Initial Experience with an Absorbable Urologic Scaffold to Mitigate Early Urinary Incontinence following Radical Prostatectomy: A Report of 2 Cases.

Introduction: Stress urinary incontinence (SUI) is a frequent, known complication following robot-assisted radical prostatectomy (RARP) for prostate cancer. Urethral shortening and reduced urethral support following RARP are contributing factors.

Case Presentations: Herein, we describe a surgical approach using a novel absorbable urologic scaffold to mitigate SUI in 2 patients enrolled in an ongoing single-arm prospective study.

Impact of Prescribed Exercise on the Physical and Cognitive Health of Adults with Down Syndrome: The MinDSets Study.

The duplication of chromosome 21, as evidenced in Down Syndrome (DS), has been linked to contraindications to health, such as chronotropic and respiratory incompetence, neuromuscular conditions, and impaired cognitive functioning. The purpose of this study was to examine the effects of eight weeks of prescribed exercise and/or cognitive training on the physical and cognitive health of adults with DS. Eighty-three participants (age 27.

Validating the Cambridge Protocol: Reliability of Hip Muscle Strength Measurements Using a Motorized Dynamometer and Electromyography.

Background: Muscle weakness is common after injury in athletes and in the presence of hip pathology. It will cause abnormal hip biomechanics and can predict future injury. However, objective measurement of hip muscle strength is difficult to perform accurately and reliably.

How Is Jump Performance Affected in Male Athletes when Completed with a Visual Impairment?

Significance: High-, long-, and triple-jump athletic events may need to consider whether it is appropriate to group vision-impaired athletes in the same classification with loss of different visual functions, and a greater emphasis may need to be placed on the visual field (VF) within the current classification system used.

Purpose: Athletes with vision impairment are grouped, based on their visual function, into one of three different classes (B1, B2, and B3, with B1 being the most severe). Athletes in class B2 have loss in visual acuity (VA; range, 1.

Implementation and Impact of a Risk-Stratified Prostate Cancer Screening Algorithm as a Clinical Decision Support Tool in a Primary Care Network.

Background: Implementation methods of risk-stratified cancer screening guidance throughout a health care system remains understudied.

Objective: Conduct a preliminary analysis of the implementation of a risk-stratified prostate cancer screening algorithm in a single health care system.

Design: Comparison of men seen pre-implementation (2/1/2016-2/1/2017) vs.

The MARBLE Study Protocol: Modulating ApoE Signaling to Reduce Brain Inflammation, DeLirium, and PostopErative Cognitive Dysfunction.

Background: Perioperative neurocognitive disorders (PND) are common complications in older adults associated with increased 1-year mortality and long-term cognitive decline. One risk factor for worsened long-term postoperative cognitive trajectory is the Alzheimer's disease (AD) genetic risk factor APOE4. APOE4 is thought to elevate AD risk partly by increasing neuroinflammation, which is also a theorized mechanism for PND.

A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults.

Objective: Lumbar punctures (LPs) are important for obtaining CSF in neurology studies but are associated with adverse events and feared by many patients. We determined adverse event rates and pain scores in patients prospectively enrolled in two cohort studies who underwent LPs using a standardized protocol and 25 g needle.

Methods: Eight hundred and nine LPs performed in 262 patients age ≥ 60 years in the MADCO-PC and INTUIT studies were analyzed.

Reaching Nonmember Advanced Practice Providers and Allied Health Care Professionals.

Introduction: The AUA (American Urological Association) partners with several organizations. However, past efforts to effectively collaborate with advanced practice provider associations, particularly SUNA (the Society of Urologic Nurses and Associates), have been unsuccessful. We define a path forward for the AUA to achieve the goal of mutually beneficial partnership.

Assessment of conservative dietary management as a method for normalization of 24-h urine pH in stone formers.

Low urine pH is a metabolic risk factor for stone formation. While medical therapy is typically prescribed (as urinary alkalinization), patients typically prefer dietary modifications. We aimed to assess capacity to alter urine pH with dietary management alone.

The INTUIT Study: Investigating Neuroinflammation Underlying Postoperative Cognitive Dysfunction.

Background/objectives: Every year, up to 40% of the more than 16 million older Americans who undergo anesthesia/surgery develop postoperative cognitive dysfunction (POCD) or delirium. Each of these distinct syndromes is associated with decreased quality of life, increased mortality, and a possible increased risk of Alzheimer's disease. One pathologic process hypothesized to underlie both delirium and POCD is neuroinflammation.

Abdominal Radiography With Digital Tomosynthesis: An Alternative to Computed Tomography for Identification of Urinary Calculi?

Objective: To compare the accuracy of plain abdominal radiography (kidneys, ureter, and bladder [KUB]) with digital tomosynthesis (DT) to noncontrast computed tomography (NCCT), the gold standard imaging modality for urinary stones. Due to radiation and cost concerns, KUB is often used for diagnosis and follow-up of nephrolithiasis. DT, a novel technique that produces high-quality radiographs with less radiation and/or cost than low-dose NCCT, has not been assessed in this situation.

Over half of contemporary clinical Gleason 8 on prostate biopsy are downgraded at radical prostatectomy.

Introduction: Contemporary clinical guidelines utilize the highest Gleason sum (HGS) in any one core on prostate biopsy to determine prostate cancer treatment. Here, we present a large discrepancy between prostate cancer risk stratified as high risk on biopsy and their pathology after radical prostatectomy.

Materials And Methods: We retrospectively reviewed 1424 men who underwent either open or robotic-assisted prostatectomy between 2004 and 2015.

Comparison of Radiation Exposure from Fixed Table Fluoroscopy to a Portable C-Arm During Ureteroscopy.

Introduction: Current treatment practices within the field of endourology require the routine use of radiation exposure to provide adequate imaging during urologic procedures. One such procedure requiring repeated radiation exposure during treatment is ureteroscopy. We set out to compare estimated fluoroscopic radiation exposures employing fixed table and portable C-arm fluoroscopy.

Evaluation of a Novel Single-Use Flexible Ureteroscope.

A novel single-use flexible ureteroscope promises the optical characteristics and maneuverability of a reusable fourth-generation flexible ureteroscope. In this study, the LithoVue Single-Use Digital flexible ureteroscope was directly compared with contemporary reusable flexible ureteroscopes, with regard to optics, deflection, and irrigation flow. Three flexible ureteroscopes such as the LithoVue (Single Use; Boston Scientific), Flex-Xc (Karl Storz, Germany), and Cobra (Richard Wolf, Germany) were assessed for image resolution, distortion, color representation, grayscale imaging, field of view, and depth of field.

Should metabolic evaluation be performed in patients with struvite stones?

Previous studies suggested that patients with pure struvite calculi rarely have underlying metabolic abnormalities. Therefore, most of these patients do not undergo metabolic studies. We report our experience with these patients and their response to directed medical therapy.

Effect of positive end-expiratory pressure on blood loss during retropubic and robot-assisted laparoscopic radical prostatectomy.

Objectives: To study the effect of end-expiratory pressure used during anesthesia on blood loss during radical prostatectomy.

Methods: We evaluated 247 patients who underwent either radical retropubic prostatectomy or robot-assisted laparoscopic prostatectomy at a single institution from 2008 to 2013 by one of four surgeons. Patient characteristics were compared using t-tests, rank sum or χ(2) -tests as appropriate.

Crowd-Sourced Assessment of Technical Skills for Validation of Basic Laparoscopic Urologic Skills Tasks.

Purpose: The BLUS (Basic Laparoscopic Urologic Skills) consortium sought to address the construct validity of BLUS tasks and the wider problem of accurate, scalable and affordable skill evaluation by investigating the concordance of 2 novel candidate methods with faculty panel scores, those of automated motion metrics and crowdsourcing.

Materials And Methods: A faculty panel of surgeons (5) and anonymous crowdworkers blindly reviewed a randomized sequence of a representative sample of 24 videos (12 pegboard and 12 suturing) extracted from the BLUS validation study (454) using the GOALS (Global Objective Assessment of Laparoscopic Skills) survey tool with appended pass-fail anchors via the same web based user interface. Pre-recorded motion metrics (tool path length, jerk cost etc) were available for each video.

Validation of the AUA BLUS Tasks.

Purpose: Standardized assessment of laparoscopic skill in urology is lacking. We investigated whether the AUA (American Urological Association) BLUS (Basic Laparoscopic Urologic Skills) skill tasks are valid to address this need.

Materials And Methods: This institutional review board approved study included 27 medical students, 42 urology residents, 18 fellows and 37 faculty urologists across 8 sites.

Radiation Dosimetry for Ureteroscopy Patients: A Phantom Study Comparing the Standard and Obese Patient Models.

Purpose: To determine the effect of obesity on radiation exposure during simulated ureteroscopy.

Methods: A validated anthropomorphic adult male phantom with a body mass index (BMI) of approximately 24 kg/m(2), was positioned to simulate ureteroscopy. Padding with radiographic characteristics of human fat was placed around the phantom to create an obese model with BMI of 30 kg/m(2).

Radiation Exposure during the Evaluation and Management of Nephrolithiasis.

Purpose: There is rising concern over the increasing amount of patient radiation exposure from diagnostic imaging and medical procedures. Patients with nephrolithiasis are at potentially significant risk for radiation exposure due to the need for imaging to manage recurrent stone disease. We reviewed the literature in an attempt to better characterize actual risks and discussed methods to reduce radiation exposure for adult patients with nephrolithiasis.

Balloon Dilation of the Ureter: A Contemporary Review of Outcomes and Complications.

Purpose: During ureteroscopy ureteral balloon dilation may be necessary to allow for passage of endoscopic instruments or access sheaths. We assessed the efficacy and complications associated with ureteral balloon dilation.

Materials And Methods: We retrospectively reviewed the records at 2 institutions from 2000 to 2012 to identify patients who underwent ureteral balloon dilation during ureteroscopic treatment of upper tract stones.

Clinical outcomes after ureteroscopic lithotripsy in patients who initially presented with urosepsis: matched pair comparison with elective ureteroscopy.

Background And Purpose: The outcomes of ureteroscopy (URS) after urgent decompression and antibiotics for patients who initially present with urosepsis because of obstructive urolithiasis have not been previously evaluated. The aim of this study was to compare the outcomes and complications of URS in patients with a recent history of sepsis with those without sepsis.

Methods: The study included 138 patients who underwent URS for stone removal from January 2004 to September 2011 at a university medical center.

Complications of surgical management of upper tract calculi in spina bifida patients: analysis of nationwide data.

Purpose: The management of upper urinary tract stones in patients with spina bifida is challenging but poorly described in the literature. We compared urolithiasis interventions and related complications in patients with spina bifida to those in other stone formers using a national database.

Materials And Methods: We retrospectively reviewed the NIS to identify hospital admissions for renal and ureteral stones from 1998 to 2011.

Does body mass index impact the outcomes of tubeless percutaneous nephrolithotomy?

Objective: To evaluate whether body mass index (BMI) has an impact on the outcomes of tubeless percutaneous nephrolithotomy (PCNL).

Patients And Methods: We retrospectively reviewed patients who underwent tubeless PCNL at our institution from 2006 to 2011. Specifically, stone-free rates, complications, and hospital length of stay (LOS) were assessed.