term impact of FG on overall and sexual quality of life using standardized questionnaires through a multi-institutional observational study.

Computed tomography-based volume calculations of renal ischemia predicts post-traumatic renal function after renal infarction injury.

Objectives: To describe a systematic method to quantify the severity of renal infarction injury and assess its association with post-traumatic renal function after blunt trauma.

Methods: We retrospectively reviewed all patients who suffered an AAST grade IV renal infarction injury without active bleeding secondary to blunt trauma between 1/2010 and 10/2020. Only patients with a pre-traumatic eGFR within 12 months of injury and post-traumatic eGFR within 3-12 months were included.

Ureteral Injuries Secondary to Blunt Abdominal Trauma: A 15-Year Review of Presentation, Management, and Outcomes at a Level 1 Trauma Center.

Objective: To report our contemporary experience with ureteral injuries secondary to blunt trauma, with diagnostic methods and management stratified according to injury severity.

Materials And Methods: We performed a retrospective 15-year study (4/2005-4/2020) at a regional level I trauma center. Patients were categorized as having a partial or complete transection injury.

Routine repeat imaging may be avoidable for asymptomatic pediatric patients with renal trauma.

Introduction: AUA Urotrauma guidelines for renal injury recommend initial nonoperative management followed by repeat CT imaging for stable patients with deep lacerations or clinical signs of complications. Particularly in pediatric patients where caution is taken to limit radiation exposure, it is not known whether routine repeat imaging affects clinical outcomes.

Objective: Our objective was to determine whether routine repeat imaging is associated with urologic intervention or complications in nonoperatively managed pediatric renal trauma.

Outcomes of mohs microgrpahic resection for cutaneous malignancy involving the scrotum.

Introduction: Squamous cell carcinoma (SCC) and extramammary Paget's Disease (EMPD) of the scrotum are exceedingly rare. Given their propensity for local invasion and treatment with wide local excision, they can be highly morbid conditions. Outcomes of Mohs Micrographic Surgery (MMS) for scrotal cutaneous malignancy is not well described in current literature.

Vicarious excretion of intravenous contrast masquerading as a nephroenteric fistula in a patient with a grade IV renal injury.

We describe a case of a patient who suffered a grade IV renal injury who demonstrated vicarious excretion of intravenous contrast into the bowel masquerading as a nephroenteric fistula. Despite concerning imaging features, given the patient's lack of clinical symptoms of a nephroenteric fistula, negative oral activated charcoal test, and our understanding of the pharmacokinetics of intravenous contrast, our suspicion for nephroenteric fistula was low. This case highlights the importance of carefully considering the mechanism of injury when developing a differential diagnosis of potential sequela after trauma and understanding the pharmacokinetics of intravenous contrast in the trauma setting.

Implementing a patient safety culture survey to identify and target process improvements in academic ambulatory urology practices: a multi-institutional collaborative.

Introduction: A shared professional culture focused on patient safety is critical to delivering high-quality care. There is a need for objective metrics to help identify target areas for improvement in patient safety culture. The Medical Office Survey on Patient Safety Culture (SOPS) was developed and validated by the United States Agency for Healthcare Research and Quality to measure patient safety culture in the ambulatory setting.

Comparison of Interhospital Urological Transfers between a Metropolitan and Rural Tertiary Care Institution.

Introduction: Urological services are not available at all hospitals and the transfer of patients between medical centers provides an avenue to meet medical need. In rural areas patients often visit community medical centers with limited services and require transfer. We compared the transfer process between 2 tertiary care institutions, one serving a metropolitan population and the other a rural population.

Historical and Current Practices in the Management of Fossa Navicularis Strictures.

Purpose Of Review: Fossa navicularis strictures represent a surgically challenging disease process that requires detailed preoperative planning and an understanding of each patient's goals in order to achieve a satisfactory long-term outcome. This review summarizes the various approaches used in the management of fossa navicularis strictures over the past several decades.

Recent Findings: In addition to existing evidence to support open flap- and graft-based reconstruction, recent studies suggest a potential role for limited open repair via a transurethral approach.