Characterizing and Quantifying Material Fatigue of the Artificial Urinary Sphincter Pressure Regulating Balloon.

Objective: To characterize and quantify changes in elastic properties and in vivo pressure characteristics of pressure regulating balloons (PRB) over time, we conducted an analysis of the mechanical characteristics of the PRB after removal from patients for revision surgery.

Methods: Pressure and elasticity characteristics of new and used 61-70 cm HO PRBs were analyzed. Pressure-volume curves were generated using commercially available urodynamics equipment.

Synchronous Bladder Neck Contracture Dilation at the Time of Artificial Urinary Sphincter Placement Is Safe and Effective.

Objective: To treat men with bladder neck contracture (BNC) and stress urinary incontinence, neither long-term nor comparative data exist to support the superiority of simultaneous BNC intervention at the time of artificial urinary sphincter placement (synchronous) or staged BNC intervention followed by artificial urinary sphincter placement (asynchronous). This study aimed to compare the outcomes of patients treated with synchronous and asynchronous protocols.

Methods: Using a prospectively maintained quality improvement database, we identified all men between the years of 2001-2021 with a history of BNC and artificial urinary sphincter placement.

Urethral Stricture Formation After Artificial Urinary Sphincter Cuff Erosion Is Uncommon in the Absence of Pelvic Radiation.

Purpose: Reported rates of urethral stricture development after artificial urinary sphincter erosion are highly variable. We hypothesized that the risk of stricture is commensurate with the degree of erosion.

Materials And Methods: We reviewed our prospectively maintained quality improvement database for all patients with artificial urinary sphincter erosion from 2011 to 2022.

Clinical and Urodynamic Determinants of Earlier Time to Failure for the Artificial Urinary Sphincter.

Objective: To determine clinical, surgical and urodynamic attributes associated with earlier AUS reintervention. The artificial urinary sphincter (AUS) is the gold standard treatment for postprostatectomy stress urinary incontinence. Factors impacting long-term device survival have not been investigated.

Bladder Neck Contractures Stabilize After Placement of the Artificial Urinary Sphincter.

Purpose: For male cancer survivors, the combination of stress urinary incontinence and recurrent bladder neck contracture presents a management dilemma with poor consensus. Our objective was to assess the impact of artificial urinary sphincter placement on bladder neck contracture recurrence among prostate cancer survivors with stress urinary incontinence and bladder neck contracture.

Materials And Methods: Men electing artificial urinary sphincter placement at our institution undergo synchronous bladder neck contracture treatment if indicated.

Artificial Urinary Sphincter Cuff Downsizing Improves Continence and Patient Satisfaction in Cases of Sub-cuff Atrophy.

Purpose: The management of artificial urinary sphincter sub-cuff atrophy remains controversial, and clinical outcomes are underreported. We intend to examine the impact of cuff downsizing in cases of isolated sub-cuff atrophy.

Materials And Methods: We reviewed our prospectively collected, institutionally approved quality improvement database for this study from 2011 to 2022.

Indications and Outcomes for Intermittent Catheterization following Bulbar AUS Cuff Placement.

Objective: To evaluate the functional and surgical impact of CIC protocols in men with a bulbar AUS in place. Stress urinary incontinence (SUI) and poor bladder emptying are both sequelae of prostate cancer treatment, though there is sparse data to guide concomitant management. The safety of intermittent catheterization (CIC) in men with an artificial urinary sphincter (AUS) at the bulbar urethra remains unclear.

Pelvic Fracture Urethral Distraction Defect.

Posterior pelvic fracture urethral distraction defects (PFUDD) can present formidable challenges in genitourinary reconstruction. Once the acuity of trauma subsides, the patient is often faced with chronic, debilitating genitourinary injuries. Treatment requires an astute diagnostic and technical approach, with definitive repair best accomplished in the hands of experts.

Resection of Pubic Symphysis and Cystectomy Significantly Improves Short-Term Patient-Reported Physical Functioning Among Patients With Pubovesical Fistula and Pubic Bone Osteomyelitis.

Objective: To investigate the impact of extirpative surgery for pubic bone osteomyelitis with pubovesical fistula on prostate cancer survivors' physical and mental health.

Materials And Methods: The Short Form 12 (SF-12) is a validated instrument for assessing health-related quality of life (HRQOL). We reviewed a prospectively maintained database of patients treated with extirpative surgery for pubovesical fistula from 2017-2021 who completed the SF-12.

Patient-Reported and Physiologic Outcomes Following Pelvic Exenteration for Non-Repairable Radiated Rectourethral Fistula.

Objective: To investigate the impact of pelvic exenteration (PelvEX) on patient-reported pain, distress, and quality of life along with physiologic indicators of health in cancer survivors with radiated, non-repairable rectourethral fistula (RUF).

Materials And Methods: We reviewed a prospectively maintained quality improvement database of RUF patients at our institution from 2012 to 2020. Patients with radiated, non-repairable RUF who underwent PelvEX and had follow up to 1 year were included.

Buccal Reharvest for Urethroplasty After Graft Site Closure is Safe and Does Not Affect Long-Term Oral Health.

Objective: To understand the effects of reharvest on safety and long-term oral health in patients requiring buccal mucosa reharvest from a previously harvested and closed site for management of recurrent urethral stricture disease.

Methods: We conducted an IRB approved retrospective chart review from 2014 to 2019 of all patients who underwent buccal graft urethroplasty at our referral based academic medical center. Surgical data was collected, and the validated Oral Health Impact Profile (OHIP-14) survey was administered to each patient.

Do commonly used prostate medications alter prostate MRI and fusion biopsy performance?

Aims: To determine whether phosphodiesterase inhibitors (PDEi) or α-antagonists (AA) were associated with differences in region of interest (ROI) characteristics or prostate cancer detection on fusion biopsy (FB).

Materials And Methods: Records from 847 consecutive patients undergoing FB at three separate institutions over a period of 2 years were retrospectively reviewed. Associations between medication use, Prostate Imaging Reporting & Data System (PIRADS) scores, and ROI locations were assessed with ordinal logistic regression.

Complaint of Testicular Discomfort in Patient with Esophageal Adenocarcinoma.

We report a case of esophageal cancer with solitary metastasis to the testicle in a 71-year-old man. The tumor was picked up on physical exam following new onset complaints of pain and swelling. While most testicular masses in older men are due to lymphoma, this case highlights the need to consider metastatic disease as a source of new symptoms in patients with a recent cancer diagnosis.

Initial Experience of Magnetic Resonance Imaging Fusion Biopsy in the Community Setting.

Introduction: Magnetic resonance imaging fusion biopsy is diagnostically superior to transrectal ultrasound guided biopsy for detecting clinically significant prostate cancer. Fusion biopsy has an expanding role at major academic centers. However, the reproducibility of outcomes in the community setting is unknown.

Multicenter surgical outcomes of penile prosthesis placement in patients with corporal fibrosis and review of the literature.

Penile prosthesis (PP) insertion in the setting of corporal fibrosis can be challenging and a variety of techniques have been described to accomplish this, however the necessity of these maneuvers is debatable. Our objective was to investigate techniques and outcomes of PP placement in patients with corporal fibrosis at tertiary referral centers. Multicenter outcomes of 42 patients (mean age 53.

Patient Satisfaction and Clinical Efficacy of an Advanced Practice Provider Stone Prevention Clinic.

Introduction: The benefits of a multidisciplinary stone prevention clinic are well established. However, the outcomes of advanced practice provider integration into this model have not been reported. Our goal was to assess the feasibility of an advanced practice provider managed stone prevention clinic.

Necrotizing Group A Strep Following Use of Penile Constriction Ring.

The development and management of necrotizing cellulitis following penile constriction ring use is described. Devastating injuries such as this can be highly distressing for patients and focused counseling is often needed to address concerns regarding cosmetic outcomes. The timeframe and appearance of recovery has not been previously captured.

Penile Melanoma In Situ: Long Term Follow Up.

Penile melanoma in situ is extremely rare. Various treatments have been reported with good success, however follow up is generally limited to 1 year or less. The optimal treatment regimen, pattern of disease progression and utility of sentinel lymph node biopsy are not established.

An assessment of current penile prosthesis reimbursement guidelines for insurance plans nationwide.

A lack of uniformity exists for insurance payer coverage for all categories of penile prostheses (PP). We sought to determine common insurance coverage criteria and barriers to implantation across common insurance plans from healthcare referral regions (HRR) nationwide. Coverage criteria and stipulations were reviewed regarding erectile dysfunction (ED) etiology, ED duration, contributing comorbid conditions, medications, drug use, diagnostic tests, use of procedures and prior interventions.

Kidney stones and the opioid epidemic: recent developments and review of the literature.

Purpose Of Review: A public health emergency has been declared in response to rising opioid addiction and opioid-related deaths in the United States. As kidney stones have been identified as an important source of initial and repeated opioid exposures, this review seeks to describe the scope of the problem and report relevant alternatives to opioid analgesia for stones.

Recent Findings: Recent literature summarizing the extent of opioid use among those with stones is reviewed.