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Objective: To establish and evaluate a multimodal, opioid-minimizing pathway for gender-affirming vaginoplasty (GAVa) and vulvoplasty (GAVu) in treating postoperative pain., Methods: A standardized pain pathway including opioids, non-opioid analgesics, and patient counseling was implemented at a single academic institution with a center for transgender care. Postoperative pain levels, analgesia methods, and opioid use for 84 GAVa and 64 GAVu patients were prospectively gathered during inpatient postoperative days 2-4 and outpatient follow-up at 2 weeks. Pertinent patient, operative, and medication administration data were extracted from patient charts and outpatient pain was measured with the Brief Pain Inventory short form (BPI-sf)., Results: On average, GAVa patients used 89.3 MME and GAVu patients used 41.8 MME during inpatient stay. MME decreased daily for both groups. There was no difference in MME between open and robotic GAVa. Forty-nine percent of GAVa patients and 54% of GAVu patients used ketorolac with decreasing daily inpatient use. Postoperative pain levels were similar between GAVa and GAVu patients. Fifty percent of respondents denied postoperative pain in the 24 hours preceding the survey. Forty-four percent of GAVa and of GAVu patients did not use any opioid medications in the outpatient setting, while 81% of GAVa and 83% of GAVu patients used fewer than 20 of 30 prescribed opioid tablets. Ibuprofen and acetaminophen were rated the most effective outpatient analgesics among GAVa and GAVu patients, respectively., Conclusion: The multimodal pathway demonstrated effective postoperative pain control for GAVa and GAVu patients while minimizing opioid use and has changed institutional prescribing practice., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To describe the characteristics of patients presenting for gender-affirming bilateral simple orchiectomy including interest in and prior education on reproductive options prior to gonad removal., Methods: A retrospective chart review evaluated patients seeking gender-affirming bilateral orchiectomy. Data collected included age, family history, history of fertility preservation education prior to gender-affirming hormone therapy initiation, prior fertility preservation, interest in fertility preservation, and postorchiectomy surgical pathology results where applicable., Results: The cohort included 78 patients. 22% (n = 17) indicated reproductive options were not discussed prior to surgical consultation. 85% (n = 66) were not interested in fertility preservation. Reasons included not having an interest in biological children (74%), not wanting to delay transition (47%), and cost (36%). Patients who were married or in long-term relationships had a higher interest in fertility preservation compared to patients who were not in long-term relationships. 40% of patients with pathology data available had at least some level of spermatogenesis present in their testicular tissue., Conclusion: Fertility preservation counseling prior to surgical referral was lower than expected. This lack of counseling could result in patients not wanting to sperm bank prior to orchiectomy as it could delay their surgical care. Increased adherence to the WPATH guidelines may improve fertility preservation interest. Our data shows a low utilization and interest in sperm preservation for transwomen and nonbinary patients seeking bilateral simple orchiectomy at our institution. Improving counseling regarding fertility preservation options earlier in transition could improve utilization of sperm cryopreservation., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2023. Published by Elsevier Inc.)

Introduction: To evaluate the effectiveness of a standardized multimodal pain pathway for gender affirming orchiectomy (GAO) in adequately addressing postoperative pain while reducing the prescribing of unnecessary opioids., Materials and Methods: A standardized discharge pain pathway for GAO +/- scrotectomy or testicular implants was implemented between May 2020 and March 2022. A retrospective analysis was performed on all consecutive patients who underwent GAO with a single surgeon. Patients answered five questions on postoperative pain management at their 3 week follow up., Results: A total of 69 patients were included in the study. Mean age was 34.3 years (SD ± 10.5; IQR 26-39) with a mean body mass index (BMI) of 27.1 (SD ± 7.5; IQR 22.3-31). No patients were taking narcotics preoperatively. Mean 4.7 tablets (SD ± 4.5; range 0-30) oxycodone tablets taken by GAO patients without concurrent procedures, with 33 patients (47.8%) taking fewer than 4 tablets. Thirteen patients (18.8%) required no narcotics. Four patients (5.8%) requested an additional narcotic prescription, none of whom underwent a concurrent procedure. There was no significant association between BMI and the number of oxycodone tablets taken. All patients used at least one recommended alternative therapy (acetaminophen, ibuprofen and ice packs) with 41 patients (59.4%) using all three., Conclusion: Most patients achieved adequate postoperative pain control as requests for additional narcotic prescriptions were low. Almost half of patients used < 4 tablets, and all patients employed at least one alternative non-narcotic analgesic. Based on these findings, we plan to decrease the quantity of opioids on discharge.

Introduction: We characterized physician burnout among urologists to determine the prevalence and efficacy of specific burnout interventions utilized and to determine involvement of workplaces in effective burnout interventions., Methods: The Western Section of the American Urological Association created an electronic, 29 question workforce survey. Several questions focused on assessing the level of urologist burnout, prevalence of work sponsored burnout interventions and efficacy of specific interventions., Results: A total of 440 responses were received (25.9% response rate); 82.2% of responders were male. The majority of urologists noted some level of burnout (79.5%) with no significant difference between those who reported no burnout vs some level of burnout (p=0.30). The most commonly tried interventions to reduce burnout were participating in regular physical exercise (76.6%), reading nonmedical literature (67.1%) and decreasing or modifying work hours (52.3%). The interventions most frequently cited as "very effective" were hiring a scribe (62.5%), regular exercise (56.1%) and participating in 1-on-1 gatherings with colleagues outside of work (44.6%). There were no significant differences noted when comparing "very effective" interventions by gender. The interventions most frequently cited as not effective were stress or burnout seminars (26.9%) and meditation/mindfulness training (11.5%); 42.5% reported workplace interventions to help prevent or reduce burnout., Conclusions: Certain practice-changing and personal burnout interventions were noted to be "very effective" in decreasing burnout. Fewer than half of responders noted workplace sponsorship of interventions. Organizational support may lead to increased participation and effectiveness of burnout interventions.

Objective: To examine voluntary reports in the Food & Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database, categorize complications and assign device-related causality with transurethral resection of the prostate (TURP), prostatic urethral lift (PUL), and transurethral water vapor therapy (TWVT)., Methods: A review was performed using the terms "Urolift," "Rezum," and "transurethral resection of the prostate" between 01/01/2015 and 12/31/2019. Duplicate and incomplete reports were excluded. The Gupta system was used to report complications and device related causality. 1 Pearson's Chi-square analysis was performed to compare minor (Level 1) versus major (Levels 2-4) complications., Results: A total of 548 events were examined. After removal of duplicates (n = 60), irrelevant reports (n=65), and incomplete information (n = 14), we included 409 events (74.6%). Of the 409 events, 214 were for TURP, 112 for TWVT, and 83 for PUL. In aggregate, 39.4% of events were minor/Level 1 (n=161/409). The proportion of subjects with Level 2-4 complications versus Level 1 complications was significantly higher for PUL than TURP or TWVT [X 2 (2, N = 408) = 41.4023, P < .00001]. Device causality was attributable to device malfunction in 60.4% of cases (n=247/409)., Conclusion: Device malfunction was noted in all groups and 39.4% of these were minor (Level 1). However, the majority of PUL reports noted a Level 3 or 4 complication (50.6%, 42/83), primarily bleeding related. Previous studies have not revealed significant risk of bleeding and suggests a discrepancy between study data and real-world experience that may alter patient counseling practices., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Aim: Gunshot wounds (GSW) to the penis represent a rare type of traumatic injury in the civilian United States population. Although small, single-center studies have reported results of care for these types of injured patients, no national analyses have examined this group., Methods: A cohort of patients with GSW to the penis was identified using the 2017 American College of Surgeons Trauma Quality Programs database, a comprehensive national database of 753 accredited trauma centers., Results: Gunshot wounds to the penis occurred in 722 patients, which represents 1.7% of all GSW patients ( n  = 41,017). Gunshot wounds from altercations with law enforcement or accidental discharge of a firearm were rare; the vast majority ( n  = 655, 90.7%) occurred as a result of assault, intentional self-harm, attempted suicide, or attempted homicide. Patients with a major concomitant non-genitourinary injury comprised 119 (16.5%) patients of the cohort. Most patients ( n  = 499, 69.1%) underwent a genitourinary procedure during their trauma admission. Penile salvage was successful in most cases, with only 13 (1.8%) patients requiring completion penectomy. Most patients (87.8%) required admission with a median length of stay of 49.8 h. Most patients were treated at the initial trauma center without requiring transfer to another center, and complications during admission were rare., Conclusions: This analysis, the first national examination of care of patients with GSW to the penis, reveals overall favorable outcomes. Admission and surgical intervention were required in most patients, but penectomy was rare and length of stay was generally short. These results will guide resource utilization and quality improvement efforts in this patient cohort., Competing Interests: Approval of the research protocol: The protocol for this research project was deemed exempt from full Legacy Health System Institutional Review Board review because it uses publicly available, deidentified data. It conforms to the provisions of the Declaration of Helsinki. Informed consent: N/A. Registry and the registration no. of the study/trial: N/A. Animal studies: N/A. Conflict of interest: None., (© 2021 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)

Objectives: We hypothesize that men with diabetes mellitus whose inflatable penile prosthesis (IPP) implantation is delayed for unacceptably high hemoglobin A1c (HbA1c) will have durable improvements in their glycemic control after achieving acceptable HbA1c levels for surgery., Methods: Per institutional protocol, an A1c <9% must be documented prior to IPP placement. After IRB approval, a single surgeon IPP database was retrospectively queried for data specific to diabetes mellitus management. Men without HbA1c values at ≥1-year follow-up were excluded. Univariate and multivariate statistical analyses were performed to assess associations with sustained HbA1c control., Results: From January 2011 to March 2019, 138 diabetics undergoing IPP were identified. Thirty-seven were excluding for insufficient follow-up. Nineteen of the 101 analyzed men (18.8%) were delayed a median 4 months (range 2-17) for elevated HbA1c values (median 10.1, range 9.1-12.3). Following improvements, median preoperative HbA1c remained higher (8.2% vs 7.0%) in delayed men (P < .001). Among delayed recipients, 11 (58%) improved without medication changes while insulin was newly initiated (5) or dosage was increased (5) in 42%. At 32 months follow-up, a HbA1c <9% was similarly maintained in delayed and nondelayed men (74% vs 87%, P = .17). Delayed men more commonly required insulin therapy at follow-up (89.5% vs 54.9%, P = .008), but had a similar median change in BMI (+0.1 vs +0.1, P = .65). Device infection occurred in 1 nondelayed patient (0.7%)., Conclusion: Men who improve HbA1c for IPP surgery are likely to demonstrate persistent improvement. IPP implantation appears to be safe in diabetic men with HbA1c <9%., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To evaluate the findings of magnetic resonance imaging (MRI) of the ipsilateral hip(s) as part of the workup of men with chronic orchialgia (CO)., Methods: Following IRB approval, a retrospective chart review was performed from a single surgeon database of all men with a diagnosis of CO from June 2018 to October 2019 who underwent subsequent hip MRI evaluation., Results: Ten men were identified. Median age was 51 years and median duration of pain was 10 months. MRI was obtained after testis pathology was ruled out. Pain was noted in the groin (100%) and hip (50%). Hip MRI identified overt labral tears in 8 men (10/12 hips evaluated, 83%) and labral fraying in the remaining 2 (16.7%). Standard plain film radiography was performed in 6 men prior to MRI, all of which were negative. Following MRI, 5 men underwent hip injection with steroid and local analgesic with lasting resolution (2 men) or significant improvement in pain (2 men; 80%, follow-up 3-15 months). Two men had complete resolution of pain with 8 weeks of physical therapy., Conclusion: Hip MRI has a high rate of diagnosis of labral tear in appropriately selected men referred to the urologist for CO. Identification of orthopedic pathology may avoid unnecessary antibiotics, opiates, or urological surgery. Referrals to orthopedics and/or physical therapy for intervention may lead to resolution of pain., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: Burnout among urologists is significant with studies estimating approximately 40% meet the criteria for burnout. This study sought to survey practicing urologists to identify factors associated with burnout and its implications., Methods: A 16-question survey was created on SurveyMonkey.com and distributed to urologists by email via their American Urological Association section. Descriptive statistics and chi-square testing were used for analysis, and logistic regression was used for multivariate analysis to assess factors associated with burnout., Results: There were 466 respondents of whom 460 were actively practicing. In all, 78% of respondents reported burnout with 45% reporting it as either moderate or severe. Respondents were 90% male and 41% fellowship trained. Females tended to report worse burnout with 4 times greater likelihood to report severe burnout on multivariate analysis (p=0.01). There was also a difference in reasons cited for burnout among genders. Females most often cited lack of personal time (51%) while males most often complained about insurance and regulations (62%). Initial analysis did not show a difference based on fellowship. Multivariate analysis revealed a possible protective role of fellowship training with nonfellowship trained urologists twice as likely to report moderate burnout (p=0.017)., Conclusions: A large number of urologists are experiencing burnout. This affects patient interaction and planned time to retirement. Most urologists do not have interventions in place to assess or prevent/change their levels of burnout. Further investigation and intervention aimed at physician wellness need to occur to prevent the worsening of this trend.

Purpose: To provide an overview of the state of tissue engineering relative to male erectile tissue and the implications for treatment of penile pathology., Methods: A PubMed review of the relevant peer-reviewed literature pertaining to engineering of penile tissues was performed., Results: There are multiple pathologies that threaten form and/or function of the penis. Management of disease rarely offers a path to true restoration. Historical efforts to correct structural defects have largely relied on synthetic materials, commercially prepared allograft or xenograft constructs, or autologous tissue substitutes. These approaches have traditionally suffered from less-than-optimal clinical outcomes and degrees of patient morbidity that may be preventable. Prior work in tissue engineering of corpora cavernosa has demonstrated the ability to produce functional tissue in small and large animal models. A human clinical trial is currently underway., Conclusions: Varied conditions pathologically affecting the penis warrant development of more sophisticated tissue-based solutions. Animal models have demonstrated efficacy in restoring functional corpora cavernosa, and upcoming clinical trials will serve to determine safety and efficacy in humans.

Background: The penile prosthesis has been used for men with erectile dysfunction for nearly 5 decades. Although many articles examine various outcome measures, wide variability exists in the quality of these studies., Aim: We sought to critically evaluate the most referenced literature related to penile prosthesis outcomes over the last 10 years., Methods: A PubMed search of the indexed English literature was performed using the search terms "prospective," "penile prosthesis," and "outcomes", and all relevant publications from 2009 to 2019 were reviewed. In addition, we performed a Google Scholar search for the same interval using the search term "penile prosthesis outcomes" to evaluate manuscripts which have been most commonly cited. The most heavily cited manuscripts were sorted for relevancy using Google's internal algorithm, and then, the articles were reviewed by the authorship team for appropriateness of the subject matter. Articles with less than 10 citations were excluded. We used the Oxford Center for Evidence-Based Medicine Criteria as part of our evaluation of the published data involving independent research, as opposed to review articles summarizing previously published findings., Results: We evaluated the most-cited literature of the past decade relevant to penile prosthesis outcomes and reported the major findings in regards to infection, erosion, extrusion, device reliability, and satisfaction (both the patient and partner). The majority of these studies are retrospective in nature., Clinical Implications: From our review of the most commonly cited studies, there was no high-level evidence published in this area within the last 10 years. There are multiple barriers to producing these types of studies in the evaluation of penile prosthesis outcomes., Strengths & Limitations: Using the most commonly cited articles allows us to understand the data that are being cited in other new publications. Focusing on the most cited articles on penile prosthesis outcomes in the last 10 years is a limitation as there have been many more studies published in this area., Conclusion: While many studies have examined penile prosthesis outcomes, most of the heavily cited literature consists of low-level evidence. Higher quality research is necessary to better assess penile prosthesis outcomes. Chouhan JD, Pearlman AM, Kovell RC, et al. A Quality Analysis of the Last Decade's Most Heavily Cited Data Relative to Outcomes After Penile Prosthesis Placement. J Sex Med 2020;17:861-869., (Copyright © 2020 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this article is to describe the indications and proper technique for RUG and MRI, their respective image findings in various disease states, and the common surgical techniques and imaging strategies employed for stricture correction., Results: Because of its length and passage through numerous anatomic structures, the adult male urethra can undergo a wide array of acquired maladies, including traumatic injury, infection, and neoplasm. For the urologist, imaging plays a crucial role in the diagnosis of these conditions, as well as complications such as stricture and fistula formation. While retrograde urethrography (RUG) and voiding cystourethrography (VCUG) have traditionally been the cornerstone of urethral imaging, MRI has become a useful adjunct particularly for the staging of suspected urethral neoplasm, visualization of complex posterior urethral fistulas, and problem solving for indeterminate findings at RUG., Conclusions: Familiarity with common urethral pathology, as well as its appearance on conventional urethrography and MRI, is crucial for the radiologist in order to guide the treating urologist in patient management.

Introduction: The artificial urinary sphincter (AUS) has long been regarded as the gold standard for surgical correction of male stress urinary incontinence (SUI). Despite impressive rates of initial success for restoration of continence, durability may wane to the point of considering revision surgery., Aim: To provide a review of existing data as well as personal experience regarding patient selection, surgical technique, and postoperative troubleshooting for the AUS., Methods: A systematic review of the peer-reviewed literature was performed to identify relevant and contemporary articles regarding perioperative and long-term management of the AUS. Additional input is presented based on clinical experience of the senior author., Main Outcome Measure: The main outcome measures are durability, patient satisfaction, mechanical failure, and urethral erosion., Results: In addition to a thorough history and examination, preoperative screening should include office cystoscopy to rule out bladder neck contracture in patients with a history of radical prostatectomy. Perineal cuff placement appears superior to alternative approaches. Prior radiation and use of the 3.5-cm cuff are risk factors for future erosion. Newer findings suggest that subsequent recurrence of SUI may be due to restrictive encapsulation, rather than true atrophy, with implications for revision surgery., Conclusion: The AUS remains an excellent option for surgical correction of moderate to severe male SUI. Detailed preoperative evaluation and patient selection are critical. The challenge of downstream recurrent SUI after AUS can be effectively managed for most patients with a structured approach. Chouhan JD, Terlecki RP. A User's Guide for Surgery Involving the Artificial Urinary Sphincter. Sex Med Rev 2019;7:167-177., (Copyright © 2018 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: We compared characteristics of patients undergoing prostate biopsy in a high-risk inner city population before and after the 2012 USPSTF recommendation against PSA based prostate cancer screening to determine its effect on prostate biopsy practices., Materials and Methods: This was a retrospective study including patients who received biopsies after an abnormal PSA measurement from October 2008-December 2015. Patients with previously diagnosed prostate cancer were excluded. Chi-square tests of independence, two sample t-tests, Mann-Whitney U tests, and Fisher's exact tests were performed., Results: There were 202 and 208 patients in the pre-USPSTF and post-USPSTF recommendation cohorts, respectively. The post-USPSTF cohort had higher median PSA (7.8 versus 7.1ng/mL, p=0.05), greater proportion of patients who were black (96.6% versus 90.5%, p=0.01), and greater percentage of biopsy cores positive for disease (58% versus 29.5%, p<0.001). Multivariable analysis supported that the increase in PSA was independent of the increase in the proportion of patients who were black. The proportion of patients who were classified as D'Amico intermediate and high-risk disease increased in the post-USPSTF cohort and approached statistical significance (70.1% versus 58.8%, p=0.12)., Conclusions: Our study suggests that the USPSTF recommendations may have led to na increase in pre-biopsy PSA as well as greater volume of disease. Also, a greater proportion of patients were being classified with intermediate or high risk disease. While the clinical significance of these findings is unknown, what the data suggests is somewhat troubling. Future research should further examine these changes in a larger cohort as well as resultant long-term outcomes., Competing Interests: Conflict of interest: None declared., (Copyright® by the International Brazilian Journal of Urology.)

We present 2 patients found to have ovotesticular disorder of sexual development (otDSD) in late adolescence. Two 15-year-old phenotypically male patients presented to a large pediatric hospital with different complaints: 1 with concern for testicular rupture after a straddle injury; 1 with gynecomastia. Further workup, including imaging and laboratory tests, was performed before surgical exploration. The first patient had unilateral ovotestis, contralateral testis, and SRY-negative 46,XX karyotype. The second patient with gynecomastia had unilateral ovotestis with hemi-uterus and fallopian tube, contralateral ovarian tissue, and 46,XX/47,XXY Klinefelter mosaic karyotype. Although rare, phenotypically normal male patients may present later with ovotesticular disorder of sexual development., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Introduction: Urological practices vie for a small number of graduating urology residents every year. In this study we determine the most desirable characteristics that current urology residents seek upon first-time employment., Methods: A 19-question survey was created and e-mailed to all 124 ACGME (Accreditation Council for Graduate Medical Education) accredited urology residencies in the United States. This link was forwarded to the urology residents for the 2013-2014 academic year., Results: A total of 232 responses were obtained, comprised of 187 from male residents (80.6%) and 43 from female residents (18.5%). Residents were primarily interested in practicing in a large urban area (153 of 232, 65.9%) or suburban setting (140, 60.3%), and 24 considered a rural location (10.3%). Female respondents were significantly more likely to consider a rural environment (p = 0.02). The most important choices when choosing a practice were geographic location (116 of 232, 50%) and proximity to family (51, 21.9%). The majority were very interested in part-time or full-time use of a physician assistant or nurse practitioner (188 of 232, 81%), and only 1 was not interested (0.4%). Overall 136 residents (58.6%) stated that they would use them for clinic and office procedures., Conclusions: Most residents seek an urban or suburban setting in a group private practice. They prefer to work 40 to 60 hours per week close to their family or in a specific geographic region. Enticing residents to a rural setting may be difficult. The use of nurse practitioners or physician assistants is extremely desirable to current residents.

Retroperitoneal hemorrhage and an associated hematoma are uncommon but potentially serious complications following ureteroscopy with laser lithotripsy. However, no reports of serious bleeding complications have been published regarding ureteroscopy without laser lithotripsy in the management of stone disease. We report of such a case here and then review the current literature in order to discuss the incidence, risk factors, and management of such events.

Introduction: Renal trauma occurs in approximately 1%-5% of all trauma cases. Improvements in imaging and management over the last two decades have caused a shift in the treatment of this clinical condition., Materials and Methods: A systematic search of PubMed was performed to identify relevant and contemporary articles that referred to the management and evaluation of renal trauma., Results: Computed tomography remains a mainstay of radiological evaluation in hemodynamically stable patients. There is a growing body of literature showing that conservative, non-operative management of renal trauma is safe, even for Grade IV-V renal injuries. If surgical exploration is planned due to other injuries, a conservative approach to the kidney can often be utilized. Follow up imaging may be warranted in certain circumstances. Urinoma, delayed bleeding, and hypertension are complications that require follow up., Conclusion: Appropriate imaging and conservative approaches are a mainstay of current renal trauma management.

Introduction: Penile implant surgery continues to be an important option for men with erectile dysfunction. Advancements in technology of implants have contributed to improved survival from mechanical breakdown. Prosthesis infection remains a serious adverse event. For the last 8 years, the Titan implant (Coloplast Corporation, Minneapolis, MN, USA) has been available with an infection-retardant polyvinylpyrrolidone coating., Aim: To compare the infection rates between coated three-piece inflatable penile prostheses (IPPs) with the previous non-coated model., Main Outcome Measures: Infection-related revisions reported in the physician-generated, manufacturer-tabulated patient information forms (PIFs)., Methods: PIFs reported into the voluntary, post-market registry of Coloplast Corporation from July 14, 2000 to September 30, 2011 were retrospectively reviewed. Infection-related revisions entered into the product evaluation database for coated and non-coated IPPs were compared. Data were analyzed using Pearson's chi-squared test., Results: The database included 36,391 PIFs related to primary IPP implantation. At 11 years of follow-up, 4.6% (7,031) of non-coated IPPs were removed or replaced due to infections, whereas 1.4% (29,360) of hydrophilic-coated implants reported replacements due to device infections. The hydrophilic coating of the IPP components makes the device slippery and prevents bacterial attachment. The hydrophilic coating allows rapid absorption of antibiotics in an aqueous solution and allows these water-soluble antibiotics to elute off the device into the implant spaces. Unfortunately, information pertaining to what agents were used in the studies patients was not tabulated. The rate of revision due to device infection was reduced 69.56% in patients with hydrophilic-coated IPPs (P<0.001)., Conclusion: To the best of our knowledge, this is the longest post-marketing registry report related to IPP infections. At 8 years of follow-up, the hydrophilic-coated IPPs demonstrated a significant reduction in revision rates due to infection when compared with the 11-year follow-up of non-coated implants. Since there was no information or uniformity of antibiotics used in the soaking solution, it is uncertain which antibiotic selection provided the best results. In vitro testing against known infectious agents may further benefit IPP patients by reducing the prosthesis infection rate., (© 2012 International Society for Sexual Medicine.)

Background: The administration of docetaxel requires the use of dexamethasone for the prevention of hypersensitivity reactions (HSRs) and fluid retention reactions (FRRs). The manufacturer recommends dexamethasone for 3 days starting the day before docetaxel. This regimen has the potential for nonadherence so the utility of a single dexamethasone dose would be welcomed., Objective: To ascertain the incidence of HSRs and FRRs after receiving a single dose of intravenous dexamethasone before docetaxel administration., Design: Retrospective chart review., Setting: Data set from an oncology clinic affiliated with a large, tertiary, academic, teaching hospital., Patients: Ninety patients (median age 59 years, range 40-92 years) with cancer (primarily breast cancer, nonsmall cell lung cancer and head/neck cancer) who received docetaxel., Measurements and Results: Patients with heart failure, renal failure, chronic edema, current steroid use and/or prostate cancer were excluded from the study. Seven patients (7.8%) experienced a HSR requiring a treatment intervention (fluid bolus, oxygen, steroid, and/or diphenhydramine). Eleven patients (12.2%) had documented fluid retention. The mean docetaxel dose at the onset of fluid retention was 247.2 ± 134.5 mg/m(2)., Limitations: This single center evaluation with a small sample size had the potential for incomplete collection of the adverse events from the medical records due its retrospective nature., Conclusion: Hypersensitivity reactions and FRRs occurred in 7.8% and 12.2% of patients, respectively. This is lower than the rates reported by the manufacturer with the oral premedication regimen.

Idiopathic thrombocytopenic purpura (ITP) is a platelet disorder that affects approximately 1 in 10,000 people. In adults, the rate of spontaneous remission is only 5%, and generally, it is a chronic disease persisting for more than 6 months. Chronic refractory ITP may be defined as the failure of any modality to keep the platelet count above 20 x 10(3)/mm(3) for an appreciable time without unacceptable toxicity. Many pharmacologic treatments have been used to manage chronic refractory ITP by attempting to increase platelet counts by decreasing the rate of destruction of these cells. They include, but are not limited to, azathioprine, danazol, dapsone, combination chemotherapy, cyclosporine, and rituximab. However, these therapies offer modest response rates and can cause adverse events that necessitate drug discontinuation. The recent United States Food and Drug Administration approval of the thrombopoietin mimetics, romiplostim and eltrombopag, has provided clinicians with a novel approach for treating chronic refractory ITP. By stimulating platelet production, these drugs offer patients with this disease an alternative to the other agents. The preapproval phase III study with subcutaneous romiplostim showed significantly higher overall response rates versus placebo in both splenectomized and nonsplenectomized patients (83% for romiplostim vs 7% for placebo, p<0.0001). Twenty-five percent of patients receiving romiplostim achieved a platelet count greater than 50 x 10(3)/mm(3) after 1 week, and 50% achieved this platelet count within 2-3 weeks. The preapproval phase III study with oral eltrombopag demonstrated that 70% of patients receiving 50 mg/day and 81% of patients receiving 75 mg/day achieved a platelet count of at least 50 x 10(3)/mm(3) by day 43 (p<0.001 vs placebo for both 50 and 75 mg). Forty-four percent and 62% of patients achieved a platelet count of at least 50 x 10(3)/mm(3) by day 8 with eltrombopag 50 and 75 mg/day, respectively. When deciding which of these agents to prescribe, considerations include oral versus injectable dosage form, adverse-event profiles, and patient adherence with both taking the drug and keeping clinic appointments for monitoring of platelet counts. Several studies are under way to evaluate these drugs in chronic refractory ITP as well as other disease states. Long-term data will also be needed to assess the safety and efficacy of these agents.

Objective: To provide a review of the clinical data supporting the use of sunitinib (Sutent), a multitargeted, small molecule, tyrosine kinase inhibitor, with focus on its approved indication for the treatment of advanced renal cell carcinoma in patients with metastatic disease requiring drug therapy., Data Source: : A MEDLINE search of the medical literature was conducted using the terms 'sunitinib' and 'SU11248'. References from the articles were reviewed and relevant sources were included., Data Summary: The introduction of dual tyrosine kinase receptor inhibitors is a novel approach to treating advanced metastatic renal cell carcinoma (mRCC) by preventing angiogenesis and tumor growth. Based on its ability to inhibit several targets involved in angiogenesis and endothelial cell proliferation, sunitinib offers patients with mRCC an alternative for treatment. A recent Phase III study evaluating sunitinib as first-line therapy showed a significant difference when compared to interferonalfa (IFN-alpha) for a progression-free survival of 11 months in the sunitinib arm and 5 months in the IFN-alpha arm (hazard ratio 0.42; 95% CI 0.32-0.54; P50.001). Two Phase II trials determined sunitinib was effective as second-line therapy in mRCC patients who failed previous cytokine treatment. Partial response rates were 40% (95% CI 28%-53%) and 34% (95% CI 25%-44%). Multiple ongoing trials are currently underway to evaluate sunitinib for first-line therapy in mRCC.