Search

We sought to perform a contemporary literature review highlighting the racial disparities which exists in the evaluation and management of benign prostatic hyperplasia (BPH).Current literature suggests that racial disparities exist in the diagnosis of BPH and treatment lower urinary tract symptoms (LUTS). This is seen in the presentation and diagnosis of the disease as well as a difference in preventative care with discordant incidences of medical and surgical management among racial groups. The racial disparities that exist in the diagnosis and management of BPH and LUTS require further investigation to better identify the underlying causes. This will ultimately allow for continued improvement in care delivery and a more personalized approach in patient management.

To determine whether patients with American Association for the Surgery of Trauma (AAST) grade III blunt renal injuries discharged within 48 hours of admission have increased rates of readmission for renal-related complications compared to patients observed for over 48 hours.Renal trauma patients from 2005 through 2020 were identified from our institutional trauma registry. Patients with AAST III blunt renal injuries who survived beyond 48 hours of admission were included. Univariable analysis was used to identify variables associated with discharge within 48 hours. Reasons for readmission were compared between patients discharged before and after 48 hours of admission.Of the 1751 renal trauma patients, 377 (21.5%) met inclusion criteria. Sixty-five of 377 (17.2%) AAST III injuries were discharged within 48 hours of admission. Forty (10.6%) patients required readmission, 3 in the early discharge group and 37 in the standard discharge group. No patient required readmission for renal-related complications.Patients with AAST grade III blunt renal injuries are not at increased risk for early renal-related complications if discharged within 48 hours of admission and should be considered for early discharge. The very low rate of renal-related complications for AAST III blunt renal injuries supports their categorization as "low-grade" renal trauma.

Introduction Treatment of urethral stricture disease with multiple repeated endoscopic procedures has been shown to be both ineffective and costly. While a number of patient and provider factors are known to be associated with likelihood of undergoing multiple endoscopic, little is known about non-clinical factors that can impact care. Objective As social inequalities such as living in a disadvantaged neighborhood are known to be associated with poorer overall health, worse health outcomes, and decreased quality of care, the aim of this study was to assess whether neighborhood deprivation is associated with delays to definitive care for urethral stricture disease. Methods This study identified patients treated by a single surgeon with urethroplasty between 9/4/2019 and 12/29/2021. Patients with a previous history of urethroplasty, under the age of 18, and those with insufficient follow-up data were excluded from the study. Area deprivation index (ADI) is a composite comprised of 17 factors describing income, education, employment and housing quality based on subject 9-digit ZIP code and obtained from the University of Wisconsin School of Medicine and Public Health Neighborhood Atlas. Scores are normalized to a percentile from 0 to 100, with higher numbers representing higher levels of disadvantage. Patient addresses were geocoded and assigned a national ADI rank based on residential census block group. For the present study, ADI rank was sub-grouped into least disadvantaged (lower 50%) and most disadvantaged (upper 50%). Multivariate logistic regression was performed to assess impact of ADI score on likelihood of receiving multiple endoscopic procedures prior to urethroplasty. Final model was assessed for multicollinearity and goodness of fit via Hosmer-Lemeshow goodness-of-fit test. Results 104 patients were included in the final analysis. 44% of patients had undergone multiple prior endoscopic procedures. Patients who had undergone ≥2 endoscopic procedures tended to be older, have higher ADI scores, and were more likely to be white. Median time to urethroplasty was significantly higher in those who had undergone multiple prior endoscopic procedures (88 mos vs 12 mos, p Conclusions Neighborhood disadvantage as assessed by the ADI provides an alternative methodology to identify disparities in health services utilization in patients with urethral stricture disease. These findings highlight needs to increase provision of urologic resources and care to disadvantaged communities. Disclosure No

To evaluate the effect of urine pH on tumor recurrence rates in patients undergoing surveillance after initial diagnosis of non-muscle invasive bladder cancer (NMIBC).All patients diagnosed with NMIBC at a tertiary referral center from January 2004 to March 2015 were reviewed. Our primary outcome was time to first recurrence after transurethral resection of bladder tumor (TURBT). Patients were analyzed according to the average urine pH of all urinalysis data over the surveillance period from TURBT to first recurrence. Kaplan-Meier survival analysis was used to determine differences in median time to recurrence. Cox proportional hazards regression was used to assess independent predictors of cancer recurrence.A total of 252 patients were included, of which 155 patients had average pH ≤ 6 (median pH 5.5) and 97 patients had average pH6 (median pH 6.8), p0.001. There was no significant difference in median time to recurrence between low/acidic pH (≤ 6) and high/basic pH (6) groups (28 months versus 17 months, respectively, p = 0.3444). Similarly, urine pH did not affect the risk of recurrence in a subgroup analysis stratified by smoking status. On multivariable Cox regression analysis, there was no association between average pH and recurrence among high grade tumors (HR = 1.33, 95% CI = 0.76 to 2.34, p = 0.3186), or low grade tumors (HR = 1.013, 95% CI = 1.01 to 1.58, p = 0.96).There was no association between urine pH and risk of tumor recurrence, regardless of smoking status. These findings suggest that modification of urine pH is unlikely to decrease the frequency of tumor recurrence in patients with NMIBC.

Purpose To determine a subset of women who could undergo ovary-sparing radical cystectomy (OSRC) for bladder cancer without compromising oncologic safety. Patients and Methods A retrospective review was performed of 164 consecutive women who underwent cystectomy at a single tertiary-care center from 1997 to 2018. Clinicopathologic and preoperative radiographic data were reviewed. Univariable and multivariable logistic regression models adjusting for pathologic stage, lymphovascular invasion (LVI), and carcinomain-situ were performed to evaluate the risk of ovarian and reproductive organ (RO) involvement. Results A total of 123 women with a median age of 71 years underwent radical cystectomy (RC) with removal of ROs for primary bladder cancer. Nineteen women (15%) had RO involvement by bladder cancer, and 5 of them (4%) were specifically found to have ovarian involvement. Patients with ovarian involvement of bladder cancer had more locally advanced disease (P = .01), LVI (P = .003) and positive margins (P = .003). On multivariable logistic regression, ≥ pT3 (odds ratio = 10.2; 95% confidence interval, 2.0-51.6; P = .005) and LVI (odds ratio = 3.9; 95% confidence interval, 1.1-14.2; P = .037) were associated with increased risk of RO involvement. Among 15 patients excluded for having a nonbladder primary malignancy, a third had RO involvement, and 2 (13%) had ovarian metastases. No women in our cohort had a primary ovarian malignancy detected at the time of RC. Conclusion Women with ovarian involvement by malignancy at the time of RC either had locally advanced disease with LVI or a non-bladder primary malignancy. The risk of incompletely resecting the primary malignancy would be rare if OSRC was performed on women with organ-confined (≤T2) urothelial carcinoma.

While surgical approach has recently been associated with positive surgical margin (PSM) after partial nephrectomy (PN) for small (4 cm) renal masses, its impact on margin status for large (4 cm) masses is unclear. We sought to evaluate the relationship between margin and surgical approach in patients undergoing PN for large renal masses.Using the National Cancer Database (NCDB), we identified patients undergoing PN for pathological TOf the 7495 patients undergoing PN for pTIn a contemporary nation-wide cohort, surgical approach was not associated with an increased risk of PSM for large, noninvasive renal masses. Furthermore, increased size from T

Objective To elucidate potential biomarkers or mechanistic principles involved with the gut microbiota and its impact on prostate cancer pathogenesis. Materials and Methods We performed a prospective case-control pilot study evaluating the gut microbiome of 20 men with either benign prostatic conditions (n = 8) or intermediate or high risk clinically localized prostate cancer (Gleason ≥4 + 3 cN0M0) (n = 12) undergoing care at tertiary referral center from September 1, 2015 to March 1, 2016. Key exclusion criteria included recent antibiotic use, significant gastrointestinal disorders, hormonal or systemic therapy for prostate cancer. Computational genomics analysis was performed on collected stool samples using MetaPhlAn2 and HUMAnN2 platforms. Linear discriminant analysis effect size method was used to support high-dimensional class comparisons to find biologically relevant features. Kruskal-Wallis sum-rank test was used to detect features with significant differential abundance with respect to class, with biological consistency investigated using a set of pairwise tests among subclasses using the Wilcoxon rank-sum test, both to an α ≤0.05. Results Higher relative abundance of Bacteriodes massiliensis was seen in prostate cancer cases compared to controls. Faecalibacterium prausnitzii and Eubacterium rectalie had higher relative abundance among controls. Biologically significant differences were also found in relative gene, pathway, and enzyme abundance. Conclusion Biologically significant differences exist in the gut microbial composition of men with prostate cancer compared to benign controls. These differences may play a role in the pathobiology of prostate cancer, and warrant further exploration.

INTRODUCTION AND OBJECTIVES: Epididymal obstruction is a common cause of obstructive azoospermia. Amongst acquired forms, those secondary to epididymal infection and prolonged vasal obstruction are the most common. Treatment is either microsurgical reconstruction and/or sperm retrieval for in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI). Microsurgical reconstruction vasoepididymostomy (VE) has been shown to be more cost-effective than sperm retrieval with IVF /ICSI. Since the earliest report of VE in 1903, the technique has undergone continuous improvement, culminating more recently in the development of the longitudinal intussusception microsurgical vasoepididymostomy (LIVE) technique. We compare the patency rates in men that underwent VE using different microsurgical techniques. METHODS: We reviewed a database of 754 microsurgical reconstructive procedures of the male reproductive tract done by a single surgeon (MG). We identified 87 cases with a history of bilateral VE and with post-operative semen analysis data available. Patency was defined as the presence of motile sperm in the ejaculate at six months post-operatively. Men who did not meet this criteria, but had unassisted clinical pregnancies were also considered patent. Men with a sperm concentration