Trends in Surgical Case Volume During Pacific Partnership Missions Onboard USNS Mercy.

Introduction: Since 2006, the U.S. Navy has conducted six Pacific Partnership (PP) missions throughout Southeast Asia on board the U.

Learning Curve for Robotic-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection.

Robotic retroperitoneal lymph node dissection (R-RPLND) is a challenging procedure. We hypothesized that surgical times and operative complications would decrease as surgeons became more facile with R-RPLND. We retrospectively reviewed 121 consecutive R-RPLNDs performed at Naval Medical Center San Diego and Mayo Clinic Arizona by 4 fellowship trained robotic surgeons between 2008 and 2018.

Use of Lean Six Sigma to Improve Access to Care in a Surgical Subspecialty Clinic.

Introduction: At the Naval Medical Center San Diego urology clinic, patients reported waiting for greater than 1 month for an initial consult. A Lean Six Sigma approach was used to improve access to care (ATC) and decrease variation in access by improving scheduling.

Methods: A Define-Measure-Analyze-Improve-Control approach was used.

Primary robotic RLPND for nonseminomatous germ cell testicular cancer: a two-center analysis of intermediate oncologic and safety outcomes.

Objective: To evaluate the intermediate-term oncologic outcomes and safety profile of the largest case series of primary robotic retroperitoneal lymphadenectomy for low-clinical-stage non-seminomatous germ cell testicular cancer.

Methods: This was a two-center retrospective analysis of robotic RPLND cases for low-clinical-stage (stage I-IIB) non-seminomatous germ cell testicular cancer in the primary setting. Demographic, perioperative, operative and oncologic variables were collected between March 2008 and May 2019.

First Do No Harm: Predicting Surgical Morbidity During Humanitarian Medical Missions.

Background: Despite good intentions, humanitarian surgical missions are unavoidably linked to some degree of complication. We hypothesized that the American College of Surgeons Surgical Risk Calculator (ACS-SRC) could estimate the risk of complications of procedures performed during the US Navy's Pacific Partnership 2015 (PP15) mission.

Methods: Patient information and surgical details recorded during PP15 were entered into the ACS-SRC.

Endoscopic Management of Primary Obstructive Megaureter: A Systematic Review.

Background: The gold standard treatment for primary obstructive megaureter (POM) with declining renal function, worsening obstruction, or recurrent infections is ureteral reimplantation with or without tapering. In infants, open surgery can be technically demanding and associated with significant morbidity. We conducted a systematic review of the literature with special interest in endoscopic management of POM and its outcomes.

To 'Pex or Not to 'Pex: What to Do for the Contralateral Testis When a Nubbin Is Discovered.

Purpose Of Review: Testicular remnants or nubbins are commonly found in the evaluation and treatment of cryptorchidism. While much debate focuses on the management of the nubbin itself, there is also great uncertainty and variation in the management of the contralateral descended testis. Herein, we review the relevant literature informing the decision to perform a contralateral orchiopexy.

Robot-assisted vasovasostomy using a single layer anastomosis.

Of all patients who have vasectomies performed in the United States, upwards of 6% will pursue a vasectomy reversal. Currently, the gold-standard reversal procedure is a microscopic vasovasostomy utilizing either a one or two-layer vasal anastomosis. Unfortunately, most urologists do not perform these procedures as they require extensive training and experience in microsurgery.

Abdominoscrotal hydrocele: A systematic review.

Background: Abdominoscrotal hydrocele (ASH) is an uncommon condition characterized by a fluid-filled mass with inguinoscrotal and abdominal components. Controversy exists regarding the best management. We conducted a systematic review of the literature with special interest in presentation, management and outcomes.

Intraocular Pressure During Robotic-assisted Laparoscopic Procedures Utilizing Steep Trendelenburg Positioning.

Purpose: To determine the effect of steep Trendelenburg (sTBURG) surgical positioning on intraocular pressure (IOP) during robotic-assisted laparoscopy (RAL) in subjects without previously identified ocular disease.

Design: Prospective cohort study.

Participants And Controls: Eighteen patients undergoing RAL with sTBURG and 21 controls undergoing open and laparoscopic cases in horizontal positioning.

Improving Clinic Productivity through a Shared Medical Appointment.

Introduction: Physicians are increasingly challenged to balance quality health care with fewer resources and limited time. To help achieve this balance, shared medical appointments have been described. We improved clinic-wide access to care by creating a shared medical appointment for minor penile complaints and anomalies.

Youth varicocele and varicocele treatment: a meta-analysis of semen outcomes.

Objective: To study youth who have a varicocele or are undergoing varicocele treatment, in relation to changes in semen, as measured by semen analysis (SA).

Design: Meta-analysis of studies identified via a search of PubMed, Medline, and the Cochrane Library covering the last 40 years.

Setting: Not applicable.

Operating characteristics of follicle-stimulating hormone in azoospermic men.

Objective: To validate factors predictive of nonobstructive azoospermia (NOA) and to determine the operating characteristics of FSH for predicting NOA.

Design: Retrospective cohort study.

Setting: Tertiary care military treatment facility.

Comparison of testicular volume differential calculations in adolescents with varicoceles.

Purpose: We aimed to develop a conversion formula between different calculations for testicular volume asymmetry.

Materials And Methods: Male adolescents with varicoceles who underwent scrotal ultrasound were studied. Two formulas were analyzed: (1) testicular volume differential, TVDiff = (RTV - LTV)/(TTV), and (2) atrophy index, AI = (RTV - LTV)/(RTV).

Active surveillance of the adolescent with varicocele: predicting semen outcomes from ultrasound.

Purpose: We hypothesized that active surveillance of the adolescent varicocele is not associated with a high prevalence of suboptimal semen analysis and that patients with abnormal semen analysis have smaller testicular volumes and larger volume differentials.

Materials And Methods: We conducted an institutional review board approved retrospective cohort study of adolescents with a clinically detected varicocele. Patients were initially observed by serial scrotal ultrasound evaluating testicular size and differential.

Morbidity and efficacy of ureteroscopic stone treatment in patients with neurogenic bladder.

Purpose: There is a lack of information on the safety and efficacy of ureteroscopy in the neurogenic bladder population. We hypothesized that ureteroscopy in patients with neurogenic bladder would be associated with an increased risk of complications and a lower stone clearance rate than in patients without neurological impairment.

Materials And Methods: We reviewed a local registry of patients with ICD-9 codes for urolithiasis between 2004 and 2012.

Reproducibility and reliability of semen analysis in youths at risk for infertility.

Purpose: There are few normative data on semen analyses in youths at risk for but not presenting with infertility. Standard practice among infertility specialists includes evaluation of 2 separate semen samples, given the degree of within subject variability. We hypothesized that males transitioning from pediatric to adult care who are at risk for infertility would similarly have this variability.

Renal transplantation into a diverted urinary system-is it safe in children?

Purpose: Historically surgeons caring for children with urinary diversion for bladder outlet obstruction have routinely performed undiversion before renal transplantation. We hypothesized that patients undergoing transplantation into a diverted system would have outcomes similar to those undergoing transplantation into a normal bladder. We review the outcomes of patients with and without diversion undergoing kidney transplantation at our institution.

Comparison of semen analyses in youths with a history of cryptorchidism or varicocele.

Purpose: We determined relative semen quality in youths diagnosed with cryptorchidism or varicocele as a surrogate for ultimate paternity potential. We hypothesized that youths with varicocele would be at lower risk for subfertility based on semen analysis than their counterparts with surgically corrected cryptorchidism.

Materials And Methods: We retrospectively reviewed the records of patients with a history of cryptorchidism or varicocele.

Changes in urine parameters after desert exposure: assessment of stone risk in United States Marines transiently exposed to a desert environment.

Purpose: Living in a desert environment has been associated with a higher incidence of kidney stone formation, likely because of concentrated urine output, higher production of vitamin D and genetic predisposition. We determined the changes in urinary parameters after a group of United States Marines temporarily transitioned from a temperate environment to a desert environment.

Materials And Methods: A total of 50 Marines completed a questionnaire and performed 3, 24-hour urine collections before mobilization to the desert, after 30 days in the desert and 2 weeks after returning from the desert.

Robot-assisted bladder diverticulectomy in the pediatric population.

Background And Purpose: Surgical intervention is warranted for symptomatic congenital bladder diverticula (CBD) in children. We hypothesized that a robot-assisted approach to bladder diverticulectomy could be performed with safety and with good efficacy. Descriptions of our approach and results with robot-assisted laparoscopic bladder diverticulectomy (RALBD) are presented.

Delayed presentation of posterior urethral valves in discordant twins.

Concordant and discordant presentations of posterior urethral valves (PUV) in twins have been described. Twin gestation may complicate the diagnosis of PUV based on prenatal evaluation. A case series of 2 sets of twin births is presented, each of which was discordant for the diagnosis of PUV.

Endoscopic management and the role of double stenting for primary obstructive megaureters.

Purpose: We determined the efficacy and potential complications of endoscopic incision and balloon dilation with double stenting for the treatment of primary obstructive megaureter in children.

Materials And Methods: We prospectively reviewed cases of primary obstructive megaureter requiring repair due to pyelonephritis, renal calculi and/or loss of renal function. A total of 17 patients were identified as candidates for endoscopy.

Flexible ureteroscopy in children with von Willebrand disease.

Background And Purpose: Treatment options for urolithiasis include shockwave lithotripsy (SWL), percutaneous nephrostolithotomy (PCNL), and ureteroscopy. While these treatment options are becoming the standard of care in the pediatric population, children with a bleeding dyscrasia must be approached differently. We report our flexible ureteroscopic experience in children with von Willebrand disease (vWd).