U.S. Army Medical Corps Recruitment, Job Satisfaction, and Retention: Historical Perspectives and Current Issues.

Introduction: This study was conducted to identify and understand the current factors affecting recruitment, job satisfaction, and retention of U.S. Army Medical Corps officers and provide historical background to understand if the current factors are dissimilar.

Army Physician Career Satisfaction Based on a Medical Corps Survey.

Introduction: It is critical the U.S. Army retains skilled physicians in the Medical Corps (MC) to ensure direct support to military operations and medical readiness.

Improving Surgical Complications and Patient Safety at the Nation's Largest Military Hospital: An Analysis of National Surgical Quality Improvement Program Data.

Introduction: The U.S. Military Health System cares for over 9 million patients and encompasses 63 hospitals and 413 clinics worldwide.

Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom: Early findings from the Trauma Outcomes and Urogenital Health (TOUGH) project.

Background: In Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), genitourinary (GU) wounds have occurred in unprecedented numbers. Severe concomitant injuries, including extremity amputations, are common. The epidemiology of GU injury and extremity amputation in OEF/OIF has not been described.

Epidemiology of Genitourinary Injuries among Male U.S. Service Members Deployed to Iraq and Afghanistan: Early Findings from the Trauma Outcomes and Urogenital Health (TOUGH) Project.

Purpose: In this study we report the number, nature and severity of genitourinary injuries among male U.S. service members deployed to Operations Iraqi Freedom and Enduring Freedom.

Improvised explosive device-related lower genitourinary trauma in current overseas combat operations.

Background: The use of improvised explosive devices (IEDs) has had a profound effect on battlefield trauma in the 21st century. Historically, wounds to the genitourinary (GU) structures have been less common than extremity and penetrating abdominal trauma in combat operations. GU injury incidence, severity, and associated injuries secondary to the use of this weapon in Operations Iraqi and Enduring Freedom has not been described.

Implementation of TeamSTEPPS at a Level-1 Military Trauma Center: The San Antonio Military Medical Center Experience.

Context: When a health care system deals with complex trauma patients while simultaneously serving as an educational platform, teamwork and clear communication are imperative. While there are numerous tools and resources available to address the concerns surrounding patient safety, Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) emphasizes a team approach to improve communication among all caregivers and is specifically designed to improve patient safety through improved communication. This article reports the interim results of implementation of TeamSTEPPS in the operating room environment at the most complex and busiest tertiary military trauma center in the Department of Defense in the midst of the longest period of continuous combat operations in US history.

Complications of male circumcision treated at a military hospital in Afghanistan.

Circumcision of male infants and children is a common ritual in Afghanistan. As in many other developing countries, there are few safeguards relating to the procedure, particularly in rural areas. Performance of ritual circumcision may result in complications requiring treatment beyond the capabilities of the practitioner performing the initial procedure.

External validation of a virtual reality transurethral resection of the prostate simulator.

Purpose: Virtual reality surgical simulation is an emerging technology that may eventually fill the gaps in surgical education created by changes in our medical system. We assessed the construct validity of a commercially available, virtual reality transurethral prostate resection simulator.

Materials And Methods: Participants performed 2, 5-minute transurethral prostate resection exercises on a standardized virtual reality prostate.

Combat urologic trauma in US military overseas contingency operations.

Background: This article reports on the occurrences and patterns of genitourinary (GU) trauma in the contemporary high-intensity conflict of the overseas contingency operations (OCOs).

Methods: The Joint Theater Trauma Registry was queried for all US military members who received treatment for GU wounds and concomitant injuries sustained in OCOs for >75 months between October 2001 and January 2008.

Results: Of the 16,323 trauma admissions annotated in the Joint Theater Trauma Registry, 819 (5%) had one or more GU injuries.

Scrotal pathology in the outpatient setting in Operation Iraqi Freedom.

The purpose of this study was to describe the incidence and pathology of scrotal pain among military men deployed in Operation Iraqi Freedom. It is a retrospective review of patients seen by the urology service at a U.S.

Patient risk stratification using Gleason score concordance and upgrading among men with prostate biopsy Gleason score 6 or 7.

Purpose: To define the impact of discordant Gleason sum (GS) between prostate biopsy (Pbx) tissue and radical prostatectomy (RP) specimen among men initially diagnosed with Gleason 6 or 7 prostate adenocarcinoma.

Materials And Methods: We evaluated patients diagnosed with GS 6 or 7 and treated primarily with RP. We defined the frequency of GS discordance between Pbx and RP pathology reports.

Penetrating trauma to the external genitalia in Operation Iraqi Freedom.

This report details the incidence and description of trauma to the external genitalia experienced during Operation Iraqi Freedom at a United States Army Combat Support Hospital, and demonstrates that acceptable rates of testicular salvage are possible in the combat setting. The operating room logs and the Joint Theater Trauma Registry were used to conduct a retrospective review of the patients who sustained genitourinary (GU) injuries at an US Army Combat Support Hospital (CSH) in Iraq from 27 February 2007 to 14 August 2007. Of the 3595 battle trauma injuries seen at the CSH during the time period, 168 (4.

Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatectomy.

Purpose: Hormonal therapy (HT) is the current mainstay of systemic treatment for prostate specific antigen (PSA) only recurrence (PSAR), however, there is virtually no published literature comparing HT to observation in the clinical setting. The goal of this study was to examine the Department of Defense Center for Prostate Disease Research observational database to compare clinical outcomes in men who experienced PSAR after radical prostatectomy by early versus delayed use of HT and by a risk stratified approach.

Materials And Methods: Of 5,382 men in the database who underwent primary radical prostatectomy (RP), 4,967 patients were treated in the PSA-era between 1988 and December 2002.

Gunshot wound injuries of the prostate and posterior urethra: reconstructive armamentarium.

Purpose: Descriptions of posterior urethral penetrating injuries are rare in the literature and their management is poorly described. We reviewed the medical records of 19 men who sustained posterior urethral gunshot wounds and report our experience with various treatment options.

Materials And Methods: We retrospectively reviewed the records of 19 men (mean age 27 years) who sustained posterior urethral gunshot wound injuries confirmed by retrograde urethrography and/or exploratory laparotomy.

Optimal cost-effective staging evaluations in prostate cancer.

A new diagnosis of prostate cancer presents to both the patient and physician questions regarding the best approach for further assessing the extent of disease prior to selecting a treatment strategy. In addition to the initial clinical data such as serum prostate-specific antigen level, findings on digital rectal examination, and core biopsy Gleason score, several procedures and imaging modalities are available to further stage newly diagnosed prostate cancer. A substantial percentage of the cost of managing prostate cancer is directly related to staging evaluations.

Laparoscopic radical prostatectomy: evaluation of specimen pathologic features to critically assess and modify surgical technique.

Objectives: To evaluate laparoscopic radical prostatectomy (LRP) specimens for pathologic stage and the malignant and benign surgical margin status to determine areas for improvement in surgical technique. LRP is gaining significant attention as a viable alternative to retropubic radical prostatectomy.

Methods: A total of 110 consecutive LRP specimens were retrospectively reviewed.

Endoscopic treatment of upper tract transitional cell carcinoma.

Purpose: To review the current literature and data describing primary endoscopic treatment of upper tract transitional cell carcinoma (TCC).

Materials And Methods: Published, peer-reviewed articles on ureteroscopic, percutaneous, and laparoscopic treatment of upper tract TCC were identified using the MEDLINE database.

Results: Nephroureterectomy has been considered the "gold standard" for upper tract TCC.

Prospective longitudinal comparative study of health-related quality of life in patients undergoing invasive treatments for localized prostate cancer.

Background And Purpose: Health-related quality of life (QoL) concerns are important for patients selecting treatment options for clinically localized prostate cancer and are critical in evaluating outcomes. We report pretreatment and post-treatment general and disease-specific QoL for the following invasive interventions: open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), and palladium-103 ((103)Pd) brachytherapy.

Patients And Methods: We performed a prospective longitudinal survey of 452 patients with newly diagnosed prostate cancer treated at a single medical center between 2001 and 2003.

Laparoscopic radical prostatectomy: is intact organ removal attainable? Study of margin status.

Purpose: To determine the initial oncologic results (pathology) of specimens removed by laparoscopic radical prostatectomy (LRP) by examining the surgical margins.

Patients And Methods: The 70 consecutive LRP procedures performed for clinically localized prostate cancer at Eastern Virginia Medical School from April 2001 to November 2002 were reviewed for preoperative and important intraoperative variables. The initial histopathology report and a prospective review by a single genitourinary pathologist for margin status as well parenchymal exposure of benign glands were assessed.

Misattributed paternity in a living related donor: to disclose or not to disclose?

Many ethical considerations surround living kidney donation, some of which are not anticipated. We present a case in which misattributed paternity was inadvertently discovered during the workup of a father and son and present arguments for and against disclosure of this information. We recommend that transplant programs advise patients participating in living organ donor programs that misattributed paternity might be discovered during routine preoperative testing and that protocols for dealing with complex ethical issues be in place.

Ureteropelvic junction obstruction: does CT angiography allow better selection of therapeutic modalities and better patient outcome?

Purpose: To determine whether preoperative helical CT angiography (CTA) with three-dimensional (3D) reconstructed images improves outcome in patients with ureteropelvic junction obstruction (UPJO) by identifying crossing vessels that may lead to surgical failure.

Patients And Methods: Twenty-five patients with UPJO underwent imaging with CTA to identify crossing vessels. Patients with crossing vessels or severe hydronephrosis underwent laparoscopic dismembered pyeloplasty.

Prostate cancer screening at an equal access tertiary care center: its impact 10 years after the introduction of PSA.

Introduction And Objectives: Dwight D. Eisenhower Army Medical Center has been involved in Prostate Cancer Awareness Week (PCAW) screening during the period 1995-2000. The purpose of this study is to review the results of screening in a self-selected population of military beneficiaries at our institution.