Introduction: Increasingly, unicompartmental knee arthroplasty (UKA) is being performed on an outpatient basis, with the growing utilization of ambulatory surgery centers (ASCs). The purpose of this study was to compare the costs of UKAs performed in an ASC to UKAs done in a hospital, either on an outpatient or inpatient basis. Methods: This study involved three matched groups, each with 50 consecutive patients, undergoing UKA either on an outpatient basis in an ASC or a community hospital, or who were admitted overnight to the same community hospital. Identical perioperative analgesic regimens and care protocols were used in each group. The primary outcomes evaluated included direct facility costs. Secondary outcomes were postoperative complications and readmissions. Results: Average age, gender ratio, and comorbidities were similar in all three cohorts. Only two patients in the study experienced complications and these were without secondary adverse consequences. Mean costs were substantially reduced when UKAs were performed in an ASC ($9,025) compared to a community hospital on either an outpatient ($12,032) or inpatient basis ($14,542).Conclusion: UKA can be safely performed in the outpatient setting, in appropriately selected patients, at substantial cost savings, particularly when performed in an ASC.

p[0.001), total length GP4 (HR[2.48; 95% CI 1.36e4.52; p[0.003), and total length GP4 in highest core (HR[1.32; 95% CI 1.11e1.57; p[0.001)dwere significantly associated with BCR. Models including all methods of GP4 quantification resulted in a meaningful increase in discrimination of BCR risk, with similar gains in Harrell's C-index ranging from 0.017 to 0.019. CONCLUSIONS: These findings further support routine reporting of and inclusion of GP4 quantification in pathology reports and risk prediction models for patients with Grade Group 2 prostate cancer. These data also support studying GP4 quantification as a surrogate endpoint for disease progression for trials, including those of men managed with active surveillance.

INTRODUCTIONHemorrhagic cystitis (HC) is a morbid condition for patients and can be challenging for urologists to manage. There are many potential contributing etiologies and the severity of bleeding can be variable. It is important to consider each clinical scenario when formulating management strategies in order to provide the highest quality of care to patients. We provide a review of the literature including diagnosis and treatment options.MATERIALS AND METHODSWe performed a literature search on PubMed using the following keywords: hemorrhagic cystitis, cystitis, gross hematuria, intractable hematuria. We considered all available published articles with no specific inclusion or exclusion criteria for the purposes of this review.RESULTSWe reviewed a total of 41 articles and identified a broad differential diagnosis for intractable hemorrhagic cystitis including infection, chemical exposure, malignancy, nephropathy, trauma, radiation therapy, and idiopathic etiology. Depending on the severity of bleeding, many treatments have been described. These range from conservative strategies (bladder fulguration and continuous irrigation) to more extreme and morbid therapies (intravesical instillations, embolization, and urinary diversion).CONCLUSIONHemorrhagic cystitis is a relatively common and can be a difficult condition to manage for urologists. It is important to understand the etiology and available treatments options in order to best treat our patients. We provide a comprehensive and thorough review of the literature and propose a stepwise treatment approach.

Catheter associated urinary tract infections (CAUTIs) are common hospital-acquired infections and remain a significant medical and financial challenge to the healthcare system. Despite this risk, incontinent women may require prolonged catheterization to accurately monitor urine output and prevent skin breakdown. The PureWick Female External Urinary Catheter is a promising non-invasive urine collection system for use in incontinent women that may help reduce CAUTI rates, maintain skin integrity, accurately quantify urine output, and avoid extra healthcare costs.

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology II (PD41)1 Sep 2021PD41-03 MULTI-INSTITUTION COMPARISON OF NINE FLEXIBLE URETEROSCOPES USING A VALIDATED FLEXIBLE URETEROSCOPE EVALUATION TOOL Margaret Knoedler, Scott Quarrier, Shuang Li, Alex Uhr, Shreya Patel, John Bell, Kristina Penniston, Scott Hubosky, Rajat Jain, and Stephen Nakada Margaret KnoedlerMargaret Knoedler More articles by this author , Scott QuarrierScott Quarrier More articles by this author , Shuang LiShuang Li More articles by this author , Alex UhrAlex Uhr More articles by this author , Shreya PatelShreya Patel More articles by this author , John BellJohn Bell More articles by this author , Kristina PennistonKristina Penniston More articles by this author , Scott HuboskyScott Hubosky More articles by this author , Rajat JainRajat Jain More articles by this author , and Stephen NakadaStephen Nakada More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002051.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical urologists need a standardized way to compare the quality of flexible ureteroscopes for clinical and research purposes. We validated a flexible ureteroscope evaluation tool (Bell 2017). Our objective was to apply the tool widely to test its consistency across multiple institutions and multiple ureteroscopes. METHODS: Ureteroscopes (n=9) were assessed using the ureteroscope evaluation tool by three academic institutions. Surgeons completed the evaluation tool at the end of cases for which a variety of flexible ureteroscopes were used [Stortz Flex Xc (Xc), Stortz Flex X2 (X2), Olympus URF-P5 (P5), Olympus URF-P6 (P6), Olympus URF-P7 (P7), WiScope, LithoVue, Dornier and Pusen]. The tool contains nine evaluation domains designed to provide a comprehensive assessment of the ureteroscope (Figure 1). The domains are: historic experience with the device, quality of image, strength of deflection, scope maneuverability, intuitiveness of controls, ease of irrigation, ease of ureteroscopic access, functionality of working channel and overall satisfaction. SPSS was used to conduct statistical analysis for internal consistency of the tool and MANOVA for comparing the scopes across domains. RESULTS: A total of 311 responses distributed across three institutions were completed for the nine ureteroscopes. Results demonstrated the tool’s internal consistency (Cronbach alpha coefficient=0.85). The ureteroscope with the highest overall satisfaction score was the P7 (4.81±0.26) and the lowest overall satisfaction score was the Pusen (1.43±0.79). Mean scores across domains are reported in Figure 2. CONCLUSIONS: Our evaluation tool can be used to evaluate new ureteroscopes as they come to market. This tool is applicable to a variety of ureteroscopes with consistent results across multiple institutions and over time. This is extremely important as urologists do not always have the ability to test each ureteroscope in hand. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e681-e681 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Margaret Knoedler More articles by this author Scott Quarrier More articles by this author Shuang Li More articles by this author Alex Uhr More articles by this author Shreya Patel More articles by this author John Bell More articles by this author Kristina Penniston More articles by this author Scott Hubosky More articles by this author Rajat Jain More articles by this author Stephen Nakada More articles by this author Expand All Advertisement Loading ...

INTRODUCTION:Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is a common condition affecting older men. New interventional treatments have emerged and evolved over the years, each with their own distinct efficacy and safety profiles. While some have fallen out of favor, new options continue to be explored.MATERIALS AND METHODS:We provide a review and update on minimally invasive treatment modalities for BPH, including prostatic artery embolization (PAE), Aquablation, convective water vapor thermal therapy (Rezum), and prostatic urethral lift (Urolift).RESULTS:While current urologic guidelines recommend against PAE outside of the context of clinical trials, Aquablation, Rezum, and Urolift have demonstrated excellent efficacy and durability in relieving LUTS in the BPH patient. When compared to the gold standard, transurethral resection of the prostate (TURP), these novel therapies yield equivalent or superior objective outcomes, with the additional benefit of significantly reduced sexual side effects. Additionally, Rezum and Urolift may be performed as outpatient procedures under local anesthesia, allowing for decreased hospitalizations, operative times, catheterization duration, and financial burden on the health care system.CONCLUSIONS:Aquablation, Rezum and Urolift are minimally invasive surgical treatment options capable of providing rapid, significant, and durable relief of LUTS secondary to BPH. Each technique demonstrates comparable efficacy to TURP with the added advantages of preserving sexual function, decreasing patient morbidity, and limiting healthcare costs.

INTRODUCTION:Prostate cancer is a common malignancy with highly variable clinical presentation and outcomes. Diagnosis and management remain a challenge and at times become highly controversial. Novel biomarker assays have shown promise as an adjunctive tool to aid in patient shared decision-making, risk stratification, and disease management. This presentation at the 2020 Jefferson Urology Symposium provided a review of current commonly used biomarkers for prostate cancer.MATERIALS AND METHODS:We reviewed the current literature on the use of biomarkers in the diagnosis and treatment decisions in localized prostate cancer.RESULTS:Biomarker assays were reviewed and presented according to clinical application of each test. In the consideration of initial prostate biopsy the blood tests for PHI, and 4K Score, and urine tests PCA3, Select MDx and ExoDx are available. In the consideration of treatment versus active surveillance in the biopsy positive setting OncotypeDx, Prolaris and Decipher are available. In patients with an initial negative biopsy, 4K score, PCA3, ExoDx and the tissue biopsy based Confirm MDx assay can help guide the decision to perform repeat biopsy. In the consideration for adjuvant radiation following radical prostatectomy the most extensive literature available supports the use of Prolaris or Decipher tissue assays.CONCLUSIONS:With the significant burden of men being diagnosed with prostate cancer, it is desirable to appropriately risk stratify patients to avoid unnecessary biopsies and over-treatment in low risk patients and guide appropriate treatment strategies in high risk patients. Selected biomarkers presented are useful adjunctive precision medicine tools to aid in shared decision making and to direct treatment decisions.

The evaluation of anatomic bladder outlet obstruction due to benign prostatic hyperplasia in patients with neurogenic bladder dysfunction can be a challenging and complex process for urologists. Lower urinary tract symptoms are non-specific, and the attribution of symptoms to underlying neurologic disease may result in withholding potentially beneficial therapies and procedures from patients with benign prostatic hyperplasia. Conversely, the underlying neurologic disorder may have profound effects on lower urinary tract symptoms and quality of life and must be considered in patient management decisions. Thorough evaluation is necessary to evaluate male patients with concomitant benign prostatic hyperplasia and neurogenic bladder with careful attention to the underlying neurologic disease. While surgical management of anatomic bladder outlet obstruction has a clear role in carefully selected and thoroughly evaluated patients with neurogenic bladder, treatment strategies must be individualized for each patient. This review seeks to explore the role of prostate-reducing surgeries in management of patients with neurogenic bladder and to compile evidence for and against these procedures in this population. Only a few studies have been published exploring prostate-reducing surgery in the management of patients with neurogenic bladder, with no recent trials. These existing studies are poorly controlled and are characterized by small, heterogeneous study populations, retrospective design, and high risk of bias. While some studies suggest positive outcomes from prostate-reducing surgery for management of patients with neurogenic bladder, more high-quality trials are needed.

INTRODUCTION:Holmium endoscopic laser enucleation of the prostate (HoLEP) is a well-established alternative to traditional transurethral resection and open prostatectomy for the treatment of benign prostatic hyperplasia (BPH). We investigate the 1470 nm diode laser for enucleation as an alternative to HoLEP. The safety, efficacy, and initial outcomes of diode enucleation of the prostate (DiLEP), when compared to HoLEP, were examined.MATERIALS AND METHODS:We reviewed records of 50 patients who underwent DiLEP between 2012 and 2015 and matched them with 50 HoLEP patients during the same time period. Objective evaluation of efficacy was determined by comparing preoperative post-void residual volume (PVR) and peak flow (Qmax) to postoperative values at 4-16 weeks and 1 year following surgery. Subjective evaluation was measured using the International Prostate Symptom Score (IPSS) before and after the operation. Safety was evaluated by the development of persistent Clavien-Dindo grade 1, or 2 or higher postoperative complications. Statistical analyses were conducted using chi-squared and paired Student's t-tests.RESULTS:Subjective and objective postoperative results showed no difference between DiLEP and HoLEP. Average PVR volume following DiLEP was 47.1 mL at 1 year. The mean increase in Qmax was 16.4 mL/s at 1 year. The IPSS improved by a mean of 12.7 points, and by 2.6 points on quality of life questioning at 1 year post operation. Compared to HoLEP patients there was no statistically significant difference. Safety assessments were the same across both procedures.CONCLUSIONS:Diode laser is safe and effective for use in patients with BPH, with no significant difference in outcomes compared to HoLEP.

Leong, Joon Yau; Syed, Ali MD; Uhr, Alexander MD; Chandrasekar, Thenappan MD; Gomella, Leonard MD, FACS; Glassman, Deborah MD, FACS Author Information

We sought to explore the relationship between obesity and overactive bladder (OAB) and to review the available literature that supports weight loss as a means to alter OAB severity and bother.

An asymptomatic 73-year-old woman was found to have a submucosal mass in the descending colon on routine colonoscopy. A CT scan revealed a 31 x 28 x 31 mm lesion in the same location. Previous biopsy proved to be nondiagnostic, and the patient underwent a laparoscopic descending colon resection. Histologic evaluation of the tumor revealed a low grade spindle cell neoplasm with strong, diffuse positivity for S-100 protein by immunohistochemistry, leading to the diagnosis of schwannoma. A review of the literature revealed intestinal schwannoma to be a rare disease entity, with only about 50 cases previously reported.