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Introduction:Despite the effectiveness of blue light cystoscopy (BLC) in the management of bladder cancer, the adoption of BLC since its approval has been limited. We evaluated the perceive...

OBJECTIVE: To review the recent milestones in MRI and PET based imaging and evaluate their evolving role in the setting of elevated PSA as well as localized prostate cancer. BACKGROUND: The importance of multiparametric MRI (mpMRI) and PET based imaging for the diagnosis and staging of prostate cancer cannot be understated. Accurate staging has become another significant milestone with the use of PET scans, particularly with prostate specific radiotracers like 68-Gallium Prostate Specific Membrane Antigen (68Ga-PSMA). Integrated PET/MRI systems are commercially available and can be modulated to evaluate the unique needs of localized as well as recurrent prostate cancer. METHODS: A literature search was performed using PubMed and Google Scholar using the MeSH compliant and other keywords that included prostate cancer, PSA, mpMRI, PET CT, PET/MRI. CONCLUSIONS: mpMRI has now established itself as the gold-standard of local prostate imaging and has been incorporated into international guidelines as part of the diagnostic work-up of prostate cancer. PSMA PET/CT has shown superiority over conventional imaging even in staging of localized prostate cancer based on recent randomized control data. Imaging parameters from PET/MRI have been shown to be associated with malignancy, Gleason score and tumour volume. As mpMRI and PSMA PET/CT become more ubiquitous and established; we can anticipate more high-quality data, cost optimization and increasing availability of PET/MRI to be ready for primetime in localized prostate cancer.

Objective To assess the perceived importance of male ejaculatory function (EjF) from the perspective of adult men and their sexual partners. Methods In a large survey study, men were asked about the importance of their own EjF. Sexual partners of men were asked about the general importance their partner's EjF, and whether they would support a partner's decision to pursue BPH treatment despite ejaculatory dysfunction. Results One hundred and two men completed the survey section regarding their own EjF, and 100 participants completed the survey section assessing the importance of their male partner's EjF. While 55% of men agreed or strongly agreed that “ejaculation is an important part of an enjoyable sexual experience,” only 30% of partners similarly agreed or strongly agreed (P = .005). A greater percentage of men (12%) agreed or strongly agreed that they “preferred large semen volume” compared to sexual partners of men (3%), however this was not significant. Sixty eight percent of sexual partners would agree or strongly agree to support their male partner's decision to pursue BPH treatment despite potential ejaculatory dysfunction. Conclusion The perceived importance of EjF differs between men and their sexual partners, as men believe ejaculation to be a more important component of an enjoyable sexual experience than their partners.

INTRODUCTION AND OBJECTIVE:Neoadjuvant chemotherapy (NAC) followed by radical cystectomy is the standard of care for patients with muscle invasive bladder cancer (MIBC). Careful selection is needed...

The aim of this study is to evaluate if the use of a smart water bottle improves urine volume in stone forming patients.Adults with nephrolithiasis and low urine volume (1.5 L) documented on a 24-hour urinalysis (24 hr U) were randomized to receive either standard dietary recommendations to increase fluid intake (DR arm), or DR and a smart water bottle (HidrateSpark®; Hydrate Inc., Minneapolis, MN) that recorded fluid intake, synced to the user's smartphone, and provided reminders to drink (SB arm). Participants completed baseline surveys assessing barriers to hydration. They then repeated a 24 hr U and survey at 6 and 12 weeks, respectively.Eighty-five subjects (44 DR, 41 SB) were enrolled. The main baseline factor limiting fluid intake was not remembering to drink (60%). Follow-up 24 hr Us were available for 51 patients. The mean increase in volume was greater in the SB arm (1.37 L, 95% confidence interval -0.51 to 3.25) than the DR arm (0.79 L, 95% confidence interval -1.15 to 2.73) (P = .04). A smaller percentage of subjects in the SB arm reported not remembering to drink as the main factor limiting fluid intake in the follow-up questionnaire compared to baseline (45.4% vs. 68.4%, P .05). This was not true for the DR arm (40.0% vs. 51.2%, P = .13).Difficulty remembering to drink is a barrier to achieving sufficient fluid intake in stone formers. The use of a smart bottle was associated with greater increases in 24 hr U volumes and less difficulty remembering to drink.

OBJECTIVE To create and validate a grading scale that facilitates communication between providers managing gross hematuria (GH). METHODS A blood simulant was used to create a spectrum of GH in 5 foley catheter tubes which were shown to a group of experienced urologists. The urologists were asked how they would adjust the continuous bladder irrigation rate if the samples represented the urine of hypothetical patients, and a 5-point scale was created by group consensus with pictures of the representative tubes printed onto a visual aid. Another cohort were then shown the 5 tubes at random and asked to describe the GH. Raters were then shown the visual aid and asked to assign a grade to the same samples. Fleiss’ kappa analysis was used to measure inter-rater agreement, and therefore fidelity of the scale. RESULTS Fourteen urologists were surveyed to determine the samples used to create the 5-point scale. After the scale was created, 43 raters (22 nurses, 16 urologists, and 5 advanced practice providers) attempted match the tubes to their corresponding images on the printout. When asked to describe the degree of GH for the samples as they would in clinical practice, 28 different descriptors were used (mean 8.6 per sample). When using the 5-point GH scale, however, raters exhibited near perfect agreement in matching each sample to its corresponding severity on the scale (κ = 0.93, P CONCLUSION We created a clinically useful GH scale that improves communication and reduces ambiguous language among providers of varying levels of experience.

Background Parastomal and ventral hernias are common complications in patients with continent catheterizable channels or incontinent urinary diversions. Patients with neurogenic bladder are at particularly high risk due to weak abdominal wall musculature, and hernia repair often requires resiting of their stoma. While parastomal hernia repair with urinary stoma resiting has acceptable long-term success rates, it often necessitates a laparotomy which is associated with significant morbidity. Objective To describe a novel approach to combined laparoscopic parastomal hernia repair with resiting of the urinary stoma in patients with neurogenic bladder. The video will outline the surgical steps and pitfalls. Materials and Methods The case begins laparoscopically or robotically with adhesiolysis to dissect out the subfascial portion of the channel and the parastomal hernia. The subfascial portion of the channel is dissected out to the anterior abdominal wall, ensuring to preserve its mesentery. The abdomen is then desufflated and the suprafascial portion of the channel is dissected and the channel dropped into the abdomen. The hernia is then repaired laparoscopically using mesh and the channel is brought out through one of the laparoscopic port sites and matured to the skin. Results In our series of 4 patients, this technique was performed for 2 continent catheterizable channels and 2 incontinent diversions. One patient developed a hernia recurrence 7 months later which was repaired laparoscopically. In another, the stoma was successfully resited but the hernia was unable to be repaired laparoscopically due to dense adhesions. Continent and patency outcomes of the urinary stomas were 100% at a mean follow-up of 2 years. Conclusion Laparoscopic parastomal hernia repair with resiting of the urinary stoma has similar long-term success rates compared to that of an open repair and avoids the morbidity of a laparotomy. This repair can be performed for catheterizable channels or incontinent diversions.

Background Continent cutaneous ileocecocystoplasty (CCIC) involves reconfiguring the ileocecal segment for use as a bladder augment and continent catheterizable channel. CCIC requires release of the hepatic flexure of the colon, which necessitates a longer midline laparotomy than would be required for a standard bladder augmentation. This is associated with high rates of ventral and parastomal hernias. Objectives To describe the technique of hand-assist laparoscopic CCIC and to compare outcomes to open CCIC. Materials and Methods We found pure laparoscopic colon mobilization difficult due to significant colonic distension in patients with neurogenic bladder and bowel. We modified our approach to hand-assisted laparoscopic mobilization for better retraction of the bowel. A 12-mm camera port is placed through the umbilicus, which later serves as the stoma site, and a 5-mm assist port is placed a handbreadth cephalad to the 12-mm port. A Pfannenstiel incision is made for use as the hand port. After colonic mobilization is completed the remainder of the procedure is performed in an open fashion through the Pfannenstiel incision. The primary outcome was 90-day Clavien grade 2 or greater complications. Secondary outcomes included revision rates, wound infection, urinary continence, operative time, and length of stay. Data was analyzed using Mann-Whitney U test and Fisher's exact test. Results Thirty-two laparoscopic and 21 open procedures were reviewed. Those who underwent open procedures were more likely to have undergone prior catheterizable channel or bladder augmentation (7 vs 1, P Conclusion Hand-assist laparoscopic CCIC offers a minimally invasive alternative to open CCIC with fewer short-term complications and comparable long-term outcomes.

Objective To describe the urologic sequalae of several rare congenital neuromuscular diseases. Methods We retrospectively reviewed medical records at Gillette Specialty Healthcare (2014-2018) of patients presenting to urology clinic with lower urinary tract symptoms and select rare congenital diseases: muscular dystrophy, spinal muscular atrophy, and Rett syndrome. Results Muscular dystrophies (n = 19) are X-linked myogenic disorders characterized by progressive muscle wasting and weakness. Men present to the urologist at variable ages, typically with complaints of functional incontinence and normal cystometrograms; we manage them with oral anticholinergic medications, condom catheter, or suprapubic catheter. Spinal muscular atrophy (n = 6) is a rare autosomal recessive disease characterized by degeneration of the anterior horn cells in the spinal cord and motor nuclei in the lower brainstem leading to progressive muscle weakness and atrophy. Patients typically present with nephrolithiasis and urinary retention in late adolescence/early adulthood, but timing varies. Filling cystometrograms have been normal. We allow passive retention with intermittent catheterization and creation of catheterizable channels, when indicated. Rett syndrome (n = 5) is a rare, noninheritable genetic condition affecting females characterized by a brief period of normal development followed by loss of speech and purposeful hand use; there are characteristic behaviors. Patients present in early adulthood with complaints of urinary retention. We manage retention with permissive retention or sphincter chemodenervation. Conclusion Several congenital neuromuscular conditions can cause lower urinary tract symptoms when these individuals become adults. We have discussed the clinical characteristics and management of select neurogenic and myogenic bladder conditions seen in adults with congenital conditions.

Cystic partially differentiated nephroblastoma (CPDN) is a rare multicystic renal tumor along the spectrum of cystic nephroma and cystic Wilms' tumor. There have only been two previously reported cases of bilateral CPDN in the literature. We present here a case of bilateral CPDN vs cystic Wilms' tumor treated with neoadjuvant and adjuvant chemotherapy in addition to a bilateral partial nephrectomy. We also review the relevant literature regarding CPDN in an effort to aid in diagnosis and management of these rare cystic renal tumors.

There have been no previous reports of post-chemotherapy robotic bilateral retroperitoneal lymph node dissection (RPLND) using a single-dock technique. One deterrent of robotic RPLND is that accessing bilateral retroperitoneal spaces requires patient reposition and surgical robot redocking, therefore increasing operative time. Herein we provide the first step-by-step description of a single-dock technique for robotic bilateral RPLND in the post-chemotherapy setting. We describe port placement and technique for robot positioning to optimize access to bilateral retroperitoneal spaces with a single dock. We also demonstrate the feasibility of sparing the inferior mesenteric artery when utilizing this approach. This single-dock approach was used on two patients at our institution who had residual paracaval masses following chemotherapy for metastatic testicular cancer. Mean operative time was 6 h, and neither patient had significant blood loss or suffered from any peri-operative complications.

Despite considerable interest in the biologic processes of regeneration and stem cell activation, little is known about the genes involved in these transformative events. In a Hydra littoralis model of regeneration, we employed a rapid shotgun suppression subtractive hybridization strategy to identify genes that are uniquely expressed in regenerating tissue. With an adaptor-PCR based technique, 16 candidate transcripts were identified, 15 were confirmed unique to mRNA isolated from hydra undergoing regeneration. Of these, 6 were undescribed in GenBank and allied expressed sequence tag (EST) databases (GenBank + EMBL + DDBJ + PDB and the Hydra EST database). BLAST analysis of these sequences identified remarkably similar sequences in anonymous ESTs found in a wide variety of animal species.

This study was designed to engineer a functional filaggrin (FLG) monomer linked to a cell-penetrating peptide (RMR) and to test the ability of this peptide to penetrate epidermal tissue as a therapeutic strategy for genetically determined atopic dermatitis (AD). A single repeat of the murine filaggrin gene (Flg) was covalently linked to a RMR motif and cloned into a bacterial expression system for protein production. Purified FLG+RMR (mFLG+RMR) was applied in vitro to HEK-293T cells and a reconstructed human epidermis (RHE) tissue model. Immunochemistry demonstrated RMR-dependent cellular uptake of FLG+RMR in a dose- and time-dependent manner in HEK cells. Immunohistochemical staining of the RHE model identified penetration of FLG+RMR to the stratum granulosum, the epidermal layer at which FLG deficiency is thought to be pathologically relevant. In vivo application of FLG+RMR to FLG-deficient flaky tail (ft/ft) mice skin demonstrated internalization and processing of recombinant FLG+RMR to restore the normal phenotype. These results suggest that topically applied RMR-linked FLG monomers are able to penetrate epidermal tissue, be internalized into the appropriate cell type, and be processed to a size similar to wild-type functional barrier peptides to restore necessary barrier function, and prove to be therapeutic for patients with AD.