ObjectiveThe United Nations defines sustainability as meeting needs of the present without compromising future generations. While often equated to “saving the planet”, sustainability is a diverse topic. Healthcare generates >5% of CO2 emissions worldwide, yet sustainability efforts in urology are limited. The North Central Section of the American Urological Association (NCSAUA) recently convened a Sustainability Task Force to address this topic. This study queried members on sustainability in urologic practice.MethodsFollowing literature review on sustainability in surgery/urology, a 19-item anonymous REDCap survey was developed and distributed via email to NCSAUA members (N = 1607). The survey assessed current best practice, institutional/personal sustainability, and demographics. Responses were compiled and summarized using descriptive statistics.ResultsSurvey response rate was 4.9% (79/1607). Respondents were most commonly from metropolitan areas (82%), male (71%), and in practice for 5–14 years (29%). Sustainability topics were prioritized as: (1) financial, (2) future workforce, (3) environmental. Over half (56%) reported no institutional sustainability programs or were unaware of them. Instrument (67%), computer (68%), and paper (65%) recycling were supported by a majority of respondents. However, only 28% and 29% of respondents reported current institutional use of instrument and computer recycling, respectively. Telemedicine was infrequent, with most urologists (58%) conducting 0-5% of visits virtually.ConclusionsCurrent institutional and urologic practice emphasis on sustainability is low. Respondents ranked highest sustainability priorities as financial and future workforce. Efforts to address environmental sustainability were also supported, namely reduction of disposables and waste. The findings support the development of targeted programs to advance sustainability priorities widely.

BACKGROUND:Surgical site infections after lower extremity dermatologic procedures increase morbidity, recovery time, and health care costs. This study examined whether the introduction of a skin adhesive closure method influenced infection rates and antibiotic use over a 10-year period. PATIENTS AND METHODS:The authors performed a single-center retrospective cohort analysis of adult patients undergoing lower-leg dermatologic surgery between 2013 and 2023. The 3 cohorts were procedures before adhesive availability closed with sutures only, after adhesive availability closed with sutures, and after adhesive availability closed with the adhesive material. The primary outcome was occurrence of surgical site infection within 30 days, confirmed by culture or clinical signs. Secondary outcomes included incidence of prophylactic and postoperative antibiotic prescriptions, wound closure length, and Mohs micrographic stages. RESULTS:Introduction of adhesive was associated with a decrease in confirmed surgical site infections from 4.78% to 1.94% ( p = .0156) and clinically suspected infections from 7.96% to 3.16% ( p = .0008). Prophylactic antibiotic use dropped from 86.31% to 77.40% ( p = .0011), and postoperative antibiotics from 7.96% to 3.04% ( p = .0005). Closure length decreased from 6.59 cm to 5.07 cm ( p = .003), and Mohs stages decreased by 0.13 stages ( p < .001). CONCLUSION:Skin adhesive correlated with reduced infection rates, antibiotic use, and more efficient procedures in lower-extremity dermatologic surgery.

You have accessJournal of UrologySurgical Technology & Simulation: Artificial Intelligence I (MP07)1 May 2024MP07-04 INITIAL EXPERIENCE WITH A FULLY INTEGRATED ARTIFICIAL INTELLIGENCE PLATFORM DURING MINIMALLY INVASIVE SURGERY Abhinav Khanna, Stephen A. Boorjian, Igor Frank, Paras Shah, Vidit Sharma, R. Houston Thompson, Aaron Potretzke, George Chow, Adam Miller, Ross Avant, Daniel Elliott, Derek Lomas, J. Nicholas Warner, Kevin Koo, Meghan Cooper, Tobias Kohler, Lance Mynderse, and Matthew Tollefson Abhinav KhannaAbhinav Khanna , Stephen A. BoorjianStephen A. Boorjian , Igor FrankIgor Frank , Paras ShahParas Shah , Vidit SharmaVidit Sharma , R. Houston ThompsonR. Houston Thompson , Aaron PotretzkeAaron Potretzke , George ChowGeorge Chow , Adam MillerAdam Miller , Ross AvantRoss Avant , Daniel ElliottDaniel Elliott , Derek LomasDerek Lomas , J. Nicholas WarnerJ. Nicholas Warner , Kevin KooKevin Koo , Meghan CooperMeghan Cooper , Tobias KohlerTobias Kohler , Lance MynderseLance Mynderse , and Matthew TollefsonMatthew Tollefson View All Author Informationhttps://doi.org/10.1097/01.JU.0001008728.41882.d7.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recent advances in computer vision have enabled artificial intelligence (AI) evaluation of surgical video at a scale not previously feasible. Applying AI video analysis to real-world practice has potential to unearth new insights into surgery. We report our experience with an AI platform that is fully integrated into our urology practice. METHODS: Video from endoscopic, laparoscopic, and robotic surgeries performed at our tertiary academic center were uploaded into a secure location on the Mayo Clinic cloud server. Videos were analyzed in real-time using a novel AI computer vision platform (Theator, Inc.). Each surgical step was automatically detected by individualized AI algorithms tailored to each surgery type. Key safety events, such as "critical views of safety", preservation of key anatomic structures, and safety maneuvers were automatically annotated. Adverse events, including hemorrhage, tumor disruption, and vascular injury were identified. All AI-generated insights were annotated directly onto surgical video timelines, and results of AI analysis were available on mobile and desktop apps in real-time. RESULTS: From December 2021-September 2023, a total of 1388 surgeries were performed by 18 individual surgeons with real-time AI analysis. This included 766 radical prostatectomy (median video duration 156 [IQR 112-197] minutes), 395 endoscopic BPH procedures (49 [25-80] minutes), 132 partial nephrectomy (122 [92-184] minutes), and 29 transurethral bladder tumor resection (31 [23-77] minutes). Insights offered by AI video analysis include breakdown of full-length surgeries into distinct labeled steps, benchmarking efficiency of individual surgical steps across surgeons, and cataloging trends in surgical step duration and safety milestones over time (Figure 1). CONCLUSIONS: To our knowledge, this represents the first report of comprehensive integration of a novel AI computer vision platform into real-world surgical practice in the United States. Future investigations should explore the relationship between AI-detected intra-operative events with clinical outcomes. AI video analysis has potential applications in surgical education, quality benchmarking, performance review, automated documentation, and surgeon decision-support, all of which warrant further study. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e105 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Abhinav Khanna More articles by this author Stephen A. Boorjian More articles by this author Igor Frank More articles by this author Paras Shah More articles by this author Vidit Sharma More articles by this author R. Houston Thompson More articles by this author Aaron Potretzke More articles by this author George Chow More articles by this author Adam Miller More articles by this author Ross Avant More articles by this author Daniel Elliott More articles by this author Derek Lomas More articles by this author J. Nicholas Warner More articles by this author Kevin Koo More articles by this author Meghan Cooper More articles by this author Tobias Kohler More articles by this author Lance Mynderse More articles by this author Matthew Tollefson More articles by this author Expand All Advertisement PDF downloadLoading ...

ImportanceLiving kidney donors may have an increased risk of fractures due to reductions in kidney mass, lower concentrations of serum 1,25-dihydroxyvitamin D, and secondary increases in serum parathyroid hormone. ObjectiveTo compare the overall and site-specific risk of fractures among living kidney donors with strictly matched controls from the general population who would have been eligible to donate a kidney but did not do so. Design, Setting, and ParticipantsThis survey study was conducted between December 1, 2021, and July 31, 2023. A total of 5065 living kidney donors from 3 large transplant centers in Minnesota were invited to complete a survey about their bone health and history of fractures, and 16 156 population-based nondonor controls without a history of comorbidities that would have precluded kidney donation were identified from the Rochester Epidemiology Project and completed the same survey. A total of 2132 living kidney donors and 2014 nondonor controls responded to the survey. Statistical analyses were performed from May to August 2023. ExposureLiving kidney donation. Main Outcomes and MeasuresThe rates of overall and site-specific fractures were compared between living kidney donors and controls using standardized incidence ratios (SIRs). ResultsAt the time of survey, the 2132 living kidney donors had a mean (SD) age of 67.1 (8.9) years and included 1245 women (58.4%), and the 2014 controls had a mean (SD) age of 68.6 (7.9) years and included 1140 women (56.6%). The mean (SD) time between donation or index date and survey date was 24.2 (10.4) years for donors and 27.6 (10.7) years for controls. The overall rate of fractures among living kidney donors was significantly lower than among controls (SIR, 0.89; 95% CI, 0.81-0.97). However, there were significantly more vertebral fractures among living kidney donors than among controls (SIR, 1.42; 95% CI, 1.05-1.83). Conclusions and RelevanceThis survey study found a reduced rate of overall fractures but an excess of vertebral fractures among living kidney donors compared with controls after a mean follow-up of 25 years. Treatment of excess vertebral fractures with dietary supplements such as vitamin D3 may reduce the numbers of vertebral fractures and patient morbidity.

You have accessJournal of UrologyEducation Research III (PD60)1 May 2024PD60-12 TOP 3 SELF-REPORTED QUALITIES OF UROLOGY RESIDENCY APPLICANTS Abrar H. Mian, Candace Granberg, Tobias Kohler, Adam Miller, Kimberly Rinehart, Kelsey Tuen, Boyd Viers, Matthew Ziegelmann, and Sevann Helo Abrar H. MianAbrar H. Mian , Candace GranbergCandace Granberg , Tobias KohlerTobias Kohler , Adam MillerAdam Miller , Kimberly RinehartKimberly Rinehart , Kelsey TuenKelsey Tuen , Boyd ViersBoyd Viers , Matthew ZiegelmannMatthew Ziegelmann , and Sevann HeloSevann Helo View All Author Informationhttps://doi.org/10.1097/01.JU.0001009460.27205.df.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Jobma is an asynchronous video interviewing platform used at Mayo Clinic to utilize a more holistic approach to selecting candidates. In this study we sought to assess responses to our prompt "What are your 3 greatest qualities that will make you an exceptional urology resident at Mayo Clinic?" METHODS: After initial applicant screening, 177 candidates were invited to record a video using Jobma. In a single attempt, candidates had five minutes to prepare and two minutes to record a response. A reviewer blinded to the selection process evaluated all submitted videos. We then compared candidates ultimately offered interviews with those who were not. Data analysis was conducted using SPSS® version 23 (IBM®, Armonk, New York). RESULTS: Of 177 candidates offered a Jobma, 96 self-identified as males, 74 as females, and 2 other, completed a video. Figure 1 reveals the top 10 most common self-described qualities. 26 were selected for interviews: 10 males and 16 females. Statistically significant factors in selection included wearing professional attire, giving specific examples demonstrating traits, mentioning Mayo Clinic and the following traits: "Personal Development" (n=4), "Teamwork" (n=3), "Adaptable" (n=2), "Perseverance" (n=2), "Initiative" (n=2), and "Positive Attitude" (n=2). Of those offered Interviews 19 smiled, 6 did not, and 1 could not be seen. Non-significant variables included video background, reference to prompt, eye contact, saying thank you, self-introduction, number of umms, or technical issues. CONCLUSIONS: Future resident candidates may benefit from professional attire, familiarity with the values of the program they are applying to, and carefully prepared memorable examples of their self-described qualities. Applicants and interviewers alike should carefully consider what traits embody an exceptional urology resident. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1278 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Abrar H. Mian More articles by this author Candace Granberg More articles by this author Tobias Kohler More articles by this author Adam Miller More articles by this author Kimberly Rinehart More articles by this author Kelsey Tuen More articles by this author Boyd Viers More articles by this author Matthew Ziegelmann More articles by this author Sevann Helo More articles by this author Expand All Advertisement PDF downloadLoading ...

In a previous study, we observed decreased 1,25-dihydroxyvitamin D levels, secondary hyperparathyroidism, and increased bone turnover markers in living kidney donors (LKDs) at 3 months and 36 months after kidney donation. In our recent survey-based study, we found no increased risk of fractures of all types but observed significantly more vertebral fractures in LKDs compared with matched controls. To elucidate the long-term effects of kidney donation on bone health, we recruited 139 LKDs and 139 age and sex matched controls from the survey-based participants for further mechanistic analyses. Specifically, we assessed whether LKDs had persistent abnormalities in calcium- and phosphorus-regulating hormones and related factors, in bone formation and resorption markers, and in density and microstructure of bone compared with controls. We measured serum markers, bone mineral density (BMD), bone microstructure and strength (via high-resolution peripheral quantitative computed tomography and micro-finite element analysis [HRpQCT]), and advanced glycation end-products in donors and controls. LKDs had decreased 1,25-dihydroxyvitamin D concentrations (donors mean 33.89 pg/mL vs. controls 38.79 pg/mL, percent difference = -12.6%; P < .001), increases in both parathyroid hormone (when corrected for ionized calcium; donors mean 52.98 pg/mL vs. controls 46.89 pg/mL,% difference 13%; P = .03) and ionized calcium levels (donors mean 5.13 mg/dL vs. controls 5.04 mg/dL; P < .001), and increases in several bone resorption and formation markers versus controls. LKDs and controls had similar measures of BMD; however, HRpQCT suggested that LKDs have a statistically insignificant tendency toward thinner cortical bone and lower failure loads as measured by micro-finite element analysis. Our findings suggest that changes in the hormonal mileu after kidney donation and the long-term cumulative effects of these changes on bone health persist for decades after kidney donation and may explain later-life increased rates of vertebral fractures.

Introduction Advancements in vascularized composite allotransplantation have made hand transplants possible for persons living with upper limb loss. Hand transplantation is not a life-saving procedure, but rather a quality-of-life enhancing procedure; hence the risk of morbidity and mortality must be weighed against improvements in function and appearance. This study explored the decision-making process of patients evaluated for hand transplantation. Methods/Approach A qualitative case series study using retrospective chart data of evaluations was conducted between January 1, 2011 and February 28, 2020. Notes were extracted and read by three reviewers. Each case was summarized noting similarities and differences. Findings Nine patients underwent evaluation. Eight were no longer under evaluation and did not receive transplant; one was still undergoing evaluation. Patient motivations for evaluation were dissatisfaction with prostheses or self-image, chronic pain, performing activities of daily living, occupation, burden placed on caregivers, and concerns about overuse of non-affected limbs. Patients chose not to pursue transplantation due to rehabilitation time, immunosuppression, alternative treatments, and social and financial challenges. The clinical team discontinued evaluations due to unmet evaluation requirements, medical contraindications, or treatment alternatives. Different modes of shared decision-making were present depending on the party most heavily featured in the charts as driving decisions. Discussion This was an examination of shared decision-making with hand transplant candidates who did not proceed to transplant. Reasons for choosing alternative strategies for management were multifactorial. Lessons learned regarding patient motivations and shared decision-making can inform future interventions to better support patients.

To the Editor: Patients with HIV are uniquely immunosuppressed and have a significantly increased risk of nonmelanoma skin cancer compared with the general population1,2 despite antiviral therapy.3 Preoperative prognostic risk factors that may predict the need for extensive Mohs micrographic surgery (MMS) for nonmelanoma skin cancer are not known. The objective of this study was to determine whether a CD4+ T-cell count nadir of less than 200 cells/μL (CD4<200) is an independent risk factor for larger surgical margins for the treatment of squamous (SCC) and basal cell carcinomas (BCC) in patients with HIV.

On February 20, 2019, PulseNet, the molecular subtyping network for foodborne disease surveillance, identified six Shiga toxin-producing Escherichia coli (STEC) O26:H11 infections with the same pulsed-field gel electrophoresis (PFGE) pattern combination.This PFGE pattern combination matched that of infections from a July 2018 outbreak that was associated with ground beef.In response, CDC initiated an investigation with federal, state, and local partners to identify the outbreak source and implement prevention measures.CDC defined a case as STEC O26 infection with an isolate matching the outbreak strain by PFGE or related by core genome multilocus sequence typing scheme (cgMLST), with dates of illness onset during December 11, 2018-May 21, 2019.Investigators initially hypothesized that ground beef was the outbreak cause because of the PFGE match to the July 2018 outbreak and because in early interviews, patients commonly reported eating ground beef and leafy greens.Investigators used cgMLST to compare the genetic sequences of isolates from both outbreaks and determined that they fell into separate genetic clades (differing by 6-11 alleles), suggesting that something other than ground beef caused the illness in 2019.CDC noted that one patient consumed raw cookie dough and that most patients were young adult females, similar to demographic distributions of past flour-associated STEC outbreaks (1-3).Investigators developed a supplemental questionnaire focusing on beef, leafy greens, and flour exposures.Twenty-one cases were reported from nine states (Figure).The median age of patients was 24 years (range = 7-86 years); 71% were female.Three patients were hospitalized, and none died.Among 13 patients asked about flour exposures, six reported eating, licking, or tasting raw homemade dough or batter during the week before illness onset.Three patients reported eating raw dough or batter made with the same grocery store brand of all-purpose flour, including a patient who reported eating raw dough at a bakery in Rhode Island.Overall, of 18 patients with store information, 11 reported shopping at this same grocery store chain.The Rhode Island Department of Health visited the bakery reported by the patient and collected flour for testing.On

PURPOSE:In 2012 the American Urological Association published vasectomy guidelines to promote best practices, including when to obtain post-vasectomy semen analyses. In this study we assessed practice patterns of post-vasectomy semen analysis since this guideline publication.MATERIALS AND METHODS:We retrospectively analyzed a database of men who underwent post-vasectomy semen analysis between 2013 and 2017. Vasectomies were performed by urologist and nonurologist providers in academic and community settings.RESULTS:A total of 4,827 men underwent post-vasectomy semen analysis with 22.3% undergoing 1 or more repeat analyses. On initial analysis 58.2% were azoospermic, 28.3% had less than 100,000/ml rare nonmotile sperm, 8.7% had greater than 100,000/ml nonmotile sperm and 4.8% had motile sperm. The rate of repeat post-vasectomy semen analysis decreased from 30.7% in 2013 to 18.6% in 2016. Overall 72% of repeat post-vasectomy semen analyses were performed for patients with azoospermia or rare nonmotile sperm on initial post-vasectomy semen analysis. Of the 421 men with greater than 100,000/ml nonmotile sperm, 61.3% did not obtain a repeat analysis. Among cases of repeat analysis after initially having greater than 100,000/ml nonmotile sperm, 67.5% were downgraded to rare nonmotile sperm or azoospermia, 32.5% had a persistent count greater than 100,000/ml nonmotile sperm and none developed motile sperm.CONCLUSIONS:The rate of repeat post-vasectomy semen analysis is decreasing, likely highlighting a decrease in unnecessary testing. However, there is ongoing discordance between vasectomy guidelines and practice patterns, with 72% of repeat post-vasectomy semen analyses obtained unnecessarily based on guideline recommendations. Interestingly, no men with greater than 100,000/ml nonmotile sperm went on to have motile sperm on repeat post-vasectomy semen analysis. Further provider education is warranted and subsequent studies may allow for guideline modification wherein all nonmotile sperm are characterized similarly.

Animal-level agility and robustness in robots cannot be accomplished by solely relying on blind locomotion controllers. A significant portion of a robot’s ability to traverse terrain comes from reacting to the external world through visual sensing. However, embedding the sensors and compute that provide sufficient accuracy at high speeds is challenging, especially if the robot has significant space limitations. In this paper, we propose a system integration of a small-scale quadruped robot, the MIT Mini-Cheetah Vision, that exteroceptively senses the terrain and dynamically explores the world around it at high velocities. Through extensive hardware and software development, we demonstrate a fully untethered robot with all hardware onboard running a locomotion controller that combines state-of-the-art Regularized Predictive Control (RPC) with Whole-Body Impulse Control (WBIC). We devise a hierarchical state estimator that integrates kinematic, IMU, and localization sensor data to provide state estimates specific to path planning and locomotion tasks. Our integrated system has demonstrated robust autonomous waypoint tracking in dynamic real-world environments at speeds of over 1 m/s with high rates of success.

*Department of Dermatology, University of California, San Diego, California Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.dermatologicsurgery.org). The authors have indicated no significant interest with commercial supporters.

Acute myeloid leukemia (AML) is frequently associated with hyperleukocytosis [white blood cell count (WBC) of >50 or >100 × 109/L at presentation] [1]. Hyperleukocytosis also predicts a higher risk...

Hyperleukocytosis in acute myeloid leukemia (AML) is associated with inferior outcomes. There is limited high quality evidence to support the benefits of leukapheresis. We retrospectively collected data from patients with newly-diagnosed AML who presented with a white cell count (WBC) >50 × 10 9 /L to 12 centers in the United States and Europe from 2006 to 2017 and received intensive chemotherapy. Logistic regression models estimated odds ratios for 30-day mortality and achievement of composite complete remission (CRc). Cox proportional hazard models estimated hazard ratios for overall survival (OS). Among 779 patients, clinical leukostasis was reported in 27%, and leukapheresis was used in 113 patients (15%). Thirty-day mortality was 16.7% (95% CI: 13.9–19.3%). Median OS was 12.6 months (95% CI: 11.5–14.9) among all patients, and 4.5 months (95% CI: 2.7–7.1) among those ≥65 years. Use of leukapheresis did not significantly impact 30-day mortality, achievement of CRc, or OS in multivariate analysis based on available data or in analysis based on multiple imputation. Among patients with investigator-adjudicated clinical leukostasis, there were statistically significant improvements in 30-day mortality and OS with leukapheresis in unadjusted analysis, but not in multivariate analysis. Given the significant resource use, cost, and potential complications of leukapheresis, randomized studies are needed to evaluate its value.

MicroRNAs (miRs) are small non-coding RNAs that can have large impacts on oncogenic pathways. Possible functions of dysregulated miRs have not been studied in neurofibromatosis type 1 (NF1) plexiform neurofibromas (PNFs). In PNFs, Schwann cells (SCs) have biallelic NF1 mutations necessary for tumorigenesis. We analyzed a miR microarray comparing with normal and PNF SCs and identified differences in miR expression, and we validated in mouse PNFs versus normal mouse SCs by qRT-PCR. Among these, miR-155 was a top overexpressed miR, and its expression was regulated by RAS/MAPK signaling. Overexpression of miR-155 increased mature Nf1−/− mouse SC proliferation. In SC precursors, which model tumor-initiating cells, pharmacological and genetic inhibition of miR-155 decreased PNF-derived sphere numbers in vitro, and we identified Maf as a miR-155 target. In vivo, global deletion of miR-155 significantly decreased tumor number and volume, increasing mouse survival. Fluorescent nanoparticles entered PNFs, suggesting that an anti-miR might have therapeutic potential. However, treatment of established PNFs using anti-miR-155 peptide nucleic acid-loaded nanoparticles marginally decreased tumor numbers and did not reduce tumor growth. These results suggest that miR-155 plays a functional role in PNF growth and/or SC proliferation, and that targeting neurofibroma miRs is feasible, and might provide novel therapeutic opportunities.

You have accessJournal of UrologyFemale Pelvic Surgery (V13)1 Apr 2020V13-12 ADNEXAL MANAGEMENT AT THE TIME OF ELECTIVE PELVIC SURGERY IN WOMEN Adam Miller*, David Yang, and Brian Linder Adam Miller*Adam Miller* More articles by this author , David YangDavid Yang More articles by this author , and Brian LinderBrian Linder More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000970.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ovarian cancer has the highest mortality rate of all gynecologic cancers and is the fifth leading cause of cancer mortality in women with a lifetime risk of 1.4%. Despite advances in medicine, there has only been marginal improvement in survival over the past 50 years, mainly due to limited screening. It is known that many ovarian cancers are derived from the fallopian tube and not directly from the ovary. As such, opportunistic salpingectomy with or without oophorectomy has been proposed as a way to decrease ovarian cancer risk in patients undergoing routine pelvic surgery for other indications. The objective of our video is to discuss the role, feasibility, and surgical technique of opportunistic salpingectomy with or without oophorectomy for ovarian cancer risk reduction at the time of open, laparoscopic, or robotic pelvic surgery for another indication. METHODS: We present opportunistic salpingectomy and salpingo-oophorectomy in three patients. The first two cases highlight examples of this technique performed during robotic pelvic surgery and the third case is an example performed during open pelvic surgery. RESULTS: In our video, salpingectomy and salpingo-oophorectomy are performed with minimal added operative time or blood loss. No complications occurred due to the additional procedure. CONCLUSIONS: Salpingectomy and salpingo-oophorectomy for ovarian cancer risk reduction is a safe, feasible option for patients undergoing pelvic surgery. Surgeons familiar with operating in this location should consider opportunistic salpingectomy or salpingo-oophorectomy in females who are no longer interested in fertility preservation and who are undergoing routine pelvic surgery for another indication. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1214-e1214 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adam Miller* More articles by this author David Yang More articles by this author Brian Linder More articles by this author Expand All Advertisement PDF downloadLoading ...

Peacekeeping mitigates killing, but nonlethal violence also influences both positive peace and stability. We evaluate peacekeepers' effect on one such type of abuse, sexual violence. We posit that peacekeepers raise the cost of abuses and foster institutional and cultural changes that curb violence. We find that missions both reduce the chance of any violence and limit its prevalence; larger deployments and multidimensional missions are more effective. Governments curtail violence more quickly than rebels do in response to military contingents; rebels are especially responsive when missions include large civilian components. These findings contribute to our understanding of peacekeeping in three primary ways: we expand the evaluation of peacekeeping to consider nonlethal violence; we draw attention to mission size, capacity to use force, and civilian-led programming as determinants of effectiveness; and we demonstrate how addressing nonlethal violence requires similar tools as lethal violence but is further enhanced by specific civilian-led initiatives.