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Objectives: To determine accuracy of negative urinalysis (UA) for predicting negative urine culture and the absence of urinary tract infection (UTI), and optimal urine culture growth cutoff for UTI diagnosis in men with and without urinary catheters. Subjects and Methods: UAs with urine cultures within 1 week from adult men were identified and evaluated. Predictive values for the absence of UTI (absence of ≥1 of the following criteria: documentation of UTI diagnosis, antibiotic prescription, uropathogen presence on culture) were calculated. Results: In total, 22 883 UAs were included. Negative UA had a high predictive value for negative urine culture (0.95, 95% confidence interval [CI]: 0.94–0.95) and absence of UTI (0.99, CI: 0.99–0.995) in the overall cohort. Negative UA also had a high predictive value for negative urine culture (0.93, CI: 0.90–0.95) and absence of UTI (0.99, CI: 0.98–0.999) in those with indwelling urinary catheters. The traditional threshold of culture growth of 100 000 colony‐forming units (CFU)/mL did not capture 22% of UTIs. Conclusion: UA exhibits high predictive value for negative urine culture and absence of UTI in men, supporting a protocol wherein culture is only performed in the context of abnormal UA. The traditional 100 000 CFU/mL cut‐off may have not captured a subset of UTI in the male population, and warrants further investigation. [ABSTRACT FROM AUTHOR]

Introduction: Patient expectations and baseline health are important drivers of outcomes following major genitourinary reconstructive surgery for neurogenic bladder (NGB). Differences in expectations and quality of life (QoL) improvements among different populations with NGB remain insufficiently explored in the literature. Objective: To compare decisional regret (DR) and urinary‐related QoL (UrQoL) in patients undergoing urinary diversion for NGB arising from spinal cord injury of acquired (A‐SCI) and congenital (C‐SCI) etiologies. We hypothesize that patients with A‐SCI have higher expectations of improvement in QoL following surgery when compared with C‐SCI, which may lead to higher DR and decreased UrQoL, postoperatively. Design: In this cross‐sectional survey study, we compared A‐SCI to C‐SCI in terms of DR, UrQoL, and postoperative changes in self‐reported physical health, mental health, and pain using validated patient‐reported outcome measures. Setting: Participants were enrolled from a quaternary care institution via mail and MyChart. Participants: The A‐SCI group consisted of 17 patients with traumatic spinal cord injury; the C‐SCI group was composed of 20 patients with spina bifida. Interventions: Not applicable. Main Outcome Measures: The Decisional Regret Scale, Short form‐ Qualiveen (SF‐Qualiveen), and Patient‐reported outcomes measurement Information system‐10 (PROMIS‐10) Global Health surveys. Results: The A‐SCI group displayed poorer preoperative physical health than the C‐SCI cohort, but absolute postoperative changes in this score, along with mental health score and pain level, were not significant after adjusting for baseline scores and follow‐up time. SF‐Qualiveen scores revealed significantly worse impact of NGB in UrQoL for A‐SCI than for C‐SCI when adjusted for other factors. No differences in DR were seen between the groups. Conclusions: Patients with A‐SCI demonstrate lower self‐reported baseline physical health compared with patients with C‐SCI, which may have implications in setting patient expectations when undergoing urinary diversion. In this small cohort, we found a milder self‐reported postoperative impact of NGB in UrQoL in patients with C‐SCI. [ABSTRACT FROM AUTHOR]

Aim: To describe the education and employment transition experience of young adults with spina bifida (YASB) and investigate factors associated with employment. Method: We queried education and employment data from the US National Spina Bifida Patient Registry from 2009 to 2019. We applied generalized estimating equations models to analyze sociodemographic and disease‐related factors associated with employment. Results: A total of 1909 participants (850 males, 1059 females) aged 18 to 26 years contributed 4379 annual visits. Nearly 84% had myelomeningocele and, at last visit, the median age was 21 years (mean 21 years 5 months, SD 2 years 10 months). A total of 41.8% had at least some post‐high school education, and 23.9% were employed. In a multivariable regression model, employment was significantly associated with education level, lower extremity functional level, bowel continence, insurance, and history of non‐shunt surgery. This large, national sample of YASB demonstrated low rates of post‐secondary education attainment and employment and several potentially modifiable factors associated with employment. Interpretation: Specific sociodemographic, medical, and functional factors associated with employment are important for clinicians to consider when facilitating transition for YASB into adulthood. Additional research is needed to understand the impact of cognitive functioning and social determinants of health on transition success in YASB. What this paper adds: There were low education attainment and employment rates in a large sample of young adults with spina bifida.Specific sociodemographic, medical, and functional factors are associated with employment.Some employment‐associated factors, such as continence and self‐management skills, are modifiable. [ABSTRACT FROM AUTHOR]

Purpose: Individuals with neuromuscular disorders and neurogenic lower urinary tract dysfunction are commonly nonweight-bearing with lower lean muscle mass than the general population. We sought to compare estimated glomerular filtration rate equations that include creatinine, cystatin C, or both, in nonweight-bearing individuals and matched ambulatory controls. Materials and Methods: Records were reviewed for individuals with serum creatinine (Cr) and cystatin C (Cys) and diagnosis consistent with nonweight-bearing status, and matched ambulatory controls. The 2021 CKD-EPI (Chronic Kidney Disease-Epidemiology Collaboration) race agnostic equations were used to calculate estimated glomerular filtration rate. Renal function was compared by equation in the overall cohorts and in a patient subset with imaging and/or urinalysis evidence of renal dysfunction. Results: Nonweight-bearing (n = 102) and control populations (n = 204) had similar demographics. In the nonweight-bearing population, estimated glomerular filtration rate differed when calculated using CKD-EPICr, CKD-EPICr+Cys, and CKD-EPICys (107, 93, 80 mL/min/1.73 m², respectively, P < .001). The differences in estimated glomerular filtration rate were greater in the nonweight-bearing relative to the control group regardless of CKD-EPI equation pairs compared (P < .001). In the patient subset with imaging and/or proteinuria evidence of renal dysfunction, the nonweight-bearing population again had different estimated glomerular filtration rate when calculated using CKD-EPICr, CKD-EPICr+Cys, and CKD-EPICys (P < .001). Fifty-eight percent of nonweight-bearing individuals with evidence of renal dysfunction on imaging or urinalysis were reclassified into a lower estimated glomerular filtration rate category when using estimated glomerular filtration rateCys relative to estimated glomerular filtration rateCr. Conclusions: Estimated glomerular filtration rate equations containing serum creatinine, cystatin C, or both, validated in mostly ambulatory populations, are not equivalently accurate in estimating kidney function in nonweight-bearing individuals. Comparison of these equations against gold standard glomerular filtration rate measurement is needed to determine which most closely approximates true glomerular filtration rate. [ABSTRACT FROM AUTHOR]

The artificial urinary sphincter (AUS) is an effective treatment option for incontinence due to intrinsic sphincteric deficiency in the context of neurogenic lower urinary tract dysfunction, or stress urinary incontinence following radical prostatectomy. A subset of AUS devices develops infection and requires explant. We sought to characterize biofilm composition of the AUS device to inform prevention and treatment strategies. Indwelling AUS devices were swabbed for biofilm at surgical removal or revision. Samples and controls were subjected to next-generation sequencing and metabolomics. Biofilm formation of microbial strains isolated from AUS devices was reconstituted in a bioreactor mimicking subcutaneous tissue with a medical device present. Mean patient age was 73 (SD 10.2). All eighteen artificial urinary sphincter devices harbored microbial biofilms. Central genera in the overall microbe–metabolite interaction network were Staphylococcus (2620 metabolites), Escherichia/Shigella (2101), and Methylobacterium-Methylorubrum (674). An rpoB mutation associated with rifampin resistance was detected in 8 of 15 (53%) biofilms. Staphylococcus warneri formed greater biofilm on polyurethane than on any other material type (p < 0.01). The results of this investigation, wherein we comprehensively characterized the composition of AUS device biofilms, provide the framework for future identification and rational development of inhibitors and preventive strategies against device-associated infection. [ABSTRACT FROM AUTHOR]

Urosymphyseal fistula (USF) is a very uncommon but catastrophic condition which typically occurs in the setting of previous radiation treatment for prostate cancer. As a result, USF has only been described in male populations. For the first time, we characterize this phenomenon in a series consisting of four women managed at our quaternary institution. We found that most patients presented with pubic pain and all were diagnosed with USF on CT or MRI. Imaging commonly demonstrated features suggesting osteomyelitis which was confirmed on histology. Patients experienced significant decreases in peri-operative pain scores following extirpative surgery with urinary diversion, bone debridement/resection and tissue interposition. This case series highlights the rarity of USF in women in order to help promote increased recognition and timely management. [ABSTRACT FROM AUTHOR]

I Dear Editor, i Colorectal grafts are rising in popularity as an alternative to buccal mucosal grafts especially for patients requiring long substitution urethroplasty (UP). The role of endoscopic submucosal dissection in harvesting rectal mucosal graft for urethral reconstruction - A Video Vignette His urethral strictures required long substitution UP and we performed ESD to obtain a rectal mucosal graft. [Extracted from the article]

Objective: To characterize perioperative morbidity and mortality in adult patients with spina bifida undergoing laparotomy.Patients and Methods: We retrospectively studied the postoperative complications of 59 operations of patients with spina bifida undergoing abdominal laparotomies for urologic indications at 3 institutions. We evaluated postoperative complications using the Clavien-Dindo classification scale.Results: The overall complication rate was 91.5%. The most common complications were ileus, pressure ulcers, urinary tract infection, and wound infection. Over 40% of the patients developed a class 3 or 4 complication requiring subsequent surgery or intensive care unit admission. The hospital readmission rate was 42% and was correlated with higher-grade complications. On multivariable analysis, only older age was significantly associated with grade of complication.Conclusion: These data demonstrate that adult patients with spina bifida comprise a unique population that faces an extremely high surgical risk even in centers of excellence. As patients with spina bifida live longer lives, thanks to modern medicine, there is a timely opportunity for research on perioperative management in these patients to improve postsurgical outcomes. [ABSTRACT FROM AUTHOR]

Over the last 5 decades, health-care advances have yielded quantum improvements in the life expectancy of individuals with congenital genitourinary conditions (CGCs), leading to a crisis of care. Many individuals with CGC enter adulthood unprepared to manage their condition. Pediatric CGC specialists lack training to manage adulthood-related health-care issues, whereas adult genitourinary specialists lack training within the context of CGCs. To address these challenges, the National Institutes of Diabetes and Digestive and Kidney Diseases convened individuals with CGCs and experts from a variety of fields to identify research needs to improve transitional urology care. This paper outlines identified research needs. [ABSTRACT FROM AUTHOR]