109 results on '"Jeremy B. Myers"'
Search Results
2. Association Between Ejaculatory Dysfunction and Post-Void Dribbling After Urethroplasty
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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
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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
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- 2021
3. Antibiotic Stewardship and Postoperative Infections in Urethroplasties
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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
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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.
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- 2021
4. Sexual function following pelvic fracture urethral injury and posterior urethroplasty
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Jill C. Buckley, Benjamin N. Breyer, Bradley A. Erickson, Sean P. Elliott, Jeremy B. Myers, Bryan B. Voelzke, Alex J. Vanni, Andrew Mazzone, and Ross Anderson
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urethroplasty ,Urologic Diseases ,Urethral injury ,medicine.medical_specialty ,Ejaculation ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,sexual function ,03 medical and health sciences ,0302 clinical medicine ,Blunt ,Clinical Research ,medicine ,Erectile dysfunction ,business.industry ,Contraception/Reproduction ,Neurosciences ,Shim (computing) ,pelvic fracture ,medicine.disease ,Surgery ,trauma ,Reproductive Medicine ,030220 oncology & carcinogenesis ,Injury (total) Accidents/Adverse Effects ,Pelvic fracture ,Original Article ,Patient Safety ,Sexual function ,business - Abstract
BACKGROUND: To evaluate erectile and sexual function after pelvic fracture urethral injury (PFUI) by performing a retrospective review of a large multi-center database. We hypothesized that most men will have erectile dysfunction (ED) and poor sexual function following PFUI, which will remain after posterior urethroplasty. METHODS: Using the Trauma and Urologic Reconstructive Networks of Surgeons (TURNS) database, we identified PFUI patients undergoing posterior urethroplasty. We excluded patients with incomplete demographic, surgical and/or questionnaire data. Sexual Health Inventory of Men (SHIM), Male Sexual Health Questionnaire (MSHQ), and subjective changes in penile curvature were collected before urethroplasty surgery and at follow-up. We performed descriptive statistics for erectile and ejaculatory function using STATA v12. RESULTS: We identified 92 men meeting inclusion criteria; median age was 41.7 years and BMI was 26.5. The mechanism of injury was blunt in all patients, and average distraction defect length was 2.3 cm (SD 1.0 cm). In the 38 patients who completed both pre and post-operative SHIM questionnaires, the mean SHIM score was 10.5 (SD 7.0), with 63% having severe ED (SHIM
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- 2021
5. Nephrectomy is Associated with Increased Mortality after Renal Trauma: An Analysis of the National Trauma Data Bank from 2007-2016
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Rupam Das, Heidi A. Hanson, Sorena Keihani, Ross E. Anderson, Marta L. McCrum, Jeremy B. Myers, and James M. Hotaling
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Adult ,Male ,medicine.medical_specialty ,Databases, Factual ,Urology ,medicine.medical_treatment ,National trauma data bank ,Kidney ,Nephrectomy ,Humans ,Medicine ,Acute management ,Retrospective Studies ,Trauma Severity Indices ,business.industry ,General surgery ,Multiple injury ,fungi ,food and beverages ,Middle Aged ,United States ,Conservative treatment ,medicine.anatomical_structure ,Female ,business - Abstract
The majority of high grade renal trauma can be managed conservatively. However, nephrectomy is still common for acute management. We hypothesized that when controlling for multiple injury severity measures, nephrectomy would be associated with increased mortality.We identified high grade renal trauma patients from the National Trauma Data Bank® from 2007-2016. Exclusion criteria were age18 years, severe head injury and death within 4 hours of admission. We performed conditional logistic regression analysis to determine if nephrectomy was independently associated with mortality, controlling for age, gender, race/ethnicity, mechanism of injury, shock, blood transfusion, Glasgow Coma Scale, Revised Trauma Score and Injury Severity Score. Interaction was measured for mechanism of injury and shock with mortality.We identified 42,898 patients with high grade renal trauma (grade III-V), of whom 3,204 (7.5%) underwent nephrectomy. Unadjusted mortality was 16.6% in nephrectomy vs 5.7% in nonnephrectomy patients. In multivariable logistic regression, nephrectomy was associated with 82% increased odds of death (OR 1.82, 95% CI 1.63-2.03, p0.001). Other significant associations with death included age, nonWhite race, penetrating mechanism, hypotension, blood transfusion, lower Glasgow Coma Scale, lower Revised Trauma Score and higher Injury Severity Score. The association between nephrectomy and death did not differ by mechanism of injury. However, it was slightly attenuated in patients presenting in shock.In the National Trauma Data Bank, nephrectomy is independently associated with increased risk of mortality after adjusting for patient demographics, injury characteristics and multiple measures of overall injury severity. Nephrectomy may impact overall survival and must be avoided when possible.
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- 2021
6. Extraperitoneal Bladder Injuries Associated With Pelvic Fracture Requiring Internal Fixation: What Is the Evidence?
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Sorena Keihani, Jeremy B. Myers, and Seyyed Saeed Khabiri
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medicine.medical_specialty ,medicine.medical_treatment ,Urinary Bladder ,030232 urology & nephrology ,Fracture Fixation, Internal ,Fractures, Bone ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Fracture fixation ,medicine ,Humans ,Surgical Wound Infection ,Internal fixation ,Pelvic Bones ,Evidence-Based Medicine ,Urinary bladder ,business.industry ,030208 emergency & critical care medicine ,General Medicine ,medicine.disease ,Surgery ,Open Fracture Reduction ,medicine.anatomical_structure ,Pelvic fracture ,Equipment Contamination ,business ,Pelvic Infection - Abstract
Traumatic bladder injuries are commonly associated with pelvic fractures. While the majority of intraperitoneal bladder injuries are surgically repaired, extraperitoneal bladder injuries (EBIs) can be managed nonoperatively in the absence of complex injury patterns such as bladder neck injury or presence of bone spicules in the bladder. Concern for pelvic hardware contamination is one of the most common reasons for repairing EBIs at the time of orthopedic interventions for pelvic fracture (usually open reduction and internal fixation). However, given the inconsistent and limited evidence, practice patterns are different and largely depend on surgeon preferences and institutional management. In this review, we explore the roots for this concern and summarize the current evidence on risk of pelvic hardware infection with nonoperative management of EBIs.
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- 2020
7. Urethrogram: Does Postoperative Contrast Extravasation Portend Stricture Recurrence?
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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
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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.
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- 2020
8. Urethroscopic Findings following Urethroplasty Predict the Need for Secondary Intervention in the Long Term: A Multi-Institutional Study from Trauma and Urologic Reconstructive Network of Surgeons
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Lee C. Zhao, Jill C. Buckley, Nejd F. Alsikafi, Alex J. Vanni, Bryan B. Voelzke, Keith Rourke, Andrew C. Peterson, Benjamin N. Breyer, Thomas G. SmithIII, Nizar Hakam, Sean P. Elliott, Joshua A. Broghammer, Behnam Nabavizadeh, Jeremy B. Myers, Bradley A. Erickson, and Gregory Amend
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Reoperation ,Male ,medicine.medical_specialty ,Urologic Surgical Procedures, Male ,recurrence ,Urethral stricture ,Urology ,Urethroplasty ,medicine.medical_treatment ,Clinical Trials and Supportive Activities ,Clinical Sciences ,Postoperative Complications ,Urethra ,Recurrence ,Clinical Research ,Intervention (counseling) ,medicine ,80 and over ,Humans ,cystoscopy ,Aged ,Aged, 80 and over ,Urethral Stricture ,medicine.diagnostic_test ,business.industry ,General surgery ,Endoscopy ,Cystoscopy ,Plastic Surgery Procedures ,Middle Aged ,Urology & Nephrology ,medicine.disease ,Term (time) ,reconstructive surgical procedures ,Urologic Surgical Procedures ,business ,Follow-Up Studies - Abstract
PurposePostoperative surveillance urethroscopy has been shown to be an effective tool to predict reoperation within 1 year after urethroplasty. We aimed to evaluate early surveillance urethroscopy findings and long-term outcomes among urethroplasty patients in order to define the value of surveillance urethroscopy to predict failure.Materials and methodsWe evaluated 304 patients with at least 4 years of followup after urethroplasty performed at 10 institutions across the United States and Canada. All patients were surveilled using a flexible 17Fr cystoscope and were categorized into 3 groups: 1) normal lumen, 2) large-caliber stricture (≥17Fr) defined as the ability of the cystoscope to easily pass the narrowing and 3) small-caliber stricture (
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- 2022
9. Outcomes of Urinary Diversion for Late Adverse Effects of Gynecologic Radiotherapy
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Rachel Moses, John T. Stoffel, Sean Elliott, Jeremy B. Myers, Diana O'Dell, Jacob Albersheim, and Daniel Smith
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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.
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- 2020
10. MP03-04 LOWER URINARY TRACT SYMPTOM MANAGEMENT TRENDS PRIOR TO REFERRAL FOR URETHROPLASTY FOR ANTERIOR URETHRAL STRICTURE DISEASE FROM A CONTEMPORARY PROSPECTIVE COHORT
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Jeremy B. Myers, Bradley A. Erickson, Alex J. Vanni, Hayden Warner, Benjamin N. Breyer, Kevin J. Flynn, Jacob Oleson, Kyle A. Gillis, and Sean Elliott
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medicine.medical_specialty ,Referral ,business.industry ,Urology ,Urethroplasty ,medicine.medical_treatment ,Urinary system ,Disease ,medicine.disease ,Diagnosis of exclusion ,Surgery ,Refractory ,Lower urinary tract symptoms ,medicine ,Prospective cohort study ,business - Abstract
INTRODUCTION AND OBJECTIVE:Anterior urethral stricture disease (aUSD) is often a diagnosis of exclusion in men presenting with refractory lower urinary tract symptoms (LUTS). When the stricture is ...
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- 2021
11. PD31-01 A MULTI-CENTER PROSPECTIVE COHORT STUDY OF ENDOSCOPIC URETHRAL REALIGNMENT VERSUS SUPRAPUBIC CYSTOSTOMY AFTER PELVIC FRACTURE URETHRAL INJURY
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Sorena Keihani, Jeremy B. Myers, and Benjamin McCormick
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body regions ,Urethral injury ,medicine.medical_specialty ,business.industry ,Urology ,medicine.medical_treatment ,medicine ,Pelvic fracture ,Prospective cohort study ,medicine.disease ,business ,Suprapubic cystostomy ,Surgery - Abstract
INTRODUCTION AND OBJECTIVE:Pelvic fracture urethral injury (PFUI) occurs in up to 10% of pelvic fractures. In management of PFUI, there is mixed evidence supporting endoscopic urethral realignment ...
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- 2021
12. MP03-02 URETHROPLASTY OUTCOMES VALIDATION OF THE LSE ANTERIOR URETHRAL STRICTURE CLASSIFICATION SYSTEM
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Brian Voelzke, Benjamin N. Breyer, Bradley A. Erickson, Lee C. Zhao, Nejd F. Alsikafi, Justin Drobish, Joshua A. Broghammer, Thomas W. Smith, Shawn Grove, Kevin J. Flynn, Alex J. Vanni, Jill C. Buckley, Keith Rourke, Andrew C. Peterson, Jeremy B. Myers, and Sean Elliot
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medicine.medical_specialty ,Anterior Urethral Stricture ,business.industry ,Urology ,Urethroplasty ,medicine.medical_treatment ,Medicine ,business ,Surgery - Abstract
INTRODUCTION AND OBJECTIVE:The LSE anterior urethral stricture classification system has previously been validated for its interrater reliability and ability to predict urethroplasty technique. Her...
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- 2021
13. MP03-03 DEFINING SUCCESS AFTER ANTERIOR URETHROPLASTY: AN ARGUMENT FOR A UNIVERSAL DEFINITION AND SURVEILLANCE PROTOCOL
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Joshua A. Broghammer, Alex J. Vanni, Jill C. Buckley, Katherine Theisen, Keith Rourke, Nejd F. Alsikafi, Bryan B. Voelzke, Lee C. Zhao, Benjamin N. Breyer, Jeremy B. Myers, Thomas W. Smith, Bradley A. Erickson, and Sean Elliott
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Protocol (science) ,business.industry ,Argument ,Urology ,Urethroplasty ,medicine.medical_treatment ,Medicine ,business ,Epistemology - Abstract
INTRODUCTION AND OBJECTIVE:A successful urethroplasty has been defined in many ways. This variability poses a challenge when trying to compare success rates and techniques across studies. We aim to...
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- 2021
14. MP56-12 CYSTOSCOPIC FINDINGS FOLLOWING ANTERIOR URETHROPLASTY PREDICTS THE NEED FOR SECONDARY SURGICAL INTERVENTION: A MULTI-INSTITUTION ANALYSIS FROM TRAUMA AND UROLOGIC RECONSTRUCTIVE NETWORK OF SURGEONS
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Jill C. Buckley, Joshua A. Broghammer, Keith Rourke, Lee C. Zhao, Alex J. Vanni, Gregory Amend, Andrew C. Peterson, Thomas W. Smith, Bryan B. Voelzke, Bradley A. Erickson, Jeremy B. Myers, Nizar Hakam, Benjamin N. Breyer, Behnam Nabavizadeh, Nejd F. Alsikafi, and Sean Elliott
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medicine.medical_specialty ,business.industry ,Urology ,Intervention (counseling) ,General surgery ,Urethroplasty ,medicine.medical_treatment ,Institution (computer science) ,Medicine ,business - Abstract
INTRODUCTION AND OBJECTIVE:Prior work has established that post-operative urethroscopy may be an effective tool to predict re-operation within 1 year following urethroplasty. Here, we examine early...
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- 2021
15. Nephrectomy After High-Grade Renal Trauma is Associated With Higher Mortality: Results From the Multi-Institutional Genitourinary Trauma Study (MiGUTS)
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Rachel Moses, Kaushik Mukherjee, Ian Schwartz, Michael E. Rezaee, Bryan B. Voelzke, Reza Askari, S. Mitchell Heiner, Matthew M. Carrick, Nima Baradaran, Sarah Majercik, Sorena Keihani, Sean P. Elliott, Erik S. DeSoucy, Brandi Miller, Benjamin N. Breyer, Joshua A. Broghammer, Raminder Nirula, Jeremy B. Myers, Christopher M. Dodgion, Judith C. Hagedorn, Clara M. Castillejo Becerra, J. Patrick Selph, Alexander P. Nocera, Chirag S. Arya, Elisa Fang, Scott Zakaluzny, Brian P. Smith, Shubham Gupta, Bradley A. Erickson, Richard A. Santucci, Katie Glavin, Benjamin J. McCormick, Margaret Higgins, Rachel L. Sensenig, Frank Burks, and Scott H. Norwood
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Adult ,Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Renal Hemorrhage ,Kidney ,Nephrectomy ,Young Adult ,Injury Severity Score ,medicine ,Humans ,Retrospective Studies ,Genitourinary system ,business.industry ,Mortality rate ,Head injury ,Middle Aged ,medicine.disease ,Surgery ,Blood pressure ,Shock (circulatory) ,Wounds and Injuries ,Female ,medicine.symptom ,business - Abstract
To test the hypothesis that undergoing nephrectomy after high-grade renal trauma is associated with higher mortality rates.We gathered data from 21 Level-1 trauma centers through the Multi-institutional Genito-Urinary Trauma Study. Patients with high-grade renal trauma were included. We assessed the association between nephrectomy and mortality in all patients and in subgroups of patients after excluding those who died within 24 hours of hospital arrival and those with GCS≤8. We controlled for age, injury severity score (ISS), shock (systolic blood pressure90 mmHg), and Glasgow Coma Scale (GCS).A total of 1181 high-grade renal trauma patients were included. Median age was 31 and trauma mechanism was blunt in 78%. Injuries were graded as III, IV, and V in 55%, 34%, and 11%, respectively. There were 96 (8%) mortalities and 129 (11%) nephrectomies. Mortality was higher in the nephrectomy group (21.7% vs 6.5%, P.001). Those who died were older, had higher ISS, lower GCS, and higher rates of shock. After adjusting for patient and injury characteristics nephrectomy was still associated with higher risk of death (RR: 2.12, 95% CI: 1.26-2.55).Nephrectomy was associated with higher mortality in the acute trauma setting even when controlling for shock, overall injury severity, and head injury. These results may have implications in decision making in acute trauma management for patients not in extremis from renal hemorrhage.
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- 2021
16. Multicenter urethroplasty outcomes for urethral stricture disease for patients with neurogenic bladder or bladder dysfunction requiring clean intermittent catheterization
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Andrew J. Cohen, Jeremy B. Myers, Justin Drobish, Alex J. Vanni, Thomas W. Fuller, Joseph J. Pariser, Jill C. Buckley, Sean P. Elliott, Nima Baradaran, German Patino, Benjamin N. Breyer, Philip J. Cheng, Sikai Song, Brad A. Erickson, and Samit S. Roy
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urethroplasty ,Urologic Diseases ,medicine.medical_specialty ,Urethral stricture ,Urology ,medicine.medical_treatment ,Urethroplasty ,Population ,030232 urology & nephrology ,Urinary catheterization ,03 medical and health sciences ,0302 clinical medicine ,Urinary Leakage ,Clinical Research ,medicine ,Spinal cord injuries ,education ,urinary catheterization ,education.field_of_study ,business.industry ,Urinary diversion ,neurogenic bladder ,030208 emergency & critical care medicine ,Clean Intermittent Catheterization ,medicine.disease ,Surgery ,Reproductive Medicine ,Etiology ,Original Article ,urethral stricture ,business - Abstract
Background Our objective is to better comprehend treatment considerations for urethral stricture disease (USD) in patients requiring long-term clean intermittent catheterization (CIC). Patient characteristics, surgical outcomes and complications are unknown in this population. Methods Six members of the Trauma and Urologic Reconstruction Network of Surgeons (TURNS) participated in a prospective (2009 to present) and retrospective (prior to 2009) database recording patient demographics, surgical approach and outcomes. We included all patients undergoing urethroplasty who perform CIC. Descriptive statistics were used to analyze results. Results A total of 37 patients with 39 strictures were included. Bladder dysfunction was characterized as detrusor failure in 35% and neurogenic etiology in 65%. Median stricture length was 3 cm (IQR: 1.5-5.5) with 28% repaired with dorsal onlay buccal mucosal graft, 26% excision and primary anastomosis, 8% dorsal inlay, 8% ventral and dorsal, 8% flap based 8% non-transecting and 15% other. Functional success was 90%: 4 patients required DVIU or dilation due to recurrence, with 2 of those ultimately requiring repeat urethroplasty. 86% of patients returned to CIC; no patients reported new pad use for urinary leakage after urethroplasty. During a median follow-up period of 3.1 years (IQR: 1.0-5.3), no patients underwent urinary diversion. Conclusions Urethroplasty is suitable, safe and effective for patients dependent on CIC suffering from USD. The effect of continual CIC on long-term outcomes remains uncertain.
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- 2021
17. Validation of Upper Extremity Motor Function as a Key Predictor of Bladder Management After Spinal Cord Injury
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Blayne Welk, Sean P. Elliott, Kazuko Shem, John T. Stoffel, Sara M. Lenherr, Jeremy B. Myers, and Christopher S. Elliott
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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.
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- 2019
18. Erectile dysfunction management after failed phosphodiesterase-5-inhibitor trial: a cost-effectiveness analysis
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Ross E. Anderson, Rachel Moses, Jaewhan Kim, Jeremy B. Myers, Sara M. Lenherr, James R. Craig, James M. Hotaling, Sorena Keihani, and William O. Brant
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,medicine.drug_mechanism_of_action ,business.industry ,Urology ,medicine.medical_treatment ,Priapism ,030232 urology & nephrology ,Psychological intervention ,Penile prosthesis ,Cost-effectiveness analysis ,medicine.disease ,Quality-adjusted life year ,03 medical and health sciences ,0302 clinical medicine ,Erectile dysfunction ,Reproductive Medicine ,Emergency medicine ,medicine ,Original Article ,business ,Phosphodiesterase 5 inhibitor ,Decision analysis - Abstract
Background: To evaluate the cost-effectiveness of alternate erectile dysfunction (ED) management options after failed first line phosphodiesterase-5-inhibitors (PDE5-I). Methods: An empiric, repetitive decision tree analysis model was constructed using literature review and expert clinical judgement. This assessed the expected costs and quality adjusted life years (QALYs) of decision alternatives over a 10-year period. The model incorporated interventions including alternate PDE5-Is, intracorporal injections (ICI) with alprostadil or trimix (alprostadil, phentolamine, and papaverine), and inflatable penile prosthesis placement (IPP) and included respective risks of failure, subsequent interventions, and other complications (including priapism risk). Average model QALY estimates obtained from the literature were as follows: ED =0.56, successful alternate PDE5-I =0.70, successful ICI =0.70, and successful IPP =0.78. Cost data were calculated from a high-volume academic center and published manufacturer data. Results: Over the 10-year period, IPP placement was the most cost-effective management option per preserved QALY (QALY =7.82, cost =$22,009/10 years) as compared to ICI alprostadil (QALY =8.51, cost =$62,890/10 years), ICI trimix (QALY =8.47, cost =$48,617/10 years) and alternate PDE5-I (QALY =7.73, $52,883/10 years). Conclusions: Using expert opinion and published utility, cost, and complication data in a decision analysis, we demonstrated that IPP placement is the most cost-effective ED intervention following failed initial PDE5-I over a 10-year period as compared to alternate treatment options. Such cost-effectiveness outcomes may be used in ED management counseling.
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- 2019
19. Trends in Urethral Stricture Disease Etiology and Urethroplasty Technique From a Multi-institutional Surgical Outcomes Research Group
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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.
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- 2019
20. The associations between initial radiographic findings and interventions for renal hemorrhage after high-grade renal trauma: Results from the Multi-Institutional Genitourinary Trauma Study
- Author
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Douglas Rogers, Bradley J. Morris, Matthew M. Carrick, Frank Burks, Benjamin N. Breyer, Brandi Miller, Bradley A. Erickson, Nima Baradaran, Joshua Piotrowski, Sorena Keihani, Sean P. Elliott, Bryn Putbrese, Barbara U. Okafor, Richard A. Santucci, Reza Askari, Kaushik Mukherjee, Ian Schwartz, Jurek F. Kocik, Chong Zhang, Brian P. Smith, Brenton Sherwood, Jeremy B. Myers, Raminder Nirula, Timothy Hewitt, Erik S. DeSoucy, Sarah Majercik, Cameron N. Fick, Christopher M. Dodgion, Scott Zakaluzny, Marta E. Heilbrun, and Xian Luo-Owen
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Renal Hemorrhage ,Psychological intervention ,Hemorrhage ,Abdominal Injuries ,Kidney ,Wounds, Nonpenetrating ,Critical Care and Intensive Care Medicine ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,Predictive Value of Tests ,Epidemiology ,medicine ,Humans ,Retrospective Studies ,Genitourinary system ,business.industry ,030208 emergency & critical care medicine ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Nephrectomy ,Surgery ,Predictive value of tests ,Female ,Kidney Diseases ,business - Abstract
Background Indications for intervention after high-grade renal trauma (HGRT) remain poorly defined. Certain radiographic findings can be used to guide the management of HGRT. We aimed to assess the associations between initial radiographic findings and interventions for hemorrhage after HGRT and to determine hematoma and laceration sizes predicting interventions. Methods The Genitourinary Trauma Study is a multicenter study including HGRT patients from 14 Level I trauma centers from 2014 to 2017. Admission computed tomography scans were categorized based on multiple variables, including vascular contrast extravasation (VCE), hematoma rim distance (HRD), and size of the deepest laceration. Renal bleeding interventions included angioembolization, surgical packing, renorrhaphy, partial nephrectomy, and nephrectomy. Mixed-effect Poisson regression was used to assess the associations. Receiver operating characteristic analysis was used to define optimal cutoffs for HRD and laceration size. Results In the 326 patients, injury mechanism was blunt in 81%. Forty-seven (14%) patients underwent 51 bleeding interventions, including 19 renal angioembolizations, 16 nephrectomies, and 16 other procedures. In univariable analysis, presence of VCE was associated with a 5.9-fold increase in risk of interventions, and each centimeter increase in HRD was associated with 30% increase in risk of bleeding interventions. An HRD of 3.5 cm or greater and renal laceration depth of 2.5 cm or greater were most predictive of interventions. In multivariable models, VCE and HRD were significantly associated with bleeding interventions. Conclusion Our findings support the importance of certain radiographic findings in prediction of bleeding interventions after HGRT. These factors can be used as adjuncts to renal injury grading to guide clinical decision making. Level of evidence Prognostic and Epidemiological Study, Level III and Therapeutic/Care Management, Level IV.
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- 2019
21. Evaluation of Generic Versus Condition-Specific Quality of Life Indicators for Successful Urethral Stricture Surgery
- Author
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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
22. Outcomes of right colon continent urinary pouch using standardized reporting methods
- Author
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Philip J. Cheng, Christopher Martin, Chong Zhang, Jeremy B. Myers, and Angela P. Presson
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Adult ,Male ,Reoperation ,medicine.medical_specialty ,Colon ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Urinary Diversion ,Article ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Diabetes mellitus ,medicine ,Humans ,Aged ,030219 obstetrics & reproductive medicine ,Bladder cancer ,business.industry ,Urinary Reservoirs, Continent ,Urinary diversion ,Perioperative ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Urinary Bladder Neoplasms ,Indiana pouch ,Female ,Neurology (clinical) ,Pouch ,business ,Body mass index ,Follow-Up Studies ,Abdominal surgery - Abstract
AIMS Studies of right colon pouch urinary diversion estimate risk of perioperative complications, 1%-50%, and reoperation, 1%-69%. This wide range is due to variable outcome measurements and reporting methods; it is also unclear which factors increase the risk of complications and reoperation. We sought to characterize the impact of patient-specific factors on risk of complications, readmission, and reoperation after right colon pouch urinary diversion. METHODS Patients undergoing right colon pouch urinary diversion from January 2010 to April 2017 were analyzed. Outcomes included: high-grade complications within 90 days (Clavien-Dindo grade ≥3), readmission within 90 days, and reoperation at any time during follow-up. Patient-specific factors were analyzed to establish any associations with these outcomes. RESULTS During the study period, 53 patients underwent the procedure and the average follow-up was 30 (standard deviation [SD] 21.5) months; 90-day high-grade complications were 22% and readmission was 45%. The cumulative rate of any reoperation was 53% and major reoperation was 32%. Diabetes was associated with an increased risk of both postoperative complications and reoperation. Larger body mass index and prior abdominal surgery were associated with increased risk of readmission. CONCLUSIONS Overall the rate of postoperative complications, readmissions, and reoperation was high, but in agreement with other contemporary series. This study helps to further characterize surgical outcomes after right colon pouch urinary diversion, however, similar to other studies in the literature, the rarity of the procedure limits the power to establish a link between preoperative patient factors and outcomes.
- Published
- 2019
23. Multi-institutional Outcomes and Associations After Excision and Primary Anastomosis for Radiotherapy-associated Bulbomembranous Urethral Stenoses Following Prostate Cancer Treatment
- Author
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Jill C. Buckley, Keith Rourke, Sean P. Elliott, Bryan B. Voelzke, T Wright, Lee C. Zhao, Joshua A. Broghammer, Jeremy B. Myers, Benjamin N. Breyer, Laura Leddy, Nedj F. Alsikafi, Bradley A. Erickson, and Alex J. Vanni
- Subjects
Male ,medicine.medical_specialty ,Urethral stricture ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,Urethral stenosis ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Recurrence ,medicine ,Humans ,Radiation Injuries ,Aged ,Retrospective Studies ,Aged, 80 and over ,Urethral Stricture ,Proportional hazards model ,business.industry ,Anastomosis, Surgical ,Age Factors ,Prostatic Neoplasms ,Middle Aged ,medicine.disease ,Surgery ,Radiation therapy ,Stenosis ,Urethra ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Urinary Sphincter, Artificial ,business - Abstract
To evaluate the outcomes of excision and primary anastomosis (EPA) for radiation-associated bulbomembranous stenoses using a multi-institutional analysis. The treatment of radiation-associated urethral stenosis is typically complex owing to the adverse impact of radiation on adjacent tissue.An IRB-approved multi-institutional retrospective review was performed on patients who underwent EPA for bulbomembranous urethral stenosis following prostate radiotherapy. Preoperative patient demographics, operative technique, and postoperative outcomes were abstracted from 1/2007-6/2018. Success was defined as voiding per urethra without the need for endoscopic treatment and a minimum follow-up of 12 months.One hundred and thirty-seven patients from 10 centers met study criteria with a mean age of 69.3 years (50-86), stenosis length of 2.3 cm (1-5) and an 86.9% (119/137) success rate at a mean follow-up 32.3 months (12-118). Univariate Cox regression analysis identified increasing patient age (P = .02), stricture length (P.0001) and combined modality radiotherapy (P = .004) as factors associated with stricture recurrence while body mass index (P = .79), diabetes (P = .93), smoking (P = .62), failed endoscopic treatment (P = .08) and gracilis muscle use (P = .25) were not. On multivariate analysis, increasing patient age (H.R.1.09, 95%CI 1.01-1.16; P = .02) and stenosis length (H.R.2.62, 95%CI 1.49-4.60; P = .001) remained associated with recurrence. Subsequent artificial urinary sphincter was performed in 30 men (21.9%), of which 25 required a transcorporal cuff and 5 developed cuff erosion.EPA for radiation-associated urethral stenosis effectively provides unobstructed instrumentation-free voiding. However, increasing stenosis length and age are independently associated with surgical failure. Patients should be counseled that further surgery for incontinence may be necessary.
- Published
- 2020
24. Clinical and Radiographic Factors Associated With Failed Renal Angioembolization: Results From the Multi-institutional Genitourinary Trauma Study (Mi-GUTS)
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Shubham Gupta, Ryan P. Joyce, Frank Burks, Reza Askari, Manuel Armas-Phan, Jeremy B. Myers, Christopher M. Dodgion, Matthew M. Carrick, Bradley A. Erickson, Douglas Rogers, Nnenaya Agochukwu-Mmonu, Benjamin N. Breyer, Sorena Keihani, Judith C. Hagedorn, Sean P. Elliott, Sarah Majercik, Rachel Moses, Kaushik Mukherjee, Ian Schwartz, Sherry S. Wang, Joel A. Gross, J. Patrick Selph, Richard A. Santucci, Nima Baradaran, Rachel L. Sensenig, Raminder Nirula, Bryan B. Voelzke, Brian P. Smith, and Andrew J. Cohen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Kidney Disease ,Physical Injury - Accidents and Adverse Effects ,Exploratory laparotomy ,Urology ,Radiography ,medicine.medical_treatment ,Clinical Sciences ,Renal and urogenital ,030232 urology & nephrology ,Wounds, Penetrating ,Kidney ,Wounds, Nonpenetrating ,Embolization ,03 medical and health sciences ,Young Adult ,Penetrating ,0302 clinical medicine ,Clinical Research ,medicine ,Nonpenetrating ,Humans ,Prospective Studies ,Treatment Failure ,medicine.diagnostic_test ,business.industry ,Genitourinary system ,Angiography ,Urology & Nephrology ,Middle Aged ,Embolization, Therapeutic ,Surgery ,030220 oncology & carcinogenesis ,Wounds ,Cohort ,Perirenal hematoma ,Female ,Therapeutic ,business - Abstract
Objective To find clinical or radiographic factors that are associated with angioembolization failure after high-grade renal trauma. Material and Methods Patients were selected from the Multi-institutional Genito-Urinary Trauma Study. Included were patients who initially received renal angioembolization after high-grade renal trauma (AAST grades III-V). This cohort was dichotomized into successful or failed angioembolization. Angioembolization was considered a failure if angioembolization was followed by repeat angiography and/or an exploratory laparotomy. Results A total of 67 patients underwent management initially with angioembolization, with failure in 18 (27%) patients. Those with failed angioembolization had a larger proportion ofgrade IV (72% vs 53%) and grade V (22% vs 12%) renal injuries. A total of 53 patients underwent renal angioembolization and had initial radiographic data for review, with failure in 13 cases. The failed renal angioembolization group had larger perirenal hematoma sizes on the initial trauma scan. Conclusion Angioembolization after high-grade renal trauma failed in 27% of patients. Failed angioembolization was associated with higher injury grade and a larger perirenal hematoma. Likely these characteristics are associated with high-grade renal trauma that may be less amenable to successful treatment after a single renal angioembolization.
- Published
- 2020
25. Outcomes and Risk Factors of Revision and Replacement Artificial Urinary Sphincter Implantation in Radiated and Nonradiated Cases
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Thomas G. Smith, Thomas W. Fuller, Jill C. Buckley, Ouida Lenaine Westney, Lee C. Zhao, Bryan B. Voelzke, Benjamin N. Breyer, Kelsey Gallo, Alex J. Vanni, Nejd F. Alsikafi, Brad A. Erickson, Sean P. Elliott, Jeremy B. Myers, Eric Ballon-Landa, Divya Ajay, Andrew J. Cohen, and Joshua A. Broghammer
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Urinary Incontinence, Stress ,Clinical Sciences ,030232 urology & nephrology ,artificial ,urinary sphincter ,Urinary incontinence ,reoperation ,digestive system ,prostatic neoplasms ,Artificial urinary sphincter ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,otorhinolaryngologic diseases ,medicine ,Humans ,Device Removal ,radiotherapy ,Proportional Hazards Models ,Prostatectomy ,urinary incontinence ,Radiotherapy ,business.industry ,Urethral sphincter ,digestive, oral, and skin physiology ,Prostatic Neoplasms ,Urology & Nephrology ,Surgery ,Radiation therapy ,Urinary Sphincter, Artificial ,medicine.symptom ,business ,Complication ,Pelvic radiotherapy - Abstract
PURPOSE:Risk factors for complications after artificial urinary sphincter surgery include a history of pelvic radiation and prior artificial urinary sphincter complication. The survival of a second artificial urinary sphincter in the setting of prior device complication and radiation is not well described. We report the survival of redo artificial urinary sphincter surgery and identify risk factors for repeat complications. MATERIALS AND METHODS:A multi-institutional database was queried for redo artificial urinary sphincter surgeries. The primary outcome was median survival of a second and third artificial urinary sphincter in radiated and nonradiated cases. A Cox proportional hazards survival analysis was performed to identify additional patient and surgery risk factors. RESULTS:Median time to explantation of the initial artificial urinary sphincter in radiated (150) and nonradiated (174) cases was 26.4 and 35.6 months, respectively (p=0.043). For a second device median time to explantation was 30.1 and 38.7 months (p=0.034) and for a third device it was 28.5 and 30.6 months (p=0.020), respectively. The 5-year revision-free survival for patients undergoing a second artificial urinary sphincter surgery with no risk factors, history of radiation, history of urethroplasty, and history of radiation and urethroplasty were 83.1%, 72.6%, 63.9% and 46%, respectively. CONCLUSIONS:Patients without additional risk factors undergoing second and third artificial urinary sphincter surgeries experience revision-free rates similar to those of their initial artificial urinary sphincter devices. Patients who have been treated with pelvic radiation have earlier artificial urinary sphincter complications. When multiple risk factors exist, revision-free rates decrease significantly.
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- 2020
26. Endoscopic treatments prior to urethroplasty: trends in management of urethral stricture disease
- Author
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Matthew J. Moynihan, Thomas G. Smith, Benjamin N. Breyer, Lee C. Zhao, Jill C. Buckley, Bradley A. Erickson, Nejd F. Alsikafi, Alex J. Vanni, Jeremy B. Myers, Bryan B. Voelzke, and Sean P. Elliott
- Subjects
Male ,Urethroplasty ,Urethral stricture ,medicine.medical_treatment ,Disease ,lcsh:RC870-923 ,Urethral stricture guidelines ,80 and over ,Child ,Aged, 80 and over ,Endoscopic treatment ,General Medicine ,Middle Aged ,Urology & Nephrology ,Child, Preschool ,Preoperative Period ,Urologic Surgical Procedures ,Research Article ,Urologic Diseases ,Adult ,medicine.medical_specialty ,Urologic Surgical Procedures, Male ,Adolescent ,Urology ,Clinical Sciences ,Context (language use) ,Young Adult ,Urethra ,Clinical Research ,medicine ,Humans ,In patient ,Preschool ,Aged ,Retrospective Studies ,Urethral Stricture ,Retrospective review ,business.industry ,General surgery ,Infant ,Endoscopy ,Guideline ,lcsh:Diseases of the genitourinary system. Urology ,medicine.disease ,Reproductive Medicine ,business ,Procedures and Techniques Utilization - Abstract
Background To determine if the number of endoscopic treatments of urethral stricture disease (USD) prior to urethroplasty has changed in the context of new AUA guidelines on management of USD. In addition to an increase in practicing reconstructive urologists and published reconstructive literature, the AUA guidelines regarding the management of male USD were presented in May 2016, advocating consideration of urethroplasty in patients with 1 prior failed endoscopic treatment. Methods A retrospective review of a prospectively maintained, multi-institutional urethral stricture database of high volume, geographically diverse institutions was performed from 2006 to 2017. We performed a review of relevant literature and evaluated pre-urethroplasty endoscopic treatment patterns prior to and after the AUA male stricture guideline. Results 2964 urethroplasties were reviewed in 10 institutions. There was both a decrease in the number of endoscopic treatments prior to urethroplasty in the pre-May 2016 compared to post-May 2016 cohorts both for overall urethroplasties (2.3 vs 1.6, P = 0.0012) and a gradual decrease in the number of pre-urethroplasty endoscopic treatments over the entire study period. Conclusion There was a decrease in the number of endoscopic treatments of USD prior to urethroplasty in the observed period of interest. Declining endoscopic USD management is not likely to be a reflection of a solely unique influence of the guidelines as endoscopic treatment decreased over the entire study period. Further research is needed to determine if there will be a continued trend in the declining use of endoscopic treatment and elucidate the barriers to earlier urethroplasty in patients with USD.
- Published
- 2020
27. MP35-11 MULTICENTER URETHROPLASTY OUTCOMES FOR URETHRAL STRICTURE DISEASE FOR PATIENTS WITH NEUROGENIC BLADDER OR BLADDER DYSFUNCTION REQUIRING CLEAN INTERMITTENT CATHETERIZATION
- Author
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Justin Drobish, Andrew J. Cohen, Jill C. Buckley, Nima Baradaran, Joseph J. Pariser, Sean Elliot, Thomas W. Fuller, Benjamin N. Breyer, Alex J. Vanni, Jeremy B. Myers, Philip J. Cheng, Samit S. Roy, German Patino, Bradley A. Erickson, and Sikai Song
- Subjects
medicine.medical_specialty ,Urethral stricture ,business.industry ,Urology ,Urethroplasty ,medicine.medical_treatment ,Patient characteristics ,Disease ,Clean Intermittent Catheterization ,medicine.disease ,Surgery ,medicine ,In patient ,business - Abstract
INTRODUCTION AND OBJECTIVE:Treatment considerations are unique for urethral stricture disease (USD) in patients requiring long-term clean intermittent catheterization (CIC). Patient characteristics...
- Published
- 2020
28. PD46-03 NEPHRECTOMY FOR HIGH-GRADE RENAL TRAUMA IS ASSOCIATED WITH HIGHER MORTALITY RATES
- Author
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Bryan B. Voelzke, Benjamin N. Breyer, Frank Burks, Raminder Nirula, Richard A. Santucci, Chirag S. Arya, Rachel L. Sensenig, J. Patrick Selph, Sean Elliott, Jeremy B. Myers, Judith C. Hagedorn, James Mercer, Elisa Wang, Rachel Moses, Nima Baradaran, Katie Glavin, Bradley A. Erickson, Shubham Gupta, Ross Anderson, Clara M. Castillejo Becerra, Joshua A. Broghammer, Michael E. Rezaee, Alexander P. Nocera, and Sorena Keihani
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,medicine.medical_treatment ,Mortality rate ,medicine ,food and beverages ,business ,Nephrectomy ,Surgery - Abstract
INTRODUCTION AND OBJECTIVE:Nephrectomy can be avoided in most patients even in cases of high-grade renal trauma (HGRT). The reasons for nephrectomy after trauma are complex but it is often done in ...
- Published
- 2020
29. MP60-07 DO POST-VOID DRIBBLING AND EJACULATORY DYSFUNCTION AFTER URETHROPLASTY SHARE THE SAME ETIOLOGY?
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Sean Elliott, Bryan B. Voelzke, Nejd F. Alsikafi, Jill C. Buckley, Keith Rourke, Ayman Soubra, Alex J. Vanni, Jeremy B. Myers, Bradley A. Erickson, Joseph J. Pariser, Shawn Grove, Joshua A. Broghammer, and Benjamin N. Breyer
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,Urethroplasty ,medicine.medical_treatment ,medicine ,Etiology ,Post-void dribbling ,medicine.symptom ,business ,Ejaculatory Dysfunction - Abstract
INTRODUCTION AND OBJECTIVE:Post-void dribbling (PVD) and ejaculatory dysfunction (EjD) are common after urethroplasty (UP). Although the etiology remains unknown, they are thought to share a simila...
- Published
- 2020
30. Development and Validation of A Male Anterior Urethral Stricture Classification System
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Benjamin N. Breyer, Andrew C. Peterson, Jeremy B. Myers, Sean P. Elliott, Alex J. Vanni, Amy E. Hahn, Thomas G. Smith rd, Joshua A. Broghammer, Kevin J. Flynn, Bradley A. Erickson, Jill C. Buckley, Keith Rourke, Nejd F. Alsikafi, Lee C. Zhao, Katherine J. Cotter, and Bryan B. Voelzke
- Subjects
Male ,medicine.medical_specialty ,Anterior Urethral Stricture ,Urethral stricture ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,MEDLINE ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Medical history ,Medical History Taking ,Retrospective Studies ,Observer Variation ,Urethral Stricture ,medicine.diagnostic_test ,business.industry ,General surgery ,Reproducibility of Results ,medicine.disease ,Inter-rater reliability ,030220 oncology & carcinogenesis ,Retrograde urethrogram ,Etiology ,business - Abstract
Objective To develop and validate a clinical classification system for urethral stricture disease (USD) based on the retrograde urethrogram (RUG), physical exam, and stricture-specific patient history. Materials and methods Three elements were chosen to be included in the classification system: 1) Length of urethral stricture (L); 2) Stricture segment/location (S); 3) Stricture Etiology (E) (LSE classification system). Each element was divided into clinically relevant sub-categories. A three-step development and validation process then ensued, culminating in an in-person Trauma and Urologic Reconstruction Network of Surgeons (TURNS) meeting, at which the final classification system was unanimously agreed upon by attendees based on interrater reliability data obtained from the classifying of 22 clinical vignettes. A final validation step involved retrospectively classifying cases in the TURNS database to determine if classification influenced surgical technique and was associated with presumed stricture etiology. Results The final LSE classification system was found to have an interrater reliability of 0.79 (individual components 0.76, 0.70 and 0.93 respectfully). Retrospective classification of the 2162 TURNS strictures revealed the segment (S) to be strongly associated with urethroplasty type (p = 0.0005) and stricture etiology (E) (p = 0.0005). Conclusion We developed and validated a novel, easy to use, urethral stricture classification system. The system's ability to aid in directing treatments, predict treatment outcomes, and facilitate collaborative research efforts will require further study.
- Published
- 2019
31. Multi-institutional Outcomes for Simultaneous and Staged Urinary and Fecal Diversions in Patients Without Cancer
- Author
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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
32. Utility of Hyperbaric Oxygen Therapy in Genitourinary Reconstruction
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Francisco Martins, Jeremy B. Myers, and Austen D. Slade
- Subjects
Radiation therapy ,medicine.medical_specialty ,Reconstructive surgery ,Hyperbaric oxygen ,Genitourinary system ,business.industry ,medicine.medical_treatment ,medicine ,Oxygen delivery ,business ,Surgery - Abstract
Background Hyperbaric Oxygen Therapy (HBOT) has numerous applications set forth by the Undersea and Hyperbaric Medical Society. Favorable properties of HBOT include increased oxygen delivery to compromised tissue, and promotion of angiogenesis. HBOT has been used in reconstructive surgery since the 1960’s primarily in the setting of threatened flaps and grafts with a good track record of improved wound healing.
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- 2019
33. Post-Prostatectomy Incontinence: How Common and Bothersome Is It Really ?
- Author
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William O. Brant, Vera Trofimenko, and Jeremy B. Myers
- Subjects
Male ,medicine.medical_specialty ,Urology ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,030232 urology & nephrology ,Urinary incontinence ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Quality of life ,Patient age ,Prevalence ,medicine ,Humans ,Intensive care medicine ,Post prostatectomy ,Prostatectomy ,Gynecology ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,Psychiatry and Mental health ,Urinary Incontinence ,Reproductive Medicine ,Overactive bladder ,030220 oncology & carcinogenesis ,medicine.symptom ,Sexual function ,business ,Radical retropubic prostatectomy - Abstract
Introduction The implications of post-prostatectomy urinary incontinence (PPI) on quality of life pose a matter of great concern for urologists and patients alike. Efforts to mitigate this devastating complication have met with varying degrees of success and the literature has shown a discrepancy between patient- and surgeon-reported outcomes. Aim To describe the multifactorial physiology of PPI, its evaluation, and its effect on health-related quality of life and sexual function and to review preoperative predictive factors for PPI and explore the disparity between patient- and surgeon-reported outcomes. Methods We selected a representative sample of principal studies addressing these topics pertaining to PPI. The search was executed by a relevant term search on PubMed from 1994 to the present. Main Outcome Measures The main topics of consideration in this review are pathophysiology, predictors and prevalence, and methods of evaluating PPI. We also report on findings on the role of PPI in sexual activity, surgical methods to prevent PPI, and variability in methods of outcome reporting. Results The application of various measures to prevent PPI has had variable success and efforts to further refine and widely implement improvements have been complicated by the heterogeneity in measurements used to report and compare outcomes. Conclusion Patient age, incontinence definitions, and preoperative baseline incontinence make collecting and interpreting urinary function data after radical prostatectomy challenging. Confusion in the literature is compounded by the discrepancy between patient- and surgeon-reported outcomes. On a patient-physician level, there is the issue of potentially under-counseling patients during preoperative discussions on the profound impact of PPI on quality of life in general and on sexual function and satisfaction in particular. Trofimenko V, Myers JB, Brant WO. Post-Prostatectomy Incontinence: How Common and Bothersome Is It Really? Sex Med Rev 2017;X:XXX–XXX.
- Published
- 2017
34. The Impact of Age on Urethroplasty Success
- Author
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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
35. Outcomes of Urethroplasty to Treat Urethral Strictures Arising From Artificial Urinary Sphincter Erosions and Rates of Subsequent Device Replacement
- Author
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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
36. Urinary Diversion for Severe Urinary Adverse Events of Prostate Radiation: Results from a Multi-Institutional Study
- Author
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Yahir Santiago-Lastra, Bryan B. Voelzke, Christopher McClung, Jonathan D. Tward, Jeremy B. Myers, Scott C. Pate, John T. Stoffel, Joshua A. Broghammer, Benjamin N. Breyer, Angela P. Presson, Sean P. Elliott, Robert Goldfarb, Thomas W. Gaither, Alex J. Vanni, Mitchell Bassett, and Bradley A. Erickson
- Subjects
Male ,medicine.medical_specialty ,Urology ,Urinary system ,medicine.medical_treatment ,030232 urology & nephrology ,Urinary Diversion ,03 medical and health sciences ,Prostate cancer ,Postoperative Complications ,0302 clinical medicine ,Prostate ,Humans ,Medicine ,External beam radiotherapy ,Adverse effect ,Aged ,Retrospective Studies ,Aged, 80 and over ,Prostatectomy ,business.industry ,Urinary diversion ,Prostatic Neoplasms ,Retrospective cohort study ,Middle Aged ,Urination Disorders ,medicine.disease ,Combined Modality Therapy ,Radiation therapy ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,business ,human activities - Abstract
We evaluated the short and long-term surgical outcomes of urinary diversion done for urinary adverse events arising from prostate radiation therapy. We hypothesized that patient characteristics are associated with complications after urinary diversion.We performed a retrospective cohort study of 100 men who underwent urinary diversion (urinary conduit or continent catheterizable pouch) due to urinary adverse events after prostate radiotherapy from 2007 to 2016 from 9 academic centers in the United States. Outcome measurements included predictors of short and long-term complications, and readmission after urinary diversion of patients who had prostate cancer treated with radiotherapy. The data were summarized using descriptive statistics and univariate associations with complications were identified with logistic regression controlling for center.Mean patient age was 71 years and median time from radiotherapy to urinary diversion was 8 years. Overall 81 (81%) patients had combined modality therapy (radical prostatectomy plus radiotherapy or various combinations of radiotherapy). Grade 3a or greater Clavien-Dindo complications occurred in 31 (35%) men, including 4 deaths (4.5%). Normal weight men had more short-term complications compared to overweight (OR 4.9, 95% CI 1.3-23.1, p=0.02) and obese men (OR 6.3, 95% CI 1.6-31.1, p=0.009). Hospital readmission within 6 weeks of surgery occurred for 35 (38%) men. Surgery was needed to treat long-term complications after urinary diversion in 19 (22%) patients with a median followup of 16.3 months.Urinary diversion after prostate radiotherapy has a considerable short and long-term surgical complication rate. Urinary diversion most often cannot be avoided in these patients but appreciation of the risks allows for informed shared decision making between surgeons and patients.
- Published
- 2017
37. MP60-11 QUALITATIVE ANALYSIS OF SUBJECTIVE IMPACT OF MALE URETHRAL STRICTURE PRE/POST URETHROPLASTY
- Author
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Brad Erickson, Shawn Grove, Sean Elliott, Jill C. Buckley, Andrew C. Peterson, Josh Broghammer, Jeremy B. Myers, Keith Rourke, Anthony Enriquez, Donald L. Patrick, Bryan B. Voelzke, Todd L. Edwards, Alex J. Vanni, Benjamin N. Breyer, and James W. Griffith
- Subjects
medicine.medical_specialty ,Qualitative analysis ,genetic structures ,Urethral stricture ,business.industry ,Urology ,Urethroplasty ,medicine.medical_treatment ,medicine ,medicine.disease ,business ,Surgery - Abstract
INTRODUCTION AND OBJECTIVE:Measurement of objective measures following urethroplasty (e.g., urethral patency, uroflowmetry) is vital, but patient-reported input via condition-specific outcome measu...
- Published
- 2020
38. High grade renal trauma management: a survey of practice patterns and the perceived need for a prospective management trial
- Author
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Ross E. Anderson, Jeremy B. Myers, James M. Hotaling, Raminder Nirula, Sorena Keihani, Daniel Vargo, and Rachel Moses
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Practice patterns ,business.industry ,Genitourinary system ,Urology ,medicine.medical_treatment ,General surgery ,030232 urology & nephrology ,030208 emergency & critical care medicine ,Interventional radiology ,urologic and male genital diseases ,Nephrectomy ,03 medical and health sciences ,0302 clinical medicine ,Reproductive Medicine ,Trauma management ,Acute care ,Angiography ,Medicine ,Original Article ,Embolization ,business - Abstract
Background: To evaluate the current practice patterns of practitioners managing high grade renal trauma and determine perceived need for a prospective trial on the management of renal trauma. Methods: We distributed an electronic survey to members of the American Association for the Surgery of Trauma (AAST) and The Society of Genitourinary Reconstructive Surgeons (GURS). The survey evaluated demographics, interventional radiology (IR) access, and renal trauma management. Descriptive statistics were utilized to analyze participants’ responses. Results: A total of 253 practitioners responded (age 48.4±10.4 years). The majority were acute care/trauma surgeons (ACS/TS) (63.2%), followed by urologists (34.4%) practicing at level 1 trauma centers (80.6%) in 39 US states. Most participants were in practice >10 years (62.8%); and had completed an ACS/TS (53.8%), or trauma/reconstructive urology (25.7%) fellowship. Ninety-five percent (241/253) found value in renal preservation with 74% utilizing IR embolization in the last year. However, there was wide variation in threshold for angiography, low rates of renal repair (24%) or packing (20%) and half reported performing a nephrectomy within the prior year. More than 80% believed there was value in a prospective trial to evaluate a protocol to decrease nephrectomy rates in renal trauma management. Conclusions: The majority of respondents had access to IR, reported comfort in renorrhaphy, and valued renal preservation. There was variation in thresholds for bleeding intervention, and nephrectomy was still a common management strategy. There is great interest among trauma surgeons and urologists for a prospective trial of renal trauma management aimed at decreasing nephrectomy when possible.
- Published
- 2019
39. Fertility concerns of the transgender patient
- Author
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Philip J. Cheng, James M. Hotaling, Isak A. Goodwin, Alexander W. Pastuszak, and Jeremy B. Myers
- Subjects
Infertility ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,media_common.quotation_subject ,Population ,Fertility ,Review Article ,03 medical and health sciences ,0302 clinical medicine ,Uterus transplantation ,Transgender ,medicine ,030212 general & internal medicine ,Fertility preservation ,education ,media_common ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,Oophorectomy ,medicine.disease ,Reproductive Medicine ,Hormone therapy ,business - Abstract
Transgender individuals who undergo gender-affirming medical or surgical therapies are at risk for infertility. Suppression of puberty with gonadotropin-releasing hormone agonist analogs (GnRHa) in the pediatric transgender patient can pause the maturation of germ cells, and thus, affect fertility potential. Testosterone therapy in transgender men can suppress ovulation and alter ovarian histology, while estrogen therapy in transgender women can lead to impaired spermatogenesis and testicular atrophy. The effect of hormone therapy on fertility is potentially reversible, but the extent is unclear. Gender-affirming surgery (GAS) that includes hysterectomy and oophorectomy in transmen or orchiectomy in transwomen results in permanent sterility. It is recommended that clinicians counsel transgender patients on fertility preservation (FP) options prior to initiation of gender-affirming therapy. Transmen can choose to undergo cryopreservation of oocytes or embryos, which requires hormonal stimulation for egg retrieval. Uterus preservation allows transmen to gestate if desired. For transwomen, the option for FP is cryopreservation of sperm either through masturbation or testicular sperm extraction. Experimental and future options may include cryopreservation and in vitro maturation of ovarian or testicular tissue, which could provide prepubertal transgender youth an option for FP since they lack mature gametes. Successful uterus transplantation with subsequent live birth is a new medical breakthrough for cisgender women with uterus factor infertility. Although it has not yet been performed in transgender women, uterus transplantation is a potential solution for those who wish to get pregnant. The transgender population faces many barriers to care, such as provider discrimination, lack of information, legal barriers, scarcity of fertility centers, financial burden, and emotional cost. Further research is necessary to investigate the feasibility of experimental FP options, provide better evidence-based information to clinicians and transgender patients alike, and to improve access to and quality of reproductive services for the transgender population.
- Published
- 2019
40. Dorsal buccal graft urethroplasty in female urethral stricture disease: a multi-center experience
- Author
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Thomas G. Smith, Bryan B. Voelzke, Leandro Capiel, Lindsay A. Hampson, Alex J. Vanni, Jeremy B. Myers, Jason Chandrapal, and Ramón Virasoro
- Subjects
Dorsum ,medicine.medical_specialty ,reconstruction ,Urethral stricture ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,Disease ,03 medical and health sciences ,0302 clinical medicine ,Clinical Research ,medicine ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Evaluation of treatments and therapeutic interventions ,Buccal administration ,Cystoscopy ,medicine.disease ,Surgery ,Urethra ,medicine.anatomical_structure ,female ,Reproductive Medicine ,Etiology ,Original Article ,urethra ,business ,6.4 Surgery ,Stricture - Abstract
Background: Female urethral stricture disease is under-recognized and is often treated with dilation despite poor definitive outcomes. Our objective was to describe a multi-institutional experience treating female urethral stricture disease with female dorsal onlay buccal mucosa graft (FD-BMG) urethroplasty outcomes. Methods: We retrospectively identified 39 consecutive FD-BMG urethroplasty operations performed by 6 reconstructive surgeons from 12/2007 to 1/2016. Surgical technique included dorsally-placed buccal mucosal grafts in all cases. Stricture recurrence was defined by cystoscopy. Results: Mean age was 50 (range, 29–81) years. Stricture etiology was unknown (49%), iatrogenic (36%), or trauma/straddle injury (15%). A majority of women (87%) women had undergone a prior stricture-related urethral procedure(s) before the surgeons’ index urethroplasty. Mean stricture length was 2.1 cm and mean caliber was 11 Fr. Mean postoperative follow-up was 33 (range, 7–106) months. Postoperative complications within 30 days were seen in 7 individuals (18%) and were all Clavien-Dindo grade II. Stricture recurrence was seen in 9 (23%) patients, with mean time to recurrence 14 months. No patients experienced de novo incontinence. Conclusions: FD-BMG urethroplasty is a safe and effective management option for female urethral strictures. Referral to a reconstructive center is encouraged to avoid repeated unnecessary endoscopic procedures that have poor definitive success.
- Published
- 2019
41. Urinary and Sexual Function after Perineal Urethrostomy for Urethral Stricture Disease: An Analysis from the TURNS
- Author
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Alex J. Vanni, Nima Baradaran, Sean P. Elliott, Gregory P. Murphy, Jill C. Buckley, Thomas W. Gaither, Bradley A. Erickson, Jeremy B. Myers, Bryan B. Voelzke, Benjamin N. Breyer, Kirkpatrick B. Fergus, and Nejd F. Alsikafi
- Subjects
Male ,Adult ,medicine.medical_specialty ,Urologic Surgical Procedures, Male ,Databases, Factual ,Urethral stricture ,erectile dysfunction ,Urology ,media_common.quotation_subject ,Urinary system ,Urethroplasty ,medicine.medical_treatment ,Sexual Behavior ,Clinical Sciences ,030232 urology & nephrology ,Urination ,Perineum ,Severity of Illness Index ,Risk Assessment ,Cohort Studies ,03 medical and health sciences ,Databases ,0302 clinical medicine ,medicine ,Confidence Intervals ,Humans ,Urethrostomy ,Factual ,media_common ,Retrospective Studies ,Aged ,Urethral Stricture ,business.industry ,Recovery of Function ,Middle Aged ,Urology & Nephrology ,medicine.disease ,Surgery ,Erectile dysfunction ,Treatment Outcome ,quality of life ,Patient Satisfaction ,patient reported outcome measures ,Urologic Surgical Procedures ,Patient-reported outcome ,business ,Sexual function ,Follow-Up Studies - Abstract
PurposePerineal urethrostomy is a viable option for many complex urethral strictures. However, to our knowledge no comparison with anterior urethroplasty regarding patient reported outcome measures has been published. We compared these groups using a large multi-institution database.Materials and methodsWe performed a retrospective study of anterior urethroplasty in the TURNS (Trauma and Urologic Reconstructive Network of Surgeons) database. The anterior urethroplasty cohort was defined by long strictures greater than 6 cm. We compared demographic, clinical, urinary and sexual characteristics using validated patient reported outcome measures between patients treated with long stricture anterior urethroplasty and those who underwent perineal urethrostomy.ResultsOf the 131 patients 92 treated with long stricture anterior urethroplasty and 39 treated with perineal urethrostomy met study inclusion criteria. The cumulative incidence of failure at 2 years was 30.2% (95% CI 18.3-47.3) for long stricture anterior urethroplasty and 14.5% (95% CI 4.8-39.1) for perineal urethrostomy (p = 0.09). Compared to baseline metrics, patients who underwent long stricture anterior urethroplasty and perineal urethrostomy had similar improvements in urinary function and stable sexual function after surgery.ConclusionsPatients reported improvement in urinary function after perineal urethrostomy with no deleterious effect on sexual function. These patient reported outcome measures were comparable to those of long stricture anterior urethroplasty. Perineal urethrostomy failure rates were similar to those of long stricture anterior urethroplasty.
- Published
- 2019
42. Multicenter analysis of posterior urethroplasty complexity and outcomes following pelvic fracture urethral injury
- Author
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Rachel Moses, Niels V. Johnsen, Alex J. Vanni, Thomas G. Smith, Sean P. Elliott, Jill C. Buckley, Garrick M. Greear, Lee C. Zhao, Bryan B. Voelzke, Bradley A. Erickson, Jeremy B. Myers, Benjamin N. Breyer, Nejd F. Alsikafi, Nima Baradaran, and Michael A. Granieri
- Subjects
Urethral injury ,Nephrology ,Adult ,Male ,medicine.medical_specialty ,Urologic Surgical Procedures, Male ,Adolescent ,Urethral stricture ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,Anastomosis ,Surgical failure ,03 medical and health sciences ,Fractures, Bone ,Young Adult ,0302 clinical medicine ,Urethra ,Internal medicine ,medicine ,Humans ,Pelvic Bones ,Retrospective Studies ,business.industry ,Perineal approach ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Pelvic fracture ,business - Abstract
To analyze outcomes of posterior urethroplasty following pelvic fracture urethral injuries (PFUI) and to determine risk factors for surgical complexity and success. Patients who underwent posterior urethroplasty following PFUI were identified in the Trauma and Urologic Reconstructive Network of Surgeons (TURNS) database. Demographics, injury patterns, management strategies, and prior interventions were evaluated. Risk factors for surgical failure and the impact of ancillary urethral lengthening maneuvers (corporal splitting, pubectomy and supracrural rerouting) were evaluated. Of the 436 posterior urethroplasties identified, 122 were following PFUI. 83 (68%) patients were acutely managed with suprapubic tubes, while 39 (32%) underwent early endoscopic realignment. 16 (13%) patients underwent pelvic artery embolization in the acute setting. 116 cases (95%) were completed via a perineal approach, while 6 (5%) were performed via an abdominoperineal approach. The need for one or more ancillary maneuvers to gain urethral length occurred in 4 (36%) patients. Of these, 44 (36%) received corporal splitting, 16 (13%) partial or complete pubectomy, and 2 (2%) supracrural rerouting. Younger patients, those with longer distraction defects, and those with a history of angioembolization were more likely to require ancillary maneuvers. 111 patients (91%) did not require repeat intervention during follow-up. Angioembolization (p = 0.03) and longer distraction defects (p = 0.01) were associated with failure. Posterior urethroplasty provides excellent success rates for patients following PFUI. Pelvic angioembolization and increased defect length are associated with increased surgical complexity and risk of failure. Surgeons should be prepared to implement ancillary maneuvers when indicated to achieve a tension-free anastomosis.
- Published
- 2019
43. MP61-16 OUTCOMES OF URINARY DIVERSION CREATED FOR LATE ADVERSE EFFECTS OF GYNECOLOGIC RADIOTHERAPY
- Author
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Joseph J. Pariser, Jacob Albersheim-Carter, Diana O'Dell, John T. Stoffel, Daniel Smith, Jeremy B. Myers, Rachel Moses, and Sean Elliott
- Subjects
Radiation therapy ,medicine.medical_specialty ,business.industry ,musculoskeletal, neural, and ocular physiology ,Urology ,medicine.medical_treatment ,Incidence (epidemiology) ,Urinary system ,Urinary diversion ,medicine ,Adverse effect ,business ,Surgery - Abstract
INTRODUCTION AND OBJECTIVES:Severe urinary adverse effects of radiation are seen in 17% of women treated for gynecologic malignancies. This incidence continues to climb through at least 25 years po...
- Published
- 2019
44. PD22-02 A MULTICENTER ASSESSMENT OF STRICTURE LOCATION AND TYPE OF URETHROPLASTY ON ERECTILE FUNCTION
- Author
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Alex J. Vanni, Bradley A. Erickson, Jeremy B. Myers, Jill C. Buckley, Bryan B. Voelzke, Nejd F. Alsikafi, Sean Elliott, Benjamin N. Breyer, and Jonathan Wingate
- Subjects
medicine.medical_specialty ,business.industry ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,Erectile function ,medicine.disease ,Neurovascular bundle ,03 medical and health sciences ,0302 clinical medicine ,Erectile dysfunction ,Medicine ,business - Abstract
INTRODUCTION AND OBJECTIVES:Urethroplasty has been associated with erectile dysfunction (ED), likely due to the close proximity of the cavernous neurovascular bundle to the membranous and bulbar ur...
- Published
- 2019
45. MP55-17 URINARY AND SEXUAL FUNCTION AFTER PERINEAL URETHROSTOMY FOR URETHRAL STRICTURE DISEASE: AN ANALYSIS FROM TRAUMA AND UROLOGIC RECONSTRUCTIVE NETWORK OF SURGEONS (TURNS)
- Author
-
Jill C. Buckley, Nejd F. Alsikafi, Nima Baradaran, Sean Elliott, Bryan B. Voelzke, Jeremy B. Myers, Gregory Murphy, Bradley A. Erickson, Thomas W. Gaither, Benjamin N. Breyer, Alex J. Vanni, and Kirk Fergus
- Subjects
medicine.medical_specialty ,Urethral stricture ,business.industry ,Urology ,Urinary system ,Urethroplasty ,medicine.medical_treatment ,Disease ,medicine.disease ,Surgery ,medicine ,Sexual function ,business ,Urethrostomy - Abstract
INTRODUCTION AND OBJECTIVES:Perineal urethrostomy is a viable option for many complex urethral strictures; however, no comparison with anterior urethroplasty (AU) or complex AU regarding patient re...
- Published
- 2019
46. MP55-09 ENDOSCOPIC TREATMENTS PRIOR TO URETHROPLASTY: TRENDS IN MANAGEMENT OF URETHRAL STRICTURE DISEASE SINCE THE AUA GUIDELINE
- Author
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Nejd F. Alsikafi, Sean Elliott, Jill C. Buckley, Lee C. Zhao, Jeremy B. Myers, Alex J. Vanni, Benjamin N. Breyer, Bradley A. Erickson, Thomas W. Smith, Bryan B. Voelzke, and Matthew J. Moynihan
- Subjects
medicine.medical_specialty ,Urethral stricture ,business.industry ,Urology ,Urethroplasty ,medicine.medical_treatment ,General surgery ,Disease ,Guideline ,medicine.disease ,parasitic diseases ,medicine ,population characteristics ,business ,Endoscopic treatment ,health care economics and organizations - Abstract
INTRODUCTION AND OBJECTIVES:Endoscopic treatment of urethral stricture disease (USD) continues to be the most common treatment of USD despite its poor success compared to urethroplasty. AUA guideli...
- Published
- 2019
47. Clinical significance of cystoscopic urethral stricture recurrence after anterior urethroplasty: a multi-institution analysis from Trauma and Urologic Reconstructive Network of Surgeons (TURNS)
- Author
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Rachel Moses, Alex J. Vanni, Sean P. Elliott, Jill C. Buckley, Thomas G. Smith, Jeremy B. Myers, Bradley A. Erickson, Nejd F. Alsikafi, Lee C. Zhao, Nima Baradaran, Thomas W. Gaither, Benjamin N. Breyer, Bryan B. Voelzke, Darshan P. Patel, and Kirkpatrick B. Fergus
- Subjects
Adult ,Male ,medicine.medical_specialty ,Urologic Surgical Procedures, Male ,Urethral stricture ,Urology ,Urethroplasty ,medicine.medical_treatment ,Clinical Sciences ,030232 urology & nephrology ,03 medical and health sciences ,0302 clinical medicine ,Urethra ,Lower urinary tract symptoms ,Recurrence ,medicine ,Humans ,Clinical significance ,Treatment outcome ,Urethrostomy ,Retrospective Studies ,Urethral Stricture ,medicine.diagnostic_test ,business.industry ,Cystoscopy ,Urology & Nephrology ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Hypospadias ,030220 oncology & carcinogenesis ,business ,Self report - Abstract
PURPOSE:To assess the functional Queryoutcome of patients with cystoscopic recurrence of stricture post-urethroplasty and to evaluate the role of cystoscopy as initial screening tool to predict future failure. METHODS:Cases with cystoscopy data after anterior urethroplasty in a multi-institutional database were retrospectively studied. Based on cystoscopic evaluation, performed within 3-months post-urethroplasty, patients were categorized as small-caliber (SC) stricture recurrence: stricture unable to be passed by standard cystoscope, large-caliber (LC) stricture accommodating a cystoscope, and no recurrence. We assessed the cumulative probability of intervention and the quality of life scores in association with cystoscopic recurrence 1-year post-urethroplasty. Patients with history of hypospadias, perineal urethrostomy, urethral fistula, and meatal pathology were excluded. RESULTS:From a total of 2630 men in our cohort, 1054 patients met the inclusion criteria: normal (n = 740), LC recurrence (n = 178), and SC recurrence (n = 136) based on the first cystoscopic evaluation performed at median 111 days postoperatively. Median follow-up was 350 days (IQR 121-617) after urethroplasty. Cystoscopic recurrence was significantly associated with secondary interventions (2.7%, 6.2%, 33.8% in normal, LC, and SC groups, respectively). Quality of life variables were not statistically significantly different among the three study groups. CONCLUSIONS:Many patients with cystoscopic recurrence do not need an intervention after initial urethroplasty. Despite good negative predictive value, cystoscopy alone may be a poor screening test for stricture recurrence defined by patient symptoms and need for secondary interventions.
- Published
- 2018
48. Measuring and Predicting Patient Dissatisfaction after Anterior Urethroplasty Using Patient Reported Outcomes Measures
- Author
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Sean P. Elliott, Christopher McClung, Christopher A. Tam, Jeremy B. Myers, Laura A. Bertrand, Gareth Warren, Bradley A. Erickson, Bryan B. Voelzke, Benjamin N. Breyer, and Alex J. Vanni
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Urethral stricture ,business.industry ,Urology ,Urethroplasty ,medicine.medical_treatment ,030232 urology & nephrology ,Cystoscopy ,medicine.disease ,Article ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Erectile dysfunction ,Patient satisfaction ,Urethra ,medicine.anatomical_structure ,Lower urinary tract symptoms ,030220 oncology & carcinogenesis ,medicine ,International Prostate Symptom Score ,business - Abstract
Purpose: Subjective measures of success after urethroplasty have become increasingly valuable in postoperative monitoring. We examined patient reported satisfaction following anterior urethroplasty using objective measures as a proxy for success.Materials and Methods: Men 18 years old or older with urethral strictures undergoing urethroplasty were prospectively enrolled in a longitudinal, multi-institutional urethroplasty outcomes database. Preoperative and postoperative assessment included questionnaires to assess lower urinary tract symptoms, pain, satisfaction and sexual health. Analyses controlling for stricture recurrence (defined as the inability to traverse the reconstructed urethra with a flexible cystoscope) were performed to determine independent predictors of dissatisfaction.Results: At a mean followup of 14 months we found a high 89.4% rate of overall postoperative satisfaction in 433 patients and a high 82.8% rate in those who would have chosen the operation again. Men with cystoscopic recurr...
- Published
- 2016
49. Perioperative and long-term surgical complications for the Indiana pouch and similar continent catheterizable urinary diversions
- Author
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Sara M. Lenherr and Jeremy B. Myers
- Subjects
medicine.medical_specialty ,Urology ,Urinary system ,medicine.medical_treatment ,030232 urology & nephrology ,Ureteral stenosis ,Constriction, Pathologic ,Urinary Diversion ,Urinary catheterization ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,business.industry ,Urinary Reservoirs, Continent ,Urinary diversion ,Perioperative ,medicine.disease ,Surgery ,Stenosis ,030220 oncology & carcinogenesis ,Indiana pouch ,Urinary Calculi ,Pouch ,Urinary Catheterization ,business ,Ureteral Obstruction - Abstract
Purpose of review This article summarizes recent evidence describing perioperative and long-term surgical complications of the Indiana pouch and similar continent catheterizable urinary diversions. Recent findings The perioperative morbidity and long-term complications are better defined in recent literature describing the Indiana and similar pouches. Both perioperative and long-term surgical complications for the Indiana and similar pouches are extremely variable between studies, but ranges between 1-32% and 6-69%, respectively. Significant perioperative surgical risks include bowel leak, deep wound and organ space infection, ureteral leak and/or stenosis, and death. Common long-term surgical risks include: ureteral stenosis, problems with the catheterizable (efferent) channel, and the treatment of pouch or other urinary calculi. Summary Perioperative and long-term surgical complications have only recently been reported in a consistent manner for continent catheterizable urinary diversions. Understanding perioperative and long-term surgical complications allows for comparison of studies and more importantly allows surgeons to provide accurate information about complications and risk to patients.
- Published
- 2016
50. Critical Analysis of the Use of Uroflowmetry for Urethral Stricture Disease Surveillance
- Author
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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
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