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Objective To review the available data related to the prevention of recurrent urinary tract infection (rUTI) in postmenopausal women with vaginal estrogen preparations and provide the urologic community with the confidence to identify and treat genitourinary syndrome of menopause (GSM). Materials and Methods A literature search of MEDLINE and the Cochrane Central Register of Controlled Trials databases was performed to identify studies utilizing vaginal estrogen in the treatment of urological conditions related to rUTI and GSM. Results In the setting of untreated GSM, the etiology of rUTIs (at least 3 episodes of UTIs in 12 months or at least 2 episodes in 6 months) is not fully elucidated, but estrogen deficiency is a contributing factor. The diagnosis of GSM is primarily a clinical diagnosis supported by other objective findings including: a vaginal pH >5, decreased content of superficial cells, and/or increased proportion of parabasal cells on vaginal maturation index. Local vaginal estrogen, dehydroepiandrosterone (prasterone), and ospemifene are commonly used GSM treatments. Thirty-one trials were identified utilizing estrogen preparations for rUTI in postmenopausal women. Conclusion Overall, multiple randomized clinical trials have successfully been completed to show the efficacy of local estrogen preparations for the treatment of rUTIs. This high yield review provides a framework for assessing GSM, prescribing recommendations for local vaginal hormone preparations, and a summary of the substantial evidence supporting the new 2019 American Urological Association/Canadian Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction Guidance for local vaginal estrogen use for rUTI.

Background Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) has improved urinary function compared with standard robotic-assisted radical prostatectomy (S-RARP). As RS-RARP spares the dorsal vascular complex, pelvic fascia, and anterior abdominal fascia, it may also lower the incidence of “neglected” postprostatectomy sequelae such as penile shortening, Peyronie’s disease, and inguinal hernias. Objective To determine whether there are patient-perceived differences in penile shortening, Peyronie’s disease, and inguinal hernia rates among men undergoing RS-RARP versus S-RARP. Design, setting, and participants Researchers uninvolved in clinical care and blinded to surgical approach surveyed 60 RS-RARP versus 57 S-RARP men with validated patient-reported items to assess penile shortening, Peyronie’s disease, and inguinal hernia sequelae following surgery. Intervention RS-RARP versus S-RARP. Outcome measurements and statistical analysis Univariate differences between the two cohorts were analyzed using Student t test. Logistic regression was used to analyze variables associated with postoperative penile shortening. Cox proportional hazards models were used to assess the risk of developing Peyronie’s disease and inguinal hernia postoperatively. Results and limitations RS-RARP was associated with less patient-reported penile shortening (41.7% vs 64.9%, p = 0.012), Peyronie’s disease (0% vs 8.7%, p = 0.020), and inguinal hernia (0.0% vs 13.0%, p = 0.004). In adjusted analyses, RS-RARP (odds ratio [OR] 0.24, 95% confidence interval [CI] 0.09–0.63, p = 0.004) was associated with lower odds of penile shortening, while a higher body mass index was associated with increased odds of penile shortening (OR 1.13, 95% CI 1.01–1.26, p = 0.037). RS-RARP was not associated with a decreased risk of Peyronie’s disease on Cox proportion hazard model; however, these models are limited due to a limited number of events in our cohort. Limitations include retrospective design, patient-reported outcomes, and small cohorts. Conclusions RS-RARP is associated with less patient-reported penile shortening and may decrease the risk of Peyronie’s disease and postoperative inguinal hernia development. These new findings add to research, showing improved urinary continence and quality of life following RS-RARP; however, a prospective study is needed to validate these findings. Patient summary Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) is an evolving surgical technique for prostate cancer treatment, which has shown improved postoperative urinary control compared with the standard technique, likely due to preservation of natural pelvic anatomy. Our findings suggest that the preservation of normal pelvic anatomy during RS-RARP may also reduce the risk of postprostatectomy penile shortening, Peyronie’s disease, and inguinal hernia., Take Home Message Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) is an evolving surgical technique for prostate cancer treatment that has shown improved postoperative urinary control compared with the standard technique, likely due to the preservation of natural pelvic anatomy. Our findings suggest that the preservation of normal pelvic anatomy during RS-RARP may also reduce the risk of postprostatectomy penile shortening, Peyronie’s disease, and inguinal hernia.

Introduction Female sexual dysfunction is common, and there is growing interest in the relationship between everyday dietary habits and female sexuality. Most of the research at this point is focused on pathological states such as metabolic syndrome, obesity, and eating disorders, which seem to exacerbate sexual dysfunction. Aim To characterize sexual dysfunction in the presence of comorbidities including metabolic syndrome, obesity, and disordered eating states and to examine the effect of dietary patterns on female sexuality. Methods A comprehensive review of peer-reviewed publications on the topic was performed through a PubMed search. Key search terms and phrases included female sexual dysfunction, diet, dietary patterns, metabolic syndrome, obesity, Mediterranean diet, and eating disorders. Main Outcome Measure The main outcome measures were female sexual function scores as measured on the Female Sexual Function Index and domain-specific dysfunctions. Results Metabolic syndrome negatively affects sexual function in women, and this effect is most pronounced in younger, premenopausal women. Obesity may also detract from female sexuality, but the data on this comorbidity are more mixed. Endothelial dysfunction, which can result from excess inflammation seen in metabolic syndrome and obesity, can lead to poor blood flow to genitourinary organs, thus providing a pathophysiological link between these diseases and sexual dysfunction. Patients with disordered eating also suffer from sexual morbidity, which may be due to comorbid psychiatric illness and emaciation-induced hypogonadism. Promising data show that the Mediterranean diet helps alleviate sexual dysfunction in women, but other dietary patterns require more formal investigation. Conclusion Incorporation of healthy dietary patterns into everyday life may positively influence female sexuality, but more substantial data are needed to confirm this idea. Towe M, La J, El-Khatib F, et al. Diet and Female Sexual Health. Sex Med Rev 2020;8:256–264.

Female sexual pain disorder or genito-pelvic pain/penetration disorder (GPPPD), previously known as dyspareunia, is defined as persistent or recurrent symptoms with one or more of the following for at least 6 months: marked vulvovaginal or pelvic pain during penetrative intercourse or penetration attempts, marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of penetration, and marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration. In this review, we discuss etiology, diagnosis, and treatment for common disorders that cause GPPD.

Objectives Widespread global transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing coronavirus disease 2019 (COVID-19), continues. Many questions remain about asymptomatic or atypical infections and transmission dynamics. We used comprehensive contact tracing of the first 2 confirmed patients in Illinois with COVID-19 and serologic SARS-CoV-2 antibody testing to determine whether contacts had evidence of undetected COVID-19. Methods Contacts were eligible for serologic follow-up if previously tested for COVID-19 during an initial investigation or had greater-risk exposures. Contacts completed a standardized questionnaire during the initial investigation. We classified exposure risk as high, medium, or low based on interactions with 2 index patients and use of personal protective equipment (PPE). Serologic testing used a SARS-CoV-2 spike enzyme-linked immunosorbent assay on serum specimens collected from participants approximately 6 weeks after initial exposure to either index patient. The 2 index patients provided serum specimens throughout their illness. We collected data on demographic, exposure, and epidemiologic characteristics. Results Of 347 contacts, 110 were eligible for serologic follow-up; 59 (17% of all contacts) enrolled. Of these, 53 (90%) were health care personnel and 6 (10%) were community contacts. Seventeen (29%) reported high-risk exposures, 15 (25%) medium-risk, and 27 (46%) low-risk. No participant had evidence of SARS-CoV-2 antibodies. The 2 index patients had antibodies detected at dilutions >1:6400 within 4 weeks after symptom onset. Conclusions In serologic follow-up of the first 2 known patients in Illinois with COVID-19, we found no secondary transmission among tested contacts. Lack of seroconversion among these contacts adds to our understanding of conditions (ie, use of PPE) under which SARS-CoV-2 infections might not result in transmission and demonstrates that SARS-CoV-2 antibody testing is a useful tool to verify epidemiologic findings.

Objectives: The purpose of this study was to identify the percentage of inappropriate telemetry and reduce inappropriate use via a multidisciplinary interventional approach. Background: Nationally studies have demonstrated that up to 43% of telemetry orders are inappropriate and do not change patient outcomes or clinical decision making. Overuse may also lead to unnecessary diagnostic workup, hospital costs, clinical duties, and even hospital divert status. Methods: Using the AHA guidelines and the TUH official policy, we created an updated table of appropriate telemetry indications (Table 1). We used the Epic telemetry column to identify active orders. Then, each patient’s chart was reviewed to determine whether the order was appropriate."We reviewed all active telemetry orders on our medicine services over four days. Results: Teaching services had 72/140 (51%) inappropriate orders while direct-care services had 4/19 (21%) inappropriate orders (Table 2). "Subspecialty teaching services had 10/15 (67%) inappropriate orders. Discussion: Inappropriate telemetry use is a systems-based, multidisciplinary problem requiring interventions at multiple levels Our goal was to reduce overall inappropriate telemetry use from 49% to 35% At our center, interventions underway include: Posting the indications on workstations, Encouraging “Time out for Tele!” review on rounds, Educating hospital teams, Additional Epic modifications. Conclusions: Inappropriate telemetry use on medicine services at our institution is higher than national averages. We increased physician awareness of orders and performed education on appropriate use. We plan to re-assess telemetry use at interval periods to assess for improvement.

INTRODUCTION AND OBJECTIVE:Recurrent urinary tract infections (UTIs) are associated with genitourinary syndrome of menopause (GSM) in postmenopausal women. Androgens, in addition to estrogens, have...

IntroductionMore than 93,000 cases of coronavirus disease (COVID-19) have been reported worldwide. We describe the epidemiology, clinical course, and virologic characteristics of the first 12 U.S. patients with COVID-19.MethodsWe collected demographic, exposure, and clinical information from 12 patients confirmed by CDC during January 20–February 5, 2020 to have COVID-19. Respiratory, stool, serum, and urine specimens were submitted for SARS-CoV-2 rRT-PCR testing, virus culture, and whole genome sequencing.ResultsAmong the 12 patients, median age was 53 years (range: 21–68); 8 were male, 10 had traveled to China, and two were contacts of patients in this series. Commonly reported signs and symptoms at illness onset were fever (n=7) and cough (n=8). Seven patients were hospitalized with radiographic evidence of pneumonia and demonstrated clinical or laboratory signs of worsening during the second week of illness. Three were treated with the investigational antiviral remdesivir. All patients had SARS-CoV-2 RNA detected in respiratory specimens, typically for 2–3 weeks after illness onset, with lowest rRT-PCR Ct values often detected in the first week. SARS-CoV-2 RNA was detected after reported symptom resolution in seven patients. SARS-CoV-2 was cultured from respiratory specimens, and SARS-CoV-2 RNA was detected in stool from 7/10 patients.ConclusionsIn 12 patients with mild to moderately severe illness, SARS-CoV-2 RNA and viable virus were detected early, and prolonged RNA detection suggests the window for diagnosis is long. Hospitalized patients showed signs of worsening in the second week after illness onset.

Background Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first detected in China in December, 2019. In January, 2020, state, local, and federal public health agencies investigated the first case of COVID-19 in Illinois, USA. Methods Patients with confirmed COVID-19 were defined as those with a positive SARS-CoV-2 test. Contacts were people with exposure to a patient with COVID-19 on or after the patient's symptom onset date. Contacts underwent active symptom monitoring for 14 days following their last exposure. Contacts who developed fever, cough, or shortness of breath became persons under investigation and were tested for SARS-CoV-2. A convenience sample of 32 asymptomatic health-care personnel contacts were also tested. Findings Patient 1-a woman in her 60s-returned from China in mid-January, 2020. One week later, she was hospitalised with pneumonia and tested positive for SARS-CoV-2. Her husband (Patient 2) did not travel but had frequent close contact with his wife. He was admitted 8 days later and tested positive for SARS-CoV-2. Overall, 372 contacts of both cases were identified; 347 underwent active symptom monitoring, including 152 community contacts and 195 health-care personnel. Of monitored contacts, 43 became persons under investigation, in addition to Patient 2. These 43 persons under investigation and all 32 asymptomatic health-care personnel tested negative for SARS-CoV-2. Interpretation Person-to-person transmission of SARS-CoV-2 occurred between two people with prolonged, unprotected exposure while Patient 1 was symptomatic. Despite active symptom monitoring and testing of symptomatic and some asymptomatic contacts, no further transmission was detected. Funding None.

To review the current literature regarding sexual dysfunction and interstitial cystitis/bladder pain syndrome (IC/BPS). Our goal was to review the epidemiology and overlap of these two conditions as well discuss the success of various IC/BPS treatment modalities with improving sexual function. Women with IC/BPS have a much higher incidence of sexual dysfunction as compared to controls, and this is often a significant predictor of poor quality of life. IC/BPS is thought to have various phenotypes and is associated with a number of overlapping chronic conditions which may contribute to sexual dysfunction thus making an accurate diagnosis imperative. Various treatments for IC/BPS may improve certain domains of sexual function. It is not surprising that IC/BPS, a chronic pelvic pain condition, negatively affects sexual function. More research is needed not just on the prevalence of sexual dysfunction in this patient population, but specifically on treatment options and ways to improve sexual function in these distressed patients.

PURPOSE/OBJECTIVE(S) Ejaculatory dysfunction after prostate radiation therapy is an important quality of life issue with limited management options. Given the high biologically effective doses (BEDs) that are delivered with stereotactic body radiation therapy (SBRT), ejaculatory dysfunction may be more common and/or more severe than with alternative external beam approaches. The purpose of this study is to evaluate ejaculatory preservation following SBRT for prostate cancer. MATERIALS/METHODS 231 patients on a prospective quality of life study (IRB#: 2009-510) with baseline ejaculatory capacity treated with prostate SBRT at a single institution from 2013 to 2019 were included in this analysis. Ejaculatory function was assessed via the validated Ejaculation Scale (ES-8) from the Male Sexual Health Questionnaire (Rosen RC et al, 2004). ES-8 scores range from 3 - 40 with lower values representing increased interference or annoyance. The ES-8 includes questions about ejaculate volume, ejaculatory pain, and bother. Patients completed the questionnaire on the first day of treatment and at 1, 3, 6, 9, 12, 18, and 24 months post-SBRT. Elderly patients (Age > 70) and those who received hormonal therapy were excluded from this analysis. All patients were treated to 35-36.25 Gy in 5 fractions delivered with a frameless robotic radiosurgery system. Data analysis was performed using XLStat. Minimally important differences (MID) were calculated by obtaining half the standard deviation at time of start of treatment. RESULTS Mean age at treatment was 64.2 years. Minimum follow-up was 24 months. Mean composite ES-8 scores showed a decline in the first month following treatment then stabilized: 30.3 (baseline); 26.7 (1 month); 27.6 (3 month); 26.9 (6 month); 26.0 (9 month); 25.4 (12 month); 25.0 (18 month) and 25.3 (24 month). The decline from baseline to one month was statistically significant (P < 0.0001). A clinically significant decrease (MID = 3.5) was achieved at 1 month (-3.6) and from 9 months (-4.3) through 24 months (-4.9). Ejaculate volume was statistically significantly reduced at all time points post-SBRT. Ejaculate volume reduction was clinically significant (MID = 0.57) from 6-24 months post SBRT. There was a clinically significant increase (MID = 0.53) in pain with ejaculation at 1-month (-0.67), 9-months (-0.63), and 12-months (-0.59). Prior to treatment, 7.6% of men reported that they were very to extremely bothered by their ejaculatory dysfunction. This was significantly increased to 14.5% at one-year (P = 0.01) and to 10.6% at 18-months (P = 0.048) post-SBRT. CONCLUSION Men undergoing SBRT monotherapy for prostate cancer have a small decline in their overall ejaculatory function from baseline to one-month post-treatment, but stable function thereafter. Bother with ejaculation peaked at one year then slowly declined. Longer follow-up is required to confirm the durability of these findings.

The algorithm for surgical management of post prostatectomy incontinence classically includes male slings and artificial urinary sphincter (AUS) placement. The Virtue Quadratic Male Sling was designed to provide both urethral elevation and prepubic compression making it a viable option for a wider spectrum of incontinent men whose symptoms range from mild to severe. With a focus on two key steps of the surgery, (I) sling fixation (II) use of intraoperative retrograde leak point pressure (RLPP), this guide is intended to outline a safe and efficacious treatment for post-prostatectomy incontinence. Intriguingly, the sling can be revised in the event of refractory or worsening leakage, and does not preclude the placement of an AUS should it be needed. This paper describes a step by step approach to performing the procedure as well as expert tips to improve outcomes and avoid/manage complications that have been learned over the years.

There has been a public outcry for the accountability of law enforcement agents who kill and injure citizens. Epidemiological surveillance can underscore the magnitude of morbidity and mortality of citizens at the hands of law enforcement. We used hospital outpatient and inpatient databases to conduct a retrospective analysis of legal interventions in Illinois between 2010 and 2015. We calculated injury and mortality rates based on demographics, spatial distribution, and cause of injury. During the study period, 8,384 patients were treated for injuries caused during contact with law enforcement personnel. Most were male, the mean age was 32.7, and those injured were disproportionately black. Nearly all patients were treated as outpatients, and those who were admitted to the hospital had a mean of length of stay of 6 days. Most patients were discharged home or to an acute or long-term care facility (83.7%). It is unclear if those discharged home or to a different medical facility were arrested, accidentally injured, injured when no crime was committed, or injured when a crime was committed. Surveillance of law enforcement–related injuries and deaths should be implemented, and injuries caused during legal interventions should be recognized as a public health issue rather than a criminal justice issue.

Background During January-February 2015, Cook County Department of Public Health led an investigation of a measles outbreak predominantly affecting infants at a child care center who were too young for routine immunization with measles-mumps-rubella (MMR) vaccine. Methods Measles cases and contacts were investigated by Illinois public health officials. Cases were isolated for 4 days after rash onset. Exposed healthcare workers and child care center staff were required to provide documentation of receipt of 2 doses of MMR vaccine or laboratory evidence of immunity to return to work. Susceptible contacts were actively monitored for 21 days after exposure and provided postexposure prophylaxis (PEP) if certain criteria were met. Results Fifteen confirmed measles cases were identified; 12 (80%) occurred in infants who were attendees of a child care center. Clinical misdiagnosis of 1 case allowed for continued transmission within the center. Twelve (86%) of 14 exposed infants at the child care center were diagnosed with measles; no other attendees or staff were infected. Five cases visited outpatient pediatric clinics during their infectious period, exposing 33 infants. Six exposed child care center staff and 3 healthcare workers did not have documentation of immunity available and were excluded from work until this was obtained. No healthcare-associated transmission was identified. Ninety-one contacts were actively monitored and 20 received PEP. Conclusions This outbreak underscores the vulnerability of infants to measles, the need for early consideration of measles in susceptible patients presenting with a febrile rash illness, and the importance of immunity among individuals working closely with infants.

Introduction The glans clitoris is covered by a prepuce that normally moves over the glans surface and can be retracted beyond the corona. Clitoral adhesions, ranging from mild to severe, occur when preputial skin adheres to the glans. Physical examination consistent with clitoral adhesions is based on the inability to visualize the entire glans corona. In this closed compartment, the space underneath the adherent prepuce and clitoris can become irritated, erythematous, or infected and can result in sexual dysfunction. Aim To determine the prevalence of clitoral adhesions in a sexual medicine practice and assess risk factors associated with clitoral adhesions. Methods This research involved retrospective examinations of vulvoscopy photographs taken from August 2007 to December 2015. Clitoral adhesions were considered absent when preputial retraction enabled full glans corona visualization. The study group consisted of women with mild, moderate, or severe clitoral adhesions based on more than 75%, 25% to 75%, or less than 25% glans clitoris exposure without full corona visualization, respectively. 2 independent reviewers evaluated photographs; a 3rd analyzed study group health record data. Main Outcome Measure Prevalence of severity of clitoral adhesions. Results Of the 1,261 vulvoscopy photographs, 767 (61%) were determined adequate for assessment and 614 photographs represented individual patients. The study group with clitoral adhesions consisted of 140 women (23%) of whom 44%, 34%, and 22% demonstrated mild, moderate, and severe clitoral adhesions, respectively. In the study group, 14% presented with clitorodynia. Risk factors included a history of sexual pain, yeast infection, urinary tract infection, blunt perineal or genital trauma, lichen sclerosus, low calculated free testosterone, and other sexual dysfunctions including persistent genital arousal disorder. Conclusion Women with sexual dysfunction should routinely undergo clitoral physical examination. If the glans corona is not fully visualized, then clitoral adhesions should be suspected. Education, counseling, and/or referral for sexual pain management should be considered.

In contemporary developmental science, relational development systems models have been used to frame the positive youth development (PYD) perspective, which posits that youth will thrive when there is alignment between their strengths and ecological resources in their context. Evidence from the 4-H Study of PYD indicates that out-of-school-time youth development programs are key ecological resources enhancing youth thriving. This chapter discusses the particular facets of youth development programs (the "Big Three"-positive and sustained adult-youth relationships, skill-building activities, and youth leadership opportunities) involved in promoting youth thriving. The importance of using theory to design and implement programs is also discussed, and challenges of reaching the diversity of American youth with effective programs are noted.

Genital pain frequently causes sexual dysfunction and psychological distress that can impact every aspect of a woman’s life. When conservative medical treatments do not adequately treat the genital pain, surgical procedures have the potential to significantly decrease the pain. The following review examines surgical procedures currently being used to treat pudendal neuralgia, scarring from lichen sclerosus, and provoked vestibulodynia. In addition, a diagnostic algorithm is included that can be used to identify specific causes of genital pain and to determining when surgery is an appropriate treatment option.