Improving the Efficiency of a Military Treatment Facility Transfer Center Process.

Introduction: A performance improvement project was initiated at Tripler Army Medical Center (TAMC) to decrease the amount of inpatient stays by military beneficiaries at civilian hospitals. Before the start of the project, the transfer process from external emergency rooms was completed by patient administration personnel and residents. This process had a median time to disposition decision of 40 minutes and led to missed opportunities for TAMC to care for military beneficiaries.

Routine Prescription of Opioids for Post-Vasectomy Pain Control Associated with Persistent Use.

Purpose: The AUA (American Urological Association) Position Statement on opioid use recommends using opioids only when necessary. We sought to determine if routine prescribing of opioids is necessary for pain control after vasectomy, and if an association exists with persistent use.

Materials And Methods: We retrospectively reviewed the charts of patients who underwent vasectomy in clinic between April 2017 and March 2018.

Preoperative Albumin Is Predictive of Early Postoperative Morbidity and Mortality in Common Urologic Oncologic Surgeries.

Introduction: Multiple studies have linked preoperative nutrition status to postoperative outcomes. This relationship has been little studied in urology. We used a standardized, national, risk-adjusted surgical database to evaluate 30-day outcomes of patients undergoing common urologic oncologic procedures as they related to preoperative albumin.

Ovotesticular Disorders of Sexual Development: A Case of Hernia Uteri Inguinalis.

Ovotesticular disorders of sexual development result in the presence of both testis and ovarian tissue. Most commonly, gonadal structures in the scrotum or inguinal canal are comprised of testis tissue. The presence of a uterus within an inguinal hernia sac in a phenotypically male patient is referred to as hernia uteri inguinalis.

Testicular Cystic Walthard Cell Nest in a 7-Month-Old.

Walthard cell nests have previously been reported arising from paratesticular structures; however, this is the first reported case of an intratesticular Walthard cell nest. We report our experience with this lesion which is interesting not only because of its extreme rarity but also because of the proposed histogenesis of such lesions.

Penile Squamous Cell Carcinoma After a Childhood Hypospadias Repair With Bladder Mucosa Graft.

Bladder mucosa grafts were historically used for hypospadias surgical repairs, when preputial or penile skin was unavailable and in cases of prior failed hypospadias repairs. We present a case of advanced penile squamous cell carcinoma diagnosed 22 years after a childhood hypospadias repair with a free bladder mucosa graft.

Sonographic evaluation of hydronephrosis in the pediatric population: is well-tempered sonography necessary?

Objectives: Standardized protocols exist for diuretic renography. There are no specific guidelines regarding hydration before renal sonography. This study assessed the importance of the hydration status by sonographic measurements of the anteroposterior diameter and its effect on Society for Fetal Urology (SFU) hydronephrosis grading.

Impact of the 2012 American Urological Association vasectomy guidelines on postvasectomy outcomes in a military population.

Objective: To evaluate the impact of the 2012 American Urological Association vasectomy guidelines on postvasectomy clinical outcomes in a highly mobile military cohort and compare these outcomes with those of civilian counterparts.

Methods: The records of service members who underwent vasectomy between January 2008 and December 2013 and provided at least 1 postvasectomy semen analysis (PVSA) were analyzed in the context of the 2012 guidelines. Time to occlusive success, repeat PVSAs and vasectomies, and health care cost savings were compared between our prior definition of vasectomy success, which required azoospermia, and the 2012 criteria, which included rare nonmotile sperm.

Upper urinary tract abnormalities: a case of bilateral kidneys within a left-sided omphalocele.

Children with omphalocele, exstrophy, imperforate anus, and spinal defects complex present with the most severe form of birth defects in the exstrophy-epispadias spectrum. Prenatal diagnosis is difficult, but improved survival over the past several decades makes understanding the potential anatomic manifestations imperative for expeditious and appropriate surgical care. The upper urinary tract is often normal in children with omphalocele, exstrophy, imperforate anus, and spinal defects complex, but malposition of one of the kidneys has previously been reported.

Impact of race in using PSA velocity to predict for prostate cancer.

Objective: To assess whether race is a significant factor in the ability of prostate-specific antigen velocity (PSAV) for predicting high-grade prostate cancer (HGPC).

Methods: Records of men who underwent prostate biopsy between January 2003 and December 2007 were retrospectively reviewed to collect demographic data, self-reported race, prostate-specific antigen (PSA) data, and pathology results. PSAV was calculated using linear regression.

Laparoscopic radical prostatectomy demonstrates less morbidity than open radical prostatectomy: an analysis of the American College of Surgeons-National Surgical Quality Improvement Program database with a focus on surgical trainee involvement.

Introduction: Complication rates of open radical prostatectomies (ORPs) and laparoscopic radical prostatectomies (LRPs) performed by highly experienced surgeons in centers of excellence are well known. Using a standardized, national, risk-adjusted surgical database, we compared 30-day outcomes following ORP and LRP and analyzed how trainee involvement influenced outcomes.

Methods: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) is a risk-adjusted data collection analyzing preoperative risk factors, demographics, and 30-day postoperative outcomes.

Comparison of outcomes after minimally invasive versus open partial nephrectomy with respect to trainee involvement utilizing the American College of Surgeons National Surgical Quality Improvement Program.

Purpose: Complication rates of open partial nephrectomies (OPN) and minimally invasive partial nephrectomies (MIPN) have largely been reported by single and multi-institutional tertiary care centers. We sought to identify complication rates of these approaches and how they are influenced by trainee involvement utilizing an independent national surgical database.

Materials And Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a risk-adjusted data collection analyzing risk factors, demographics, and 30-day perioperative outcomes.

Bilateral fibrous pseudotumors of the tunica albuginea in a pediatric patient.

Fibrous pseudotumor, previously named nodular fibrous periorchitis, is a very rare disease entity in the pediatric patient. This is the first reported case of bilateral synchronous fibrous pseudotumors in the testes of a pediatric patient.

Hydrocele: an atypical presentation of metastatic sarcomatoid renal cell carcinoma.

Herein is a case of a 55-year-old man who presented with epididymitis. He subsequently failed medical management for the suspected infection and progressed to develop an acute scrotum and sonographic findings consistent with a pyocele. Concurrent computed tomography (CT), obtained for persistent abdominal pain, revealed a large enhancing upper pole renal mass suspicious for malignancy.

Primary adenocarcinoma of the rete testis: improved staging accuracy with CT-PET.

A case of adenocarcinoma of the rete testis in a 54-year-old man is presented. Most such patients harbor metastatic disease, even in clinically localized presentations. CT-PET may provide improved diagnostic sensitivity over conventional CT in this setting.

Ambiguous genitalia in a newborn with 45,X/46,X,idic(Y) ovotesticular disorder of sex development.

Objective: To discuss a case of ovotesticular disorder of sex development (DSD) with ambiguous genitalia, isodicentric Y sex chromosome mosaicism, and unique histopathologic findings.

Methods: We report the clinical, laboratory, imaging, and operative findings, and we highlight the pertinent features of this case. Results of hormonal and genetic testing are reviewed, and histopathologic findings are illustrated.

Oral ketoconazole for prevention of postoperative penile erection: a placebo controlled, randomized, double-blind trial.

Purpose: Patients undergoing penile surgery often have postoperative erections that can be painful and may interfere with wound healing. In retrospective studies ketoconazole has been shown to decrease the number and pain of postoperative erections. We conducted a prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of ketoconazole in the prevention of postoperative erections.

Long-term preservation of dextranomer/hyaluronic acid copolymer implants after endoscopic treatment of vesicoureteral reflux in children: a sonographic volumetric analysis.

Purpose: We compared injected volume of dextranomer/hyaluronic acid with sonographic volumes obtained 2 weeks to 36 months postoperatively to evaluate the amount of volume retention with time and to correlate volume retention with voiding cystourethrogram results.

Materials And Methods: We retrospectively reviewed sonographic volume measurements of dextranomer/hyaluronic acid implants in children at 2 weeks to 36 months postoperatively. Hydronephrosis and percentage of dextranomer/hyaluronic acid retained at each interval were recorded.

Magnetic resonance urography in the evaluation of prenatally diagnosed hydronephrosis and renal dysgenesis.

Purpose: We present our experience with dynamic contrast enhanced magnetic resonance urography for evaluation and treatment in infants born with prenatally recognized hydronephrosis. We determined the characteristics of renal dysgenesis in this population.

Materials And Methods: We reviewed magnetic resonance urography images done within the first 6 months of life in 67 infants born with prenatally recognized hydronephrosis.

Magnetic resonance urography for evaluating outcomes after pediatric pyeloplasty.

Purpose: We report the role of magnetic resonance urography in children with ureteropelvic junction obstruction. Differential renal function, the single kidney glomerular filtration rate index, renal transit time, renal length and renal pelvis anteroposterior diameter were compared before and after pyeloplasty.

Materials And Methods: Magnetic resonance urography was performed before and after pyeloplasty in 24 patients with a mean age of 1.

Spontaneous perinephric hemorrhage associated with urolithiasis in pregnancy.

Spontaneous perinephric hematoma in the absence of anticoagulation, arteritis, or trauma is uncommon. We report the case of a postpartum patient with nephrolithiasis who initially presented to the obstetric service with a spontaneous perinephric hemorrhage.

Outcomes of Extravesical Versus Intravesical Ureteral Reimplantation.

Purpose: The purpose of our study was to examine outcomes and compare length of stay after extravesical and intravesical ureteral reimplantation at our institution.

Materials And Methods: Retrospective review was performed of 30 patients (55 ureters) with vesicoureteral reflux who underwent either the Cohen (intravesical) cross-trigonal procedure or the extravesical (detrusorrhaphy) approach. Each patient had documented follow-up consisting of a postoperative renal ultrasound and/or a voiding cystourethrogram (VCUG).