37 results on '"Jeremy B. Myers"'
Search Results
2. The Outcomes of Pelvic Fracture Urethral Injuries Stratified by Urethral Injury Severity: A Prospective Multi-institutional Genitourinary Trauma Study (MiGUTS)
- Author
-
Kiarad Fendereski, Benjamin J. McCormick, Sorena Keihani, Judith C. Hagedorn, Bryan Voelzke, J. Patrick Selph, Bradley D. Figler, Niels V. Johnsen, Rodrigo Donalisio da Silva, Joshua A. Broghammer, Shubham Gupta, Brandi Miller, Frank N. Burks, Jairam R. Eswara, E. Charles Osterberg, Kenneth J. Carney, Brad A. Erickson, Matthew B. Gretzer, Paul H. Chung, Catherine R. Harris, Gregory P. Murphy, Paul Rusilko, Katherine T. Anderson, Anand Shridharani, Cooper R. Benson, Amjad Alwaal, Sarah D Blaschko, Benjamin N. Breyer, Maxim McKibben, Ian W. Schwartz, Jay Simhan, Alex J. Vanni, Rachel A. Moses, and Jeremy B. Myers
- Subjects
Adult ,Male ,Urologic Diseases ,Urethral Obstruction ,Physical Injury - Accidents and Adverse Effects ,Multiple Trauma ,Urology ,Clinical Sciences ,Injuries and accidents ,Urology & Nephrology ,Fractures, Bone ,Good Health and Well Being ,Urethra ,Clinical Research ,Urethral Diseases ,Humans ,Prospective Studies ,Pelvic Bones ,Bone ,Fractures ,Retrospective Studies - Abstract
ObjectiveTo determine patient outcomes across a range of pelvic fracture urethral injury (PFUI) severity. PFUI is a devastating consequence of a pelvic fracture. No study has stratified PFUI outcomes based on severity of the urethral distraction injury.MethodsAdult male patients with blunt-trauma-related PFUI were followed prospectively for a minimum of six months at 27 US medical centers from 2015-2020. Patients underwent retrograde cystourethroscopy and retrograde urethrography to determine injury severity and were categorized into three groups: (1) major urethral distraction, (2) minor urethral distraction, and (3) partial urethral injury. Major distraction vs minor distraction was determined by the ability to pass a cystoscope retrograde into the bladder. Simple statistics summarized differences between groups. Multi-variable analyses determined odds ratios for obstruction and urethroplasty controlling for urethral injury type, age, and Injury Severity Score.ResultsThere were 99 patients included, 72(72%) patients had major, 13(13%) had minor, and 14(14%) had partial urethral injuries. The rate of urethral obstruction differed in patients with major (95.8%), minor (84.6%), and partial injuries (50%) (P < 0.001). Urethroplasty was performed in 90% of major, 66.7% of minor, and 35.7% of partial injuries (P < 0.001).ConclusionIn PFUI, a spectrum of severity exists that influences outcomes. While major and minor distraction injuries are associated with a higher risk of developing urethral obstruction and need for urethroplasty, up to 50% of partial PFUI will result in obstruction, and as such need to be closely followed.
- Published
- 2022
3. Patient Selection and Outcomes of Urinary Diversion
- Author
-
Kevin J, Hebert, Rano, Matta, and Jeremy B, Myers
- Subjects
Postoperative Complications ,Urinary Bladder Neoplasms ,Patient Selection ,Urology ,Humans ,Urinary Diversion ,Cystectomy - Abstract
Urinary diversion selection depends highly on surgeon experience, patient comorbidities, operative indication, and preoperative risk assessment. Navigating this process in the setting of emerging surgical approaches, new operative technology, and evolving perioperative care plans can be difficult for general and reconstructive urologists alike. In this article, we highlight considerations for urinary diversion selection and review new updates in the literature regarding preoperative patient assessment and nutrition optimization. In addition, we review unique perioperative considerations including role of preoperative bowel prep and intraoperative maneuvers in the setting of obesity and prior radiation. Last, we examine postoperative expectations, long-term outcomes, and emerging technology to mitigate postoperative risk associated with urinary diversions.
- Published
- 2022
4. Genitourinary Radiation Injury Following Prostate Cancer Treatment: Assessment of Cost and Health Care System Burden
- Author
-
Kevin J Hebert, Rano Matta, Kia Fendereski, Joshua J Horns, Niraj Paudel, Rupam Das, Boyd R. Viers, James Hotaling, Benjamin J. McCormick, and Jeremy B. Myers
- Subjects
Urology - Published
- 2023
5. Association Between Ejaculatory Dysfunction and Post-Void Dribbling After Urethroplasty
- Author
-
Alex J. Vanni, Katherine M. Theisen, Andrew C. Peterson, Bradley A. Erickson, Jill C. Buckley, Keith Rourke, Ayman Soubra, Jeremy B. Myers, Joshua A. Broghammer, Shawn Grove, Sean P. Elliott, Bryan B. Voelzke, Benjamin N. Breyer, and Nejd F. Alsikafi
- Subjects
Male ,Adult ,medicine.medical_specialty ,Urologic Surgical Procedures, Male ,Sexual Dysfunction ,Anastomosis ,Urethral stricture ,Physiological ,Urology ,Urethroplasty ,medicine.medical_treatment ,media_common.quotation_subject ,Clinical Sciences ,030232 urology & nephrology ,Post-void dribbling ,Urination ,Sacculation ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Urethra ,Clinical Research ,Surgical ,medicine ,Humans ,Ejaculation ,Prospective Studies ,Urge ,media_common ,business.industry ,Anastomosis, Surgical ,Urinary Incontinence, Urge ,Middle Aged ,Urology & Nephrology ,medicine.disease ,Surgery ,Sexual Dysfunction, Physiological ,Urinary Incontinence ,030220 oncology & carcinogenesis ,Cohort ,Etiology ,Urologic Surgical Procedures ,medicine.symptom ,business - Abstract
ObjectiveTo determine whether ejaculatory dysfunction (EjD) and post-void dribbling (PVD) after urethroplasty are associated, providing evidence for a common etiology.MethodsWe reviewed a prospectively maintained database for first-time, anterior urethroplasties. One item from the Male Sexual Health Questionnaire (MSHQ) assessed EjD: "How would you rate the strength or force of your ejaculation". One item from the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) assessed PVD: "How often have you had slight wetting of your pants after you had finished urinating?". The frequency of symptoms was compared after penile vs. bulbar repairs, and anastomotic versus augmentation bulbar repairs. Associations were assessed with chi-square.ResultsA total of 728 men were included. Overall, postoperative EjD and PVD were common; 67% and 66%, respectively. There was a significant association between EjD and PVD for the whole cohort (p
- Published
- 2021
6. Antibiotic Stewardship and Postoperative Infections in Urethroplasties
- Author
-
Katherine C. Cheng, Bradley A. Erickson, Joshua A. Broghammer, Thomas G. Smith, Alex J. Vanni, Bryan B. Voelzke, Lee C. Zhao, Nejd F. Alsikafi, Jeremy B. Myers, Jill C. Buckley, Saatchi Patell, Sunchin Kim, Sean P. Elliott, and Benjamin N. Breyer
- Subjects
Male ,Multivariate analysis ,medicine.medical_treatment ,Antibiotics ,030232 urology & nephrology ,Urine ,urologic and male genital diseases ,Antimicrobial Stewardship ,0302 clinical medicine ,Risk Factors ,Prospective Studies ,Incidence ,Middle Aged ,Urology & Nephrology ,female genital diseases and pregnancy complications ,Anti-Bacterial Agents ,Infectious Diseases ,Nitrofurantoin ,Indwelling ,030220 oncology & carcinogenesis ,Urinary Tract Infections ,Practice Guidelines as Topic ,Urologic Surgical Procedures ,Antibiotic Stewardship ,Patient Safety ,Infection ,medicine.drug ,Adult ,Urologic Diseases ,medicine.medical_specialty ,Catheters ,medicine.drug_class ,Urology ,Urethroplasty ,Urinary system ,Clinical Sciences ,Renal and urogenital ,Risk Assessment ,Perioperative Care ,03 medical and health sciences ,Urethra ,Clinical Research ,medicine ,Humans ,Surgical Wound Infection ,Reconstructive Surgical Procedures ,Aged ,Urethral Stricture ,business.industry ,Perioperative ,Plastic Surgery Procedures ,Surgery ,business ,Follow-Up Studies - Abstract
Objective To determine surgical site infection and urinary tract infection (UTI) rates in the setting of urethroplasty. Given significant variation in the utilization of antibiotics, there is an opportunity to improve antibiotic stewardship. This study aims to elucidate the rate of both UTI and surgical site infection after urethroplasty on a standardized perioperative antibiotic regimen, and to obtain patient and operative characteristics that may predict infection. Methods We prospectively treated 390 patients undergoing urethroplasty at 11 centers with a standardized perioperative antibiotic protocol. Patients had a urine culture or urine analysis within 3 weeks of surgery. After surgery, patients were discharged with an indwelling catheter, removed per usual surgeon practice. All were given nitrofurantoin from discharge until catheter removal. Logistic regression analyses were performed to determine the correlation between patient characteristics or operative categories with post-operative infection. Results The rates of postoperative UTI and wound infection within 30 days were 6.7% and 4.1%, respectively. On multivariate analysis of demographics, comorbidities, and stricture characteristics and repair, only preoperative UTI (P = .012), history of cardiovascular disease (P = .015), and performing a membranous urethroplasty (0.018) were significant predictors of a UTI within 30 days postoperatively. Location of repair nor graft use increased the risk of UTI. There were no factors predictive of postoperative wound infection. Conclusion A standardized antibiotic protocol was created to narrow and limit excess antibiotic use. This protocol, with clear definitions of UTI and wound infection, allowed determination of accurate infection rates in urethroplasties. Preoperative UTI, even when properly treated, increases the risk of postoperative UTI.
- Published
- 2021
7. Urethrogram: Does Postoperative Contrast Extravasation Portend Stricture Recurrence?
- Author
-
Jeremy B. Myers, Anthony Enriquez, Lee C. Zhao, Benjamin N. Breyer, Andrew J. Cohen, Jill C. Buckley, Bradley A. Erickson, Sean P. Elliott, German Patino, Alex J. Vanni, Nedj F. Alsikafi, Thomas G. Smith, and Bryan B. Voelzke
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,Cystoscopy ,Predictive value ,Extravasation ,Urinary extravasation ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,Contrast extravasation ,Radiology ,business - Abstract
OBJECTIVE To demonstrate our hypothesis that the presence of extravasation on postoperative urethrogram is inconsequential for disease recurrence in urethroplasty postoperative follow-up. MATERIALS AND METHODS We utilized the Trauma and Urologic Reconstructive Network of Surgeons database to assess 1691 patients who underwent urethroplasty and post-operative urethrogram. Anatomic and functional recurrence were defined as RESULTS Among 1101 patients with cystoscopy follow-up, 54 (4.9%) had extravasation on initial postoperative urethrogram. Among those 54, 74.1% developed an anatomic recurrence vs 13% without extravasation (P CONCLUSION Postoperative urethrogram has a high specificity but low sensitivity for anatomic and functional recurrence during short term follow-up. The positive predictive value of urinary extravasation is high: patients with extravasation incur a high risk of anatomic recurrence within 1 year and such patients may warrant increased monitoring.
- Published
- 2020
8. Outcomes of Urinary Diversion for Late Adverse Effects of Gynecologic Radiotherapy
- Author
-
Rachel Moses, John T. Stoffel, Sean Elliott, Jeremy B. Myers, Diana O'Dell, Jacob Albersheim, and Daniel Smith
- Subjects
Sarcopenia ,medicine.medical_specialty ,Genital Neoplasms, Female ,Urology ,medicine.medical_treatment ,Urinary system ,030232 urology & nephrology ,Urinary Diversion ,Cystectomy ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Radiation Injuries ,Adverse effect ,Aged ,Retrospective Studies ,business.industry ,Urinary diversion ,Middle Aged ,medicine.disease ,Surgery ,Radiation therapy ,Treatment Outcome ,030220 oncology & carcinogenesis ,Concomitant ,Female ,Seventy Nine ,business ,human activities - Abstract
Objectives To describe the risks of urinary diversion performed to address adverse effects of gynecologic radiation, with the hypothesis that high grade complications would be more common in sarcopenic women and in those undergoing continent diversion (vs. non-continent) or concomitant cystectomy (vs. bladder-sparing diversion). Methods : A retrospective review was performed of patient records of women who underwent urinary diversion for urinary adverse effects of gynecologic radiotherapy during the period of 2008 - 2018 from three tertiary centers. Skeletal muscle index was calculated to assess for sarcopenia based on preoperative computed tomography scans. Outcomes include high-grade post-operative complications within 90 days of surgery, 30-day readmission rate, and long-term (>90 days) outcomes. Results : Among 34 women who met the inclusion criteria, the majority were white/Caucasian (73.5%). 26/34 (76.5%) underwent non-continent diversion. Seventy nine percent (27/34) (79.4%) of women experienced complications within 90 days; 9/34 (26.5%) experienced high-grade (Clavien grade ≥3) complications. Thirty two percent (11/34) were readmitted within 30 days. Rates of high-grade complications were not significantly impacted by diversion type (p=0.49), concurrent cystectomy (p=0.70), or sarcopenia (p=1.0). Conclusions : Urinary diversion for late adverse effects of gynecologic radiotherapy is associated with high peri-operative risk, even in skilled hands. In this series, neither sarcopenia, nor continent diversion, nor cystectomy were associated with increased complications. Patients and surgeons should consider risks and benefits when deciding to proceed with urinary diversion, however further study is needed to elucidate significant pre-operative markers which may pre-dispose patients to significant complications.
- Published
- 2020
9. EDITORIAL COMMENT
- Author
-
Jeremy B. Myers
- Subjects
Urology - Published
- 2022
10. EDITORIAL COMMENT
- Author
-
Jeremy B, Myers
- Subjects
Urology - Published
- 2022
11. Validation of Upper Extremity Motor Function as a Key Predictor of Bladder Management After Spinal Cord Injury
- Author
-
Blayne Welk, Sean P. Elliott, Kazuko Shem, John T. Stoffel, Sara M. Lenherr, Jeremy B. Myers, and Christopher S. Elliott
- Subjects
Adult ,Male ,030506 rehabilitation ,medicine.medical_specialty ,Multivariate analysis ,medicine.medical_treatment ,Physical Therapy, Sports Therapy and Rehabilitation ,Comorbidity ,Logistic regression ,Odds ,Cohort Studies ,Upper Extremity ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,medicine ,Humans ,Intermittent Urethral Catheterization ,Obesity ,Registries ,Urinary Bladder, Neurogenic ,Spinal cord injury ,Spinal Cord Injuries ,Rehabilitation ,business.industry ,Racial Groups ,Age Factors ,Odds ratio ,Middle Aged ,medicine.disease ,Female ,Observational study ,0305 other medical science ,business ,Body mass index ,030217 neurology & neurosurgery - Abstract
Objective To validate if better upper extremity (UE) motor function predicts clean intermittent catheterization (CIC) adoption and adherence after spinal cord injury (SCI) using a validated instrument (as opposed to prior research using scales based on expert opinion). Design We examined data from the Neurogenic Bladder Research Group SCI registry, a multicenter, prospective, observational study assessing persons with neurogenic bladder following SCI. All participants who were unable to volitionally void and were >1 year post injury were included. Participants were dichotomized into those performing CIC vs those using other bladder management methods. In addition to demographic and clinical characteristics, UE motor function was examined using the SCI-Fine Motor Function Index using validated categorization levels: (1) no activities requiring hand function, (2) some activities involving gross hand movement, (3) some activities requiring dexterity or coordinated UE movement, or (4) most activities requiring dexterity and coordinated UE movement. Associations were examined using logistic regression. Setting Multicenter study. Participants Registry participants unable to volitionally void after SCI (N=1236). Intervention Not applicable. Main outcome measure Upper extremity motor function association with CIC. Results A total of 1326 individuals met inclusion criteria (66% performing CIC, 60% male, and 82% white). On multivariate analysis, better UE motor function was associated with a statistically increased odds of performing CIC (odds ratio, 3.10 [Level 3] and odds ratio, 8.12 [Level 4] vs Levels 1 and 2 [P Conclusion In persons with SCI who are unable to volitionally void, UE motor function is highly associated with CIC. These results validate prior findings and continue to suggest that following SCI, the degree of preserved UE motor function is associated with CIC more than any other factor.
- Published
- 2019
12. Trends in Urethral Stricture Disease Etiology and Urethroplasty Technique From a Multi-institutional Surgical Outcomes Research Group
- Author
-
Jill C. Buckley, Alex J. Vanni, Sean P. Elliott, Lee C. Zhao, Joshua A. Broghammer, Thomas G. Smith rd, Amy E. Hahn, Bryan B. Voelzke, Benjamin N. Breyer, Nejd F. Alsikafi, Bradley A. Erickson, Jeremy B. Myers, and Katherine J. Cotter
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Urologic Surgical Procedures, Male ,Urethral stricture ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,Urologic Surgical Procedure ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Urethra ,Randomized controlled trial ,law ,Outcome Assessment, Health Care ,medicine ,Humans ,Retrospective Studies ,Urethral Stricture ,business.industry ,Retrospective cohort study ,medicine.disease ,Surgery ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Etiology ,Outcomes research ,business - Abstract
Objective To analyze contemporary urethroplasty trends and urethral stricture etiologies over a 7-year study period among urologists from a large multi-institutional surgical outcomes group. Methods Review of a multi-institutional, prospectively maintained urethroplasty database was performed on 2098 anterior urethroplasties done between 2010 and 2017 by 10 surgeons. Stricture characteristics, including etiology, length, and anatomic location were analyzed and compared to urethroplasty type over the study period using chi-squared analysis to assess for linear trends within the group and by surgeon. Results Average stricture lengths for bulbar (2.8 ± 1.8 cm), penile (3.6 ± 2.6 cm), and penile-bulbar strictures (8.7 ± 5.0) remained stable. The most common stricture etiology was idiopathic/unknown in all study years (63%). In the bulbar urethra, the group performed significantly (1) fewer excisional repairs (−31%) and more substitutional repairs (+78%); (2) of substitutional repairs, more grafts are being placed dorsally (+95%) vs ventrally (−75%) (3) of the bulbar excisional repairs, more are being performed without transection of the bulbar urethra (+430%); and in the penile urethra (4) the fasciocutaneous flap is in decline (−86%), while single-stage dorsal repairs are increasing (+280%). Conclusion Anterior urethroplasty techniques continue to evolve in the absence of robust clinical data or randomized controlled trials, with a general movement in this cohort toward an initial dorsal approach for most strictures. Inter- and intrasurgeon variability in the surgical management of similar strictures was noted, and the feasibility of any future randomized controlled trials, without apparent surgical equipoise, must be questioned.
- Published
- 2019
13. Evaluation of Generic Versus Condition-Specific Quality of Life Indicators for Successful Urethral Stricture Surgery
- Author
-
Paul H. Chung, Alex J. Vanni, Benjamin N. Breyer, Bradley A. Erickson, Jeremy B. Myers, Nejd Alsikafi, Jill Buckley, Sean P. Elliott, Lee C. Zhao, and Bryan B. Voelzke
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Urethral stricture ,Visual analogue scale ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,medicine ,Humans ,Patient Reported Outcome Measures ,Prospective Studies ,030212 general & internal medicine ,Bladder Pain ,Prospective cohort study ,Aged ,Aged, 80 and over ,Urethral Stricture ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Urethra ,medicine.anatomical_structure ,Quality of Life ,Anxiety ,medicine.symptom ,business - Abstract
Author(s): Chung, Paul H; Vanni, Alex J; Breyer, Benjamin N; Erickson, Bradley A; Myers, Jeremy B; Alsikafi, Nejd; Buckley, Jill; Elliott, Sean P; Zhao, Lee C; Voelzke, Bryan B; Trauma and Urologic Reconstructive Network of Surgeons (TURNS) | Abstract: ObjectiveTo compare the utility of generic health quality of life (QOL) and condition specific indicators as patient reported outcomes measures for urethral stricture surgery.Materials and methodsPatient data were obtained from the Trauma and Urologic Reconstructive Network of Surgeons collaborative database. Patients who underwent any successful urethroplasty and completed both pre- and postoperative generic and condition-specific questionnaires were included.ResultsA total of 201 patients met inclusion criteria. Urethral-stricture specific measures improved after surgery: mean LUTS score (13.1-4.0, pl0.05), Peeling curve (3.1-1.7, p l 0.05), and overall interference of urinary symptoms on life (3.0-1.6, p l 0.05). Mean overall health status visual analog scale (74.2-80.0, p l 0.05) and generic health QOL EQ-5D index scores (0.90-0.95, p l 0.05) also improved; however, individual EQ-5D measures assessing mobility, self-care, and activity level did not change. EQ-5D measures for pain/discomfort (1.48-1.23, p l 0.05) and anxiety/depression (1.33-1.21, p l 0.05) improved, but not to the same extent as stricture-specific measures. More patients reported improvement in condition-specific urethra/penis pain and bladder pain compared to improvement in generic EQ-5D pain/discomfort (p l 0.001).ConclusionGeneric health QOL indicators are less meaningful in the assessment of urethral stricture surgery and should be replaced with condition-specific outcomes measures. It is important to ensure that appropriate condition-specific outcomes measures are utilized as patient reported outcomes measures become more prevalent in medicine and potentially become utilized to evaluate surgeon outcomes and determine surgeon reimbursement.
- Published
- 2019
14. Efficacy of Pressure Regulating Balloon Exchange in Men With Post Artificial Urinary Sphincter Persistent or Recurrent Stress Urinary Incontinence
- Author
-
Rachel A. Moses, Sorena Keihani, James R. Craig, Jacob Basilius, James M. Hotaling, Sara M. Lenherr, William O. Brant, and Jeremy B. Myers
- Subjects
Male ,Prosthesis Implantation ,Postoperative Complications ,Recurrence ,Urinary Incontinence, Stress ,Urology ,Pressure ,Humans ,Urinary Sphincter, Artificial ,Device Removal ,Aged ,Retrospective Studies - Abstract
To assess the efficacy of exchanging the pressure regulating balloon (PRB) to 71-80 cm HPatients with SUI following AUS placement who underwent PRB replacement between 2011 and 2017 in the absence of urethral cuff malfunction, atrophy, stricture, or erosion were reviewed. Primary outcomes included changes in pad per day (PPD), Incontinence Symptom Index score, and Incontinence Quality of Life (I-QOL). Secondary outcomes included rates of device erosion and all-cause explant or revision. Differences were compared between patients with and without erosion, explant, or revision. Kaplan Meier device survival analysis was performed.Twenty two patients (67 ± 9 years, body mass index of 30 ± 5 kg/mPRB exchange can transiently alleviate persistent or recurrent post-AUS SUI in the absence of mechanical failure or urethral pathology. Caution is warranted in patients with prior radiation as this was a risk factor for urethral erosion. Although many patients may require device revision within 2 years, it can be a temporizing solution that avoids urethral manipulation and periprocedural device deactivation.
- Published
- 2019
15. Multi-institutional Outcomes for Simultaneous and Staged Urinary and Fecal Diversions in Patients Without Cancer
- Author
-
Piyush Pathak, Yahir Santiago-Lastra, Sean P. Elliott, John T. Stoffel, Paholo Barboglio Romo, Jeremy B. Myers, and Katherine J. Cotter
- Subjects
medicine.medical_specialty ,Double diversion ,business.industry ,Urology ,Urinary system ,medicine.medical_treatment ,Urinary diversion ,030232 urology & nephrology ,Colostomy ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Urinary Fistula ,030220 oncology & carcinogenesis ,Cohort ,medicine ,Complication ,Adverse effect ,business ,human activities - Abstract
Objective To compare the morbidity and postoperative recovery between patients treated with urinary diversion after colostomy with patients undergoing simultaneous double diversion (DD). Methods A multi-institutional retrospective review was performed in patients treated with urinary diversion after colostomy or simultaneous DD between 2007 and 2014 for noncancerous indications. The Clavien-Dindo system was used to classify complications occurring within 90 days of surgery, and high-grade adverse events (HGAE) were classified grade 3 or higher. Results A total of 46 patients were identified with fecal and urinary diversions (19 in the after colostomy (AC) group, 27 in the DD group). Common indications for urinary diversion were neurogenic bladder (54%) and urinary fistula (44%). Mean hospital stay and return of bowel function after surgery for entire cohort was 13 and 7 days, respectively, with no differences between AC and DD groups. Almost 50% of patients in the cohort experienced an HGAE but there was no difference in HGAE incidence (8/19 AC, 13/27 DD; P = .69) or complication type between the groups. Increased operative time (5% risk per every 15 minutes over 7 hours, P = .03) was the only independent variable associated with increased risk of HGAE. DD was not independently associated with increased risk of HGAE compared with staged urinary diversion. Conclusion Morbidity and postoperative recovery appeared similar whether urinary diversion is performed after colostomy or during a DD.
- Published
- 2018
16. Response to Letter to Editor: 'Development and Validation of a Male Anterior Urethral Stricture Classification System'
- Author
-
Lee C. Zhao, Amy E. Hahn, Alex J. Vanni, Katherine J. Cotter, Jill C. Buckley, Bradley A. Erickson, Jeremy B. Myers, Thomas G. Smith, Keith Rourke, Andrew C. Peterson, Bryan B. Voelzke, Benjamin N. Breyer, Sean P. Elliott, Kevin J. Flynn, Nejd F. Alsikafi, and Joshua A. Broghammer
- Subjects
medicine.medical_specialty ,Anterior Urethral Stricture ,business.industry ,Urology ,medicine ,MEDLINE ,business ,Surgery - Published
- 2021
17. The Impact of Age on Urethroplasty Success
- Author
-
Christopher McClung, Bradley A. Erickson, Jeremy B. Myers, Kristian D. Stensland, Sean P. Elliott, Alex J. Vanni, Mya E. Levy, Yunhua Fan, Nejd F. Alsikafi, Ronak A. Gor, Benjamin N. Breyer, Bryan B. Voelzke, and Thomas G. Smith
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Vascular disease ,Urethral stricture ,business.industry ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,Retrospective cohort study ,Cystoscopy ,Anastomosis ,medicine.disease ,Urologic Surgical Procedure ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Older patients ,030220 oncology & carcinogenesis ,medicine ,business - Abstract
Objective To determine if age is an independent predictor of surgical success in patients undergoing urethroplasty. Urethroplasty performed by excision and primary anastomosis depends on vascular collateralization. Successful augmented urethroplasty depends on graft neovascularization. Older patients have more comorbid conditions including peripheral vascular disease associated with reduced penile blood flow. Methods This is a retrospective review of urethroplasties from 11 institutions. Primary outcome was functional success at 1 year from surgery, defined as freedom from post-urethroplasty procedures. Secondary outcome was freedom from cystoscopic evidence of stricture recurrence at 3 months. Study outcomes were compared between 2 age cohorts ( Results Of 322 urethroplasties, 258 were performed in patients Conclusion Urethroplasty success may be affected by comorbidities but not age. Age alone should not be used as an absolute exclusion criterion for men needing urethral reconstruction.
- Published
- 2017
18. Outcomes of Urethroplasty to Treat Urethral Strictures Arising From Artificial Urinary Sphincter Erosions and Rates of Subsequent Device Replacement
- Author
-
Jason Chandrapal, Nathan Chertack, Jill C. Buckley, Andrew C. Peterson, Keith Rourke, Jeremy B. Myers, Joshua A. Broghammer, Sorena Keihani, Sean P. Elliott, Lee C. Zhao, Benjamin N. Breyer, William O. Brant, Thomas G. Smith, Bryan B. Voelzke, and Nejd F. Alsikafi
- Subjects
Male ,medicine.medical_specialty ,Urologic Surgical Procedures, Male ,Urethral stricture ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,Artificial urinary sphincter ,03 medical and health sciences ,0302 clinical medicine ,Urethra ,Interquartile range ,medicine ,Humans ,Aged ,Retrospective Studies ,Urethral Stricture ,medicine.diagnostic_test ,Prostatectomy ,business.industry ,Urethral sphincter ,Anastomosis, Surgical ,Cystoscopy ,Plastic Surgery Procedures ,medicine.disease ,Prosthesis Failure ,Surgery ,medicine.anatomical_structure ,Replantation ,030220 oncology & carcinogenesis ,Urinary Sphincter, Artificial ,business ,Follow-Up Studies - Abstract
Objective To evaluate the success of urethroplasty for urethral strictures arising after erosion of an artificial urinary sphincter (AUS) and rates of subsequent AUS replacement. Patients and Methods From 2009-2016, we identified patients from the Trauma and Urologic Reconstruction Network of Surgeons and several other centers. We included patients with urethral strictures arising from AUS erosion undergoing urethroplasty with or without subsequent AUS replacement. We retrospectively reviewed patient demographics, history, stricture characteristics, and outcomes. Variables in patients with and without complications after AUS replacement were compared using chi-square test, independent samples t test, and Mann-Whitney U test when appropriate. Results Thirty-one men were identified with the inclusion criteria. Radical prostatectomy was the etiology of incontinence in 87% of the patients, and 29% had radiation therapy. Anastomotic (28) and buccal graft substitution (3) urethroplasty were performed. Follow-up cystoscopy was done in 28 patients (median 4.5 months, interquartile range [IQR]: 3-8) showing no urethral stricture recurrences. Median overall follow-up was 22.0 months (IQR: 15-38). In 27 men (87%), AUS was replaced at median of 6.0 months (IQR: 4-7) after urethroplasty. In 25 patients with >3 months of follow-up after AUS replacement, urethral complications requiring AUS revision or removal occurred in 9 patients (36%) and included subcuff atrophy (3) and erosion (6). Mean length of stricture was higher in patients who developed a complication after urethroplasty and AUS replacement (2.2 vs. 1.5 cm, P = .04). Conclusion In patients with urethral stricture after AUS erosion, urethroplasty is successful. However, AUS replacement after urethroplasty has a high erosion rate even in the short-term.
- Published
- 2017
19. Mending Gaps in Knowledge
- Author
-
Jeremy B. Myers, Amitabh Jha, Sean P. Elliott, Darshan P. Patel, Sara M. Lenherr, John T. Stoffel, and Blayne Welk
- Subjects
030506 rehabilitation ,medicine.medical_specialty ,Research groups ,business.industry ,Urology ,030232 urology & nephrology ,Disease ,medicine.disease ,Reconstructive urology ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Physical therapy ,medicine ,Treatment strategy ,0305 other medical science ,business ,Prospective cohort study ,Spinal cord injury - Abstract
Patient-reported outcomes and quality of life assessments are essential to studying conditions such as neurogenic bladder in which multiple management strategies are approximately equally efficacious. Innovations for the treatment of neurogenic bladder need to be guided by both clinical and patient-reported outcomes that are rigorously tested via high-quality prospective cohort or randomized studies. Collaborative research groups in reconstructive urology are critical to the study of uncommon disease processes because they allow studies to be powered adequately, foster innovative treatment strategies through collaboration, and help moderate the risk of investigator and or institutional biases.
- Published
- 2017
20. Critical Analysis of the Use of Uroflowmetry for Urethral Stricture Disease Surveillance
- Author
-
Benjamin N. Breyer, Alex J. Vanni, Sean P. Elliott, Christopher McClung, Bradley A. Erickson, Christopher A. Tam, Jeremy B. Myers, and Bryan B. Voelzke
- Subjects
Adult ,Male ,medicine.medical_specialty ,Urethral stricture ,Urology ,Urinary system ,Urethroplasty ,medicine.medical_treatment ,Penile Induration ,030232 urology & nephrology ,Sensitivity and Specificity ,Article ,Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,Older patients ,Recurrence ,medicine ,Humans ,Pain Management ,In patient ,Prospective Studies ,Prospective cohort study ,Physical Therapy Modalities ,Urethral Stricture ,medicine.diagnostic_test ,business.industry ,Cystoscopy ,medicine.disease ,Surgery ,Urodynamics ,Population Surveillance ,030220 oncology & carcinogenesis ,International Prostate Symptom Score ,Rheology ,business ,Penis - Abstract
Uroflowmetry (UF) is a simple, noninvasive method to evaluate voiding function in patients experiencing lower urinary tract symptoms.1,2 It is often combined with other metrics, including the International Prostate Symptom Score, in the initial diagnosis and follow-up of benign prostatic hyperplasia (BPH), and other causes of obstruction.3 In patients with urethral stricture disease (USD) who have undergone urethroplasty, UF is one of the most frequently used tests to monitor for stricture recurrence.4 However, UF’s use as a stand-alone tool to screen for recurrence following urethroplasty has never been rigorously validated. It has been well established that the maximum flow rate (Qm) in patients with USD is significantly diminished relative to age-matched normal controls.5,6 This knowledge has been extrapolated to the post-urethroplasty setting, where commonly used cutpoints of a postoperative Qm of less than 10 mL/s or a postoperative Qm of less than 15 mL/s are used as indicators of urethral stricture recurrence.5–7 Similarly, when UF data are available both pre- and postoperatively, a change in Qm following surgery of less than 10 mL/s has also been suggested as a predictor of recurrence.8 The goal for each of these UF parameters is to minimize the invasiveness of postoperative screening while maximizing the ability to find recurrences. The purpose of this study is to rigorously evaluate the capability of individual UF parameters, such as Qm and average flow rate (Qa), as well as a novel hybrid measure (Qm-Qa) to monitor for urethral stricture recurrence. Use of Qm-Qa has not been described in prior literature and attempts to provide a simple method to quantify the shape of the voiding curve. The study tested two hypotheses: (1) when compared to the gold-standard cystoscopy, UF parameters will have high test (screening) sensitivity and specificity, and (2) the sensitivity and specificity of UF to screen for stricture recurrence will be diminished in older patients.
- Published
- 2016
21. Sperm Concentration Is Poorly Associated With Hypoandrogenism in Infertile Men
- Author
-
Darshan P. Patel, Douglas T. Carrell, James M. Hotaling, Jessie Dorais, Jeremy B. Myers, William O. Brant, Chong Zhang, Kenneth I. Aston, Angela P. Presson, and Erica Johnstone
- Subjects
Adult ,Male ,Gynecology ,Infertility ,Azoospermia ,medicine.medical_specialty ,Sperm Count ,business.industry ,Urology ,Normal semen analysis ,Oligospermia ,medicine.disease ,Serum testosterone level ,Sperm ,Cross-Sectional Studies ,Primary outcome ,medicine ,Humans ,Referral center ,Testosterone ,business ,Retrospective Studies ,Hormone - Abstract
To evaluate the utility of routine hormone evaluation in all men presenting for infertility by understanding the relationship between sperm concentration and hypoandrogenism.We performed a retrospective cross-sectional study between September 2013 and May 2014 at a tertiary referral center in Utah. Ninety-four men presenting for infertility consecutively between the ages of 18 and 55 years were identified. Our primary outcome was rate of hypoandrogenism among infertile men defined as the baseline total serum testosterone levels300 ng/dL or bioavailable testosterone (BAT) levels155 ng/dL. Secondary outcomes included association of normospermia, oligozoospermia, or azoospermia with biochemical or clinical hypoandrogenism.Thirty-nine men (41%) had a total serum testosterone level of300 ng/dL, and 41 men (43%) had a BAT level155 ng/dL. Biochemical and symptomatic hypoandrogenism was common; 17 men (18%) had a total testosterone level300 ng/dL and ≥ 3 positive Androgen Deficiency in Aging Male (ADAM) responses, and 18 men (19%) had a BAT level of155 ng/dL and ≥ 3 positive ADAM responses. Sperm concentration (normospermia, oligozoospermia, and azoospermia) was not associated with biochemical hypoandrogenism (total testosterone level300 ng/dL or BAT level155 ng/dL), symptomatic hypoandrogenism (≥ 3 positive ADAM responses), or sexual dysfunction (Sexual Health Inventory for Men score21).Hypoandrogenism is common among infertile men, and routine hormonal evaluation may identify hypoandrogenism in many infertile men with otherwise normal semen analysis. Sperm concentration (normospermia, oligozoospermia, and azoospermia) is not well associated with hypoandrogenism in infertile men.
- Published
- 2015
22. Multi-institutional 1-Year Bulbar Urethroplasty Outcomes Using a Standardized Prospective Cystoscopic Follow-up Protocol
- Author
-
Sean P. Elliott, Chris McClung, Nejd F. Alsikafi, Jeremy B. Myers, William O. Brant, Bryan B. Voelzke, Bradley A. Erickson, Thomas G. Smith, and Joshua A. Broghammer
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Urethral stricture ,business.industry ,Urology ,Urethroplasty ,medicine.medical_treatment ,Functional failure ,Gold standard ,Cystoscopy ,medicine.disease ,Secondary procedure ,Surgery ,Urethra ,medicine.anatomical_structure ,medicine ,business ,Prospective cohort study - Abstract
Objective To evaluate multi-institutional outcomes of bulbar urethroplasty utilizing a standardized cystoscopic follow-up protocol. Methods Eight reconstructive surgeons prospectively enrolled urethral stricture patients in a multi-institutional study and performed postoperative cystoscopy at 3 and 12 months. Anatomic failure was defined as the inability to pass a flexible cystoscope without force. Functional failure was defined as the need for a secondary procedure. Men not compliant with the 12-month cystoscopy were called and asked if any interval secondary procedures had been performed. Patients with bothersome voiding complaints at cystoscopy were considered symptomatic. Results Of 213 men in study, 136 underwent excisional urethroplasty (excision and primary anastomosis [EPA]) and 77 underwent repair with buccal grafts. Cystoscopy compliance was 79.8% at 3 months and 54.4% at 12 months. Anatomic success rates were higher at 3 vs 12 months for EPA repairs (97.2% [106 of 109] vs 85.5% [65 of 76; P = .003] but not buccal repairs (85.5% [53 of 62] vs 77.5% [31 of 40]; P = .30). Functional success rates at a year were higher but statistically similar to anatomical success rates (EPA—90.3% [93 of 103]; P = .33; buccal—87% [47 of 54]; P = .22). Of the 20 anatomic recurrences, only 13 (65%) were symptomatic at the time of cystoscopic diagnosis. Conclusion Rates of success are lower when using the anatomic vs traditional definition. Of recurrences found by cystoscopy, only 65% were symptomatic. One-year patient cystoscopy compliance was poor and its ability to be used as the gold standard screening methodology for recurrence is questionable.
- Published
- 2014
23. Short-term Outcomes of Chait Trapdoor for Antegrade Continence Enema in Adults
- Author
-
Jeremy B. Myers, Jeffrey D. Redshaw, Sean P. Elliott, Patrick Hovert, Andrew Nguyen, Eric Hu, M. Chad Wallis, Blake D. Hamilton, and William O. Brant
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Urology ,medicine.medical_treatment ,Enema ,Risk Assessment ,Severity of Illness Index ,Cohort Studies ,Prosthesis Implantation ,Postoperative Complications ,Neurogenic Bowel ,medicine ,Humans ,Therapeutic Irrigation ,Device Removal ,Aged ,Retrospective Studies ,Splenic flexure ,Equipment Safety ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,Retrospective cohort study ,Equipment Design ,Middle Aged ,Surgery ,Regimen ,Cecostomy ,Treatment Outcome ,Patient Satisfaction ,Quality of Life ,Defecation ,Female ,Peristalsis ,Complication ,business ,Fecal Incontinence ,Spleen ,Follow-Up Studies - Abstract
Objective To examine our short-term experience of antegrade continence enema (ACE) delivered via a Chait Trapdoor (Cook Medical, Bloomington, IN) in adults with intractable neurogenic bowel. Methods We performed a retrospective review at the Universities of Utah and Minnesota of 15 patients with Chait Trapdoor placed for the purpose of ACE from 2011 to 2013. Our primary outcome was continued utilization of the Chait Trapdoor. Secondary outcomes included volume of ACE used and time to produce a bowel movement. Results All patients had neurogenic bowel refractory to conventional bowel regimen. Mean follow-up was 6 months (range, 1-17 months). Thirteen patients had the Chait Trapdoor placed in the splenic flexure and 2 had it placed in the cecum. Of the 15 patients, 12 (80%) were still using the Chait Trapdoor at last follow-up. A median of 425 mL (range, 120-1000 mL) of fluid was used to produce a bowel movement in 5-120 minutes. Two patients developed postoperative wound infections, requiring return to the operating room (Clavien IIIb). Long-term complications included 5 patients with a dislodged tube requiring replacement by interventional radiology and 2 patients with local cellulitis. Two patients had the Chait Trapdoor moved to a new location to improve efficacy. Conclusion Although the revision, removal, and complication rates were high, 80% of the patients were satisfied with the function and continued to use the Chait Trapdoor. The volume of irrigation required for ACE and the time it takes to produce a bowel movement vary significantly between patients.
- Published
- 2014
24. AUTHOR REPLY
- Author
-
Rachel A. Moses, Sorena Keihani, James R. Craig, Jacob Basilius, James M. Hotaling, Sara M. Lenherr, William O. Brant, and Jeremy B. Myers
- Subjects
Urology - Published
- 2019
25. High-grade Renal Injuries
- Author
-
William O. Brant, Jeremy B. Myers, and Joshua A. Broghammer
- Subjects
medicine.medical_specialty ,Kidney ,Conservative management ,medicine.diagnostic_test ,business.industry ,Urology ,Radiography ,Renal Hemorrhage ,Computed tomography ,urologic and male genital diseases ,Surgery ,medicine.anatomical_structure ,Intervention (counseling) ,medicine ,Radiology ,business - Abstract
With the advent of advanced trauma critical care, and precise methods of assessing renal trauma with computed tomography, most patients with high-grade renal trauma can be managed conservatively. Some patients, however, do not do well with conservative management. This article evaluates specific radiographic characteristics that have recently been associated with intervention for renal hemorrhage after trauma.
- Published
- 2013
26. Practice Patterns of Recently Fellowship-trained Reconstructive Urologists
- Author
-
Sean P. Elliott, William O. Brant, Bryan B. Voelzke, Bradley A. Erickson, Nejd F. Alsikafi, Thomas G. Smith, Joshua A. Broghammer, Christopher McClung, and Jeremy B. Myers
- Subjects
Male ,Urologic Neoplasms ,medicine.medical_specialty ,Scope of practice ,Urology ,media_common.quotation_subject ,Specialty ,Urogenital System ,Article ,Humans ,Medicine ,Fellowships and Scholarships ,Practice Patterns, Physicians' ,Fellowship training ,media_common ,Medical education ,Practice patterns ,business.industry ,Endoscopy ,Surgery ,Feeling ,Education, Medical, Graduate ,Private practice ,Urologic Surgical Procedures ,Female ,business ,Postgraduate training ,Graduation - Abstract
The past decade has seen significant changes in the training for all surgical residents.1 Residents are working fewer hours and spending less time in the operating rooms. Of the hours spent operating, a greater percentage of them are being focused on learning robotic and laparoscopic skills than ever before, especially in urology, as these are the skills often coveted by the private practice jobs being pursued by nearly 90% of graduates.2,3 This means that by default, less time will be spent during training performing complex open procedures. It is perhaps not surprising, that the decade has also seen an increase in fellowship training of all surgical subspecialties. Proposed reasons for this trend are many,4 but it has been postulated that with less operating room exposure, graduating residents are more commonly feeling they need more training before starting their careers.5 Until recently, few residents pursued formal postgraduate training in adult reconstructive urology, a specialty that performs many complex open procedures, but there are now 15 single-year positions available for postresidency training,6 prompting the Genitourinary Reconstructive Society to begin a formal matching process for reconstructive fellows beginning in the year 2013. As this fellowship becomes more formalized and learning objectives are outlined, it is important to better understand the scope of practice required of potential fellows upon fellowship graduation. The purpose of this study was to examine the early practice patterns of recently trained reconstructive fellows. We hypothesized that the practice patterns will vary widely depending on the respective fellows’ home institution, but that reconstructive procedures will make up a large percentage of their practice. Additionally, we hypothesized that with increased years in practice, the number and complexity of reconstructive cases will increase.
- Published
- 2012
27. The Outcomes of Perineal Urethrostomy With Preservation of the Dorsal Urethral Plate and Urethral Blood Supply
- Author
-
Jack W. McAninch, Jeremy B. Myers, and Sima P. Porten
- Subjects
Adult ,Male ,medicine.medical_specialty ,Urologic Surgical Procedures, Male ,Ostomy ,Urology ,Urethroplasty ,medicine.medical_treatment ,Perineum ,Young Adult ,Postoperative Complications ,Urethra ,Urethral Diseases ,medicine ,Humans ,Penile cancer ,Prospective Studies ,Prospective cohort study ,Urethrostomy ,Aged ,Aged, 80 and over ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Catheter ,Stenosis ,Treatment Outcome ,medicine.anatomical_structure ,business - Abstract
OBJECTIVES To describe the surgical technique and outcomes for perineal urethrostomy. We sought to identify factors that predicted surgery failure within our patient cohort and to describe key aspects of the operation aimed at preservation of the dorsal urethral plate and longitudinal blood supply within the urethra. METHODS We reviewed our prospectively collected database and identified 45 men who underwent definitive perineal urethrostomy from 1989 to 2009. Primary success was defined as no need for additional treatment. If 1 urethral dilation was performed, outcome was defined as a secondary success. Statistical analyses were performed to determine variables associated with failure. RESULTS Urethral pathology was varied and included idiopathic strictures (20%), lichen sclerosis (20%), infection (16%), radiation for prostate cancer (13%), prior hypospadias repair (11%), instrumentation or catheter trauma (11%), and penile cancer or condyloma (9%). Of these men, 21 (48%) had prior urethroplasty. Forty patients had follow-up greater than 3 months (median, 31 months). Postoperative stenosis occurred in 7 (18%) patients. Previous radiation therapy was a significant risk factor for postoperative stenosis on univariate (OR 12.4, 95% CI 1.8-84.3, P
- Published
- 2011
28. Editorial Comment
- Author
-
Jeremy B. Myers, William O. Brant, and James M. Hotaling
- Subjects
Urology - Published
- 2015
29. Reply
- Author
-
Darshan P. Patel and Jeremy B. Myers
- Subjects
Psychotherapist ,business.industry ,Urology ,Medicine ,business - Published
- 2015
30. Reply
- Author
-
William O. Brant, Smith Tg rd, Sean P. Elliott, Powell C, Nejd F. Alsikafi, Joshua A. Broghammer, Christopher McClung, Bradley A. Erickson, Jeremy B. Myers, and Bryan B. Voelzke
- Subjects
World Wide Web ,Text mining ,business.industry ,Urology ,Medicine ,business - Published
- 2014
31. Editorial Comment
- Author
-
Jeremy B, Myers, James M, Hotaling, and William O, Brant
- Subjects
Male ,Urethral Stricture ,Urethra ,Urology ,Humans - Published
- 2014
32. Comparison of patients seeking male infertility evaluation and undergoing vasectomy: data from the national survey of family growth
- Author
-
James M. Hotaling, William O. Brant, Jeremy B. Myers, Michael L. Eisenberg, and Mark R. Cullen
- Subjects
Gynecology ,medicine.medical_specialty ,Reproductive Medicine ,business.industry ,Family medicine ,National Survey of Family Growth ,Vasectomy ,medicine ,Obstetrics and Gynecology ,business ,medicine.disease ,Male infertility - Published
- 2014
33. Reply
- Author
-
William O. Brant, McClung Cd, Sean P. Elliott, Nejd F. Alsikafi, Joshua A. Broghammer, Jeremy B. Myers, Bryan B. Voelzke, Bradley A. Erickson, and Smith Tg rd
- Subjects
Psychotherapist ,business.industry ,Urology ,Medicine ,business - Published
- 2014
34. Editorial Comment
- Author
-
Jeremy B, Myers and William O, Brant
- Subjects
Male ,Urology ,Scrotum ,Humans ,Genital Diseases, Male ,Plastic Surgery Procedures ,Fournier Gangrene ,Surgical Flaps ,Penis - Published
- 2012
35. Editorial Comment
- Author
-
Jeremy B. Myers and William O. Brant
- Subjects
Urology - Published
- 2012
36. Editorial Comment
- Author
-
Jeremy B. Myers and William O. Brant
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,General surgery ,Medicine ,business - Published
- 2009
37. O-27
- Author
-
J.N. Mills, Hari K. Koul, Jeremy B. Myers, Joseph E. Dall'Era, Randall B. Meacham, and Sweaty Koul
- Subjects
biology ,Diabetic rat ,business.industry ,Genetic enhancement ,VEGF receptors ,Obstetrics and Gynecology ,Erectile function ,Viral gene ,Vascular endothelial growth factor ,chemistry.chemical_compound ,Reproductive Medicine ,chemistry ,Cancer research ,biology.protein ,Medicine ,Delivery system ,business - Published
- 2006
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.