Genitourinary tract injuries can occur in the urinary tract or reproductive system as a result of trauma-related pelvic fractures, iatrogenic lacerations or ligations, and radiation therapy for reproductive or digestive malignancies. Although surgical reintervention is possible for large urinary tract injuries, a key component for healing smaller injuries is the ability to divert urine from the injury site to prevent urine-wound contact. This enables the injury to heal prior to reintervention and can eliminate the need for a secondary procedure, reducing the potential for complications. This type of urinary diversion is required by 140,000 patients in the United States annually, leading to the development of several devices to divert urine. The current standard of care includes minimally invasive procedures, such as placement of a catheter, double-J stent, or nephroureteral stent, but such measures often do not maintain sufficient dryness to enable wound healing. Based on a review of the literature, we have determined that successful devices need to prevent 100% of the anterograde urine flow, resist migration down the ureter because of peristalsis, and prevent urothelium growth over the device to promote wound healing without causing complications or necessitating reintervention. We also evaluated these devices according to the robustness of the study populations and designs in which they are reported. Some of the more successful devices include detachable, semicompliant balloons, platinum coils, and ureteral clips. Here, we present a narrative review of temporary and permanent ureteral occlusion devices and evaluate their potential for supporting wound healing. We also explore metrics by which to compare and select appropriate devices for urinary diversion.

Background: Artificial urinary sphincter (AUS) placement remains the gold-standard treatment for post-prostatectomy urinary incontinence (PPUI), despite their need for periodic surgical revision. Objective: To understand the experiences of patients who undergo repeat AUS revisions. Design: Mixed design including quantitative surveys and qualitative interviews for thematic analysis. Methods: Men with ⩾2 revisions were collected from a single-institution, retrospective database of AUS patients. Participants were interviewed about their prostatectomy, incontinence, AUS placement, and revisions. A survey was administered utilizing validated tools (e.g., Decision Regret Scale (DRS), Incontinence Impact Questionnaire-7) for quantitative analysis. Interview transcripts were used for qualitative thematic analysis. Results: Of 26 respondents, 20 completed the interview. Twenty-three men completed the survey. The mean DRS score for prostatectomy was 24 (standard deviation (SD) = 27), indicating low regret. Median Incontinence Impact Questionnaire score was 54 (SD = 27), with 70% of participants describing their PPUI as “severe.” Participants experienced a significant decrease in daily pad usage with AUS placement (5.5 pre-AUS vs 1.4 post-AUS, p < 0.0001). Qualitative analysis revealed themes involving prostatectomy urgency, physician–patient relationships, expectation setting, and quality of follow-up. Most participants (96%) were satisfied with their initial AUS placement and endorsed a positive relationship with their urologist. However, 22% of participants were unaware of device limitations, including the need for revision. Some participants (26%) were uncertain of the status of their AUS, while some participants (35%) desired improved follow-up. Conclusions: Initial improvement and positive experiences with urologists motivate patients to undergo AUS repeat revision. Urologists should emphasize the limitations of the AUS before placement and follow up with patients to evaluate their needs for future care.

You have accessJournal of UrologyReconstruction: Urethral Reconstruction (including stricture) I (MP06)1 May 2024MP06-07 FROM CONSENSUS TO VALIDATION: DESIGN AND DEVELOPMENT OF A HIGH-FIDELITY HYDROGEL SIMULATION MODEL FOR URETHROPLASTY PROCEDURES Patrick Saba, Lauren Shepard, Katherine T. Anderson, Nick Warner, Nima Baradaran, Cooper Benson, William R. Boysen, Benjamin N. Breyer, Lindsay Hampson, Ty T. Higuchi, Niels V. Johnsen, Joseph J. Pariser, Jay Simhan, Alex J. Vanni, Dmitriy Nikolavsky, Edward J. Wright, Arthur L. Burnett, Andrew Cohen, and Ahmed Ghazi Patrick SabaPatrick Saba , Lauren ShepardLauren Shepard , Katherine T. AndersonKatherine T. Anderson , Nick WarnerNick Warner , Nima BaradaranNima Baradaran , Cooper BensonCooper Benson , William R. BoysenWilliam R. Boysen , Benjamin N. BreyerBenjamin N. Breyer , Lindsay HampsonLindsay Hampson , Ty T. HiguchiTy T. Higuchi , Niels V. JohnsenNiels V. Johnsen , Joseph J. PariserJoseph J. Pariser , Jay SimhanJay Simhan , Alex J. VanniAlex J. Vanni , Dmitriy NikolavskyDmitriy Nikolavsky , Edward J. WrightEdward J. Wright , Arthur L. BurnettArthur L. Burnett , Andrew CohenAndrew Cohen , and Ahmed GhaziAhmed Ghazi View All Author Informationhttps://doi.org/10.1097/01.JU.0001009452.79331.fd.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethroplasty is the gold standard treatment for urethral stricture repair; however, it is a technically difficult operation due to complex anatomy, large learning curves, lack of intraoperative teaching, and variations in approaches. Utilizing the consensus-building Delphi process, we sought to create a high-fidelity, non-biohazardous, simulation model to train excision and primary anastomosis or graft urethroplasties. METHODS: 20 high volume reconstructive urologists were recruited to complete the Delphi process aimed to reach expert consensus on necessary parameters and design specifications for the simulation model. Consensus>80% was reached regarding procedural realism, anatomical realism, and educational effectiveness. Using previously validated 3D printing and hydrogel molding techniques, researchers fabricated a hydrogel model that incorporated all the expert determined aspects. Prototypes were sent to 55% of the experts who performed a skin-to-skin urethroplasty simulation (Figure 1) as well as a questionnaire evaluating the model to determine if the consensus defined steps were met. The questionnaire utilized a 5-point Likert scale where agreement=4/5, neutral=3, and disagreement=1/2. RESULTS: 91%, 82%, and 100% agreed the model procedurally replicates: the steps necessary to complete the procedure, tissue textures/behaviors, and anatomical relationships including urethral spatulation (91%), suture placement (91%), perineal incision/exposure (91%), and urethral dissection/exposure (100%). 82%, 91%, 64%, 91%, 55%, and 91% agreed it anatomically replicates the; perineum, urethra, fascia over urethra, corpora cavernosa and spongiosum, and bulbospongiosus muscle. 100%, 100%, 100%, 91% and 82% agreed it offers: a safe/non-biohazardous training platform, is useful for teaching/practicing, improving the technical skills, can assess user's ability to perform this procedure and provides useful error feedback. CONCLUSIONS: We successfully designed a high-fidelity, non-biohazardous, simulation model for urethroplasty procedures utilizing expert consensus which displayed high procedural realism, anatomical realism, and educational effectiveness. Ultimately, this model can be used to improve current urethroplasty training. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e54 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Patrick Saba More articles by this author Lauren Shepard More articles by this author Katherine T. Anderson More articles by this author Nick Warner More articles by this author Nima Baradaran More articles by this author Cooper Benson More articles by this author William R. Boysen More articles by this author Benjamin N. Breyer More articles by this author Lindsay Hampson More articles by this author Ty T. Higuchi More articles by this author Niels V. Johnsen More articles by this author Joseph J. Pariser More articles by this author Jay Simhan More articles by this author Alex J. Vanni More articles by this author Dmitriy Nikolavsky More articles by this author Edward J. Wright More articles by this author Arthur L. Burnett More articles by this author Andrew Cohen More articles by this author Ahmed Ghazi More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyFemale Voiding Dysfunction/ Pelvic Floor Disorders/ Incontinence/ Neuro-Urology (V02)1 May 2024V02-01 DESIGN AND DEVELOPMENT OF A HIGH-FIDELITY HYDROGEL SIMULATION MODEL FOR ARTIFICIAL URINARY SPHINCTER PLACEMENT UTILIZING EXPERT CONSENSUS Patrick Saba, Lauren Shepard, Katherine T. Anderson, Nick Warner, Nima Baradaran, Cooper Benson, William R. Boysen, Benjamin N. Breyer, Lindsay Hampson, Ty T. Higuchi, Niels V. Johnsen, Joseph J. Pariser, Jay Simhan, Alex J. Vanni, Omar RaheeM, Dmitriy Nikolavsky, Edward J. Wright, Arthur L. Burnett, Andrew Cohen, and Ahmed Ghazi Patrick SabaPatrick Saba , Lauren ShepardLauren Shepard , Katherine T. AndersonKatherine T. Anderson , Nick WarnerNick Warner , Nima BaradaranNima Baradaran , Cooper BensonCooper Benson , William R. BoysenWilliam R. Boysen , Benjamin N. BreyerBenjamin N. Breyer , Lindsay HampsonLindsay Hampson , Ty T. HiguchiTy T. Higuchi , Niels V. JohnsenNiels V. Johnsen , Joseph J. PariserJoseph J. Pariser , Jay SimhanJay Simhan , Alex J. VanniAlex J. Vanni , Omar RaheeMOmar RaheeM , Dmitriy NikolavskyDmitriy Nikolavsky , Edward J. WrightEdward J. Wright , Arthur L. BurnettArthur L. Burnett , Andrew CohenAndrew Cohen , and Ahmed GhaziAhmed Ghazi View All Author Informationhttps://doi.org/10.1097/01.JU.0001008636.33664.3e.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Artificial urinary sphincter (AUS) implantation is a safe and effective treatment for severe stress urinary incontinence. However, high rates of reoperation due to device erosion, infection, and mechanical failure, combined with limited amount of training outside of live surgery, creates the need to train the next generation of surgeons without patient risk. Utilizing the consensus-building Delphi process, we sought to create a high-fidelity, non-biohazardous, simulation model for AUS implantation. METHODS: 20 high volume AUS implanters were recruited to complete a Delphi process to reach expert consensus on the necessary parameters and design specifications for the simulation model. Consensus>80% was reached in 46% of 187 questions pertaining to procedural realism, anatomical realism, and educational effectiveness. Using previously validated 3D printing and hydrogel molding techniques, researchers fabricated a hydrogel model that incorporated all the expert determined aspects. Prototypes were sent to 9 of the experts who performed a skin-to-skin AUS implantation and a questionnaire evaluating the model and determining if the consensus defined steps were met. The questionnaire utilized a 5-point Likert scale where agreement=4/5, neutral=3, and disagreement=1/2. RESULTS: 100%, 89%, and 100% agreed the model procedurally replicates; all steps of the procedure, tissue texture/behavior, and anatomical relationships including perineal and urethral incision/exposure (100%), circumferential urethral dissection (89%), AUS device prep (89%), reservoir counter incision (67%), cuff measurement/placement (100%), tubing passage (89%), development of subdartos pouch (78%), pump placement (89%), fashioning of tubing (78%), skin closure (89%), and device cycling (79%). 89%, 89%, 78%, 89%, 78%, 89%, and 56% agreed it anatomically replicates the; perineum, urethra, fascia over urethra, corpora cavernosa/spongiosum, bulbospongiosus and pubic bone. 78%, 100%, 100%, 100%, and 89% agreed it offers; useful error feedback, a safe/non-biohazardous training platform, and is useful for teaching/practicing, improving technical skills and assessing trainees. CONCLUSIONS: We successfully created a high-fidelity, non-biohazardous, simulation model for AUS implantation utilizing expert consensus. The model replicated the entire implantation and was rated highly for procedural realism, anatomical realism, and educational effectiveness. Ultimately, this model can be used to improve current AUS training. Source of Funding: n/a © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e100 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Patrick Saba More articles by this author Lauren Shepard More articles by this author Katherine T. Anderson More articles by this author Nick Warner More articles by this author Nima Baradaran More articles by this author Cooper Benson More articles by this author William R. Boysen More articles by this author Benjamin N. Breyer More articles by this author Lindsay Hampson More articles by this author Ty T. Higuchi More articles by this author Niels V. Johnsen More articles by this author Joseph J. Pariser More articles by this author Jay Simhan More articles by this author Alex J. Vanni More articles by this author Omar RaheeM More articles by this author Dmitriy Nikolavsky More articles by this author Edward J. Wright More articles by this author Arthur L. Burnett More articles by this author Andrew Cohen More articles by this author Ahmed Ghazi More articles by this author Expand All Advertisement PDF downloadLoading ...

Purpose: Patients may remain catheterized after artificial urinary sphincter surgery to prevent urinary retention, despite a lack of evidence to support this practice. Our study aims to evaluate the feasibility of outpatient, catheter-free continence surgery using a multi-institutional database. We hypothesize that between catheterized controls and patients without a catheter, there would be no difference in the rate of urinary retention or postoperative complications.Materials and Methods: We conducted a retrospective review of patients undergoing first-time artificial urinary sphincter placement from 2009-2021. Patients were stratified by postoperative catheter status into either no-catheter (leaving the procedure without a catheter) or catheter (postoperative indwelling catheter for similar to 24 hours). The primary outcome, urinary retention, was defined as catheterization due to subjective voiding difficulty or documented postvoid residual over 250 mL. Results: Our study identified 302 catheter and 123 no-catheter patients. Twenty (6.6%) catheter and 9 (7.3%) no-catheter patients developed urinary retention (P = .8). On multivariable analysis, controlling for age, cuff size, radiation history and surgeon, there was no statistically significant association between omitting a catheter and urinary retention (OR: 0.45, 95% CI: 0.13-1.58; P = .2). Furthermore, at 30 months follow-up, Kaplan-Meier survival analysis revealed that device survival was 70% (95% CI: 62%-76%) vs 69% (95% CI: 48%-82%) for the catheter and no-catheter group, respectively. Conclusions: In our multi-institutional cohort, overall retention rates were low (7%) in groups with a catheter and without. Obviating postoperative catheterization facilitates outpatient incontinence surgery without altering reoperation over medium-term follow-up.

not associated with the patient's age, body mass index, a history of urethroplasty, or the type of urethroplasty (simple perineal or elaborate approach). However, an open bladder neck on antegrade cystoscopy and/or cystourethrography (OR 11.85, 95% CI 2.23-62.9, p [ 0.004) and a longer MUL (every extra millimeter, OR 0.87, 95% CI 0.76-1.00, p [ 0.04) were signi fi cant predictors of PUI on multivariate analysis. CONCLUSIONS: A greater preoperative MUL is signi fi cantly and positively associated with PUI in male patients with PFUI. MUL on MRI may be potentially valuable to reconstructive urologists when counseling patients in clinical practice, prior to urethroplasty.

Purpose: In order to accurately characterize how a history of radiation therapy affects the lifespan of replacement artificial urinary sphincters (AUSs), all possible sources of device failure must be considered. We assessed the competing risks of device failure based on radiation history in men with replacement AUSs. Materials and Methods: We identified men who had a replacement AUS in a single institutional, retrospective database. To assess survival from all-cause device failure based on radiation history and other factors, we conducted Kaplan-Meier, Cox proportional-hazards and competing risks analyses. Results: Among 247 men who had a first replacement AUS, men with a history of radiation had shorter time to all-cause device failure (median 1.4 vs 3.5 years for men with radiation vs without radiation history, p=0.02). On multivariable Coxproportional hazards analysis, previous radiation was associated with increased risk of all-cause device failure (HR: 2.12, 95% CI: 1.30-3.43, p=0.002). On multivariable cause-specific hazards analysis, prior radiation was associated with a higher risk of erosion/infection (HR: 7.57, 95% CI: 2.27-25.2, p <0.001), but was not associated with risk of urethral atrophy (p=0.5) or mechanical failure (p=0.15). Conclusions: Among men with a replacement AUS, a history of pelvic radiation was associated with shorter time to device failure of any cause. Radiation was also specifically associated with a sevenfold increase in the risk of erosion or infection of replacement AUS, but not with urethral atrophy or mechanical failure. Patients with a replacement AUS should be appropriately counseled on how radiation history may impact outcomes of future revisions.

You have accessJournal of UrologyLower-Tract Reconstruction I: Sling/ Sphincter/ Penile & Urethral Reconstruction (V06)1 Apr 2020V06-12 COMPONENT-SPARING REVISION OF ARTIFICIAL URINARY SPHINCTER Russell Becker*, Gregory Joice, and E. James Wright Russell Becker*Russell Becker* More articles by this author , Gregory JoiceGregory Joice More articles by this author , and E. James WrightE. James Wright More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000885.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Artificial urinary sphincter (AUS) remains the gold standard of surgical therapy for post-prostatectomy incontinence. These prosthetic devices have an expected failure-free lifespan of 7-10 years. Reoperation with complete device replacement is invasive, resource-intensive, and costly. This video demonstrates our stepwise operative approach to interrogate each device component and replace individual components only as necessary. This allows for the remaining functional components of the device to be preserved, minimizing operative time, cost, patient morbidity, and recovery time. METHODS: The pressure-regulating balloon (PRB) is exposed first through a groin incision, to interrogate for any fluid leak or loss of pressure regulating function using a water column test. If failure of the PRB fully accounts for the device malfunction, and replacement of the PRB restores proper device function, the procedure can be safely concluded at this stage, sparing the patient a perineal incision and dissection, and allowing them to retain their functioning urethral cuff and pump. If the PRB does not fully account for the device malfunction, the urethral cuff is exposed through a perineal incision and interrogated for fluid leak or malfunction, and replaced if necessary. The device is cycled intraoperatively under cystoscopic vision to confirm restoration of proper function. RESULTS: In our experience, the PRB is the most common cause of device malfunction, and replacement of this single component can be safely and reliably performed through a single groin incision, sparing the patient a perineal dissection, and allowing them to retain the functional components of their AUS device. In these cases, most patients are discharged home on the day of surgery, and resume use of their device immediately. CONCLUSIONS: Component-sparing revision of AUS devices is technically feasible and spares the patient unnecessary morbidity and cost. The PRB is the most common cause of device failure, and replacement of the PRB alone can often restore proper device function. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e559-e559 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Russell Becker* More articles by this author Gregory Joice More articles by this author E. James Wright More articles by this author Expand All Advertisement PDF downloadLoading ...

Hypothesis / aims of study Stress urinary incontinence (SUI) occurs in 60% of men after radical prostatectomy, with 5% requiring surgical treatment. The artificial urinary sphincter (AUS), which offers excellent control of their post-prostatectomy SUI, contains 3 parts: the pump, urethral cuff, and pressure regulating balloon reservoir. Despite the effectiveness of AUS, up to 50% of patients require surgical revision after initial placement due to recurring SUI. Thus far, literature is heterogeneous regarding the causes of mechanical AUS failure and appropriate surgical management. Our study aims to tabulate the most common reasons of AUS failure requiring surgical revision and measure the differential survival of each AUS component.

Voiding is the culmination of a complex, exquisitely coordinated neuromuscular system under voluntary control but subsuming numerous visceral reflex arcs acting independently of volitional awareness or control. Urine storage and emptying are active processes. Urinary continence is maintained by anatomic support structures and neuromuscular control mechanisms. Urodynamic testing provides manometric, neuromuscular, and perceptual information to inform the practitioner approaching a patient with voiding dysfunction. Goals of therapy for neurogenic voiding dysfunction include preservation of renal function, adequate urinary continence, and maximum independence/ease of care.

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (PD22)1 Apr 2019PD22-07 ANALYSIS OF PROGRESSIVE LUMENAL EXPANSION ON URETHRAL MICROPERFUSION USING LASER DOPPLER FLOWMETRY IN NEW ZEALAND WHITE MALE RABBITS Teja Maruvada*, Gregory Joice, Chanya Elakkad, Sarah Beck, and E. James Wright Teja Maruvada*Teja Maruvada* More articles by this author , Gregory JoiceGregory Joice More articles by this author , Chanya ElakkadChanya Elakkad More articles by this author , Sarah BeckSarah Beck More articles by this author , and E. James WrightE. James Wright More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555763.12516.fdAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Male urethral stricture disease (USD) is a relatively common condition often requiring multiple endoscopic and open procedures as treatment. Repeat urethral catheterization is a risk factor for USD likely resulting from focal urethral ischemia leading to scar formation but this process is not well understood. We sought to better understand the impact of urethral expansion on tissue microperfusion using a rabbit model. METHODS: 12 NZ white male rabbits were anesthetized and their urethras wereserially expanded using pulmonary CRE balloons (Boston Scientific), which expand to 24/27/30/33 Fr. Concentration and velocity of red blood cells are recorded using a 4 Fr endoscopic side-viewing laser Doppler flowmetry (LDF) probe (Moor Instruments). To assess the impact of expansion time on microperfusion, the balloon was expanded to 30 Fr and LDF measurements were continuously recorded for 30 minutes. Rabbits were euthanized at 0 or 1 week and their urethras harvested and stained for hematoxylin and eosin (H&E) to study the acute and chronic effects of urethral expansion. RESULTS: Increasing urethral expansion was shown to have an inverse linear relationship tissue microperfusion. Tissue microperfusion was decreased by 74% at 33 Fr expansion compared to 24 Fr (34.30 vs. 107.9 perfusion units (PU), p <0.05). Over time, tissue perfusion increased slightly from nadir of 42.7 PU to peak of 52.4 PU before stabilizing at an expansion on 30 Fr. However, perfusion did not reach normal values at any time period tested. On H&E staining, there was evidence of acute inflammation at week 0 that was no longer present after 1 week. We did not see any evidence of scar formation over this short time period. CONCLUSIONS: Increasing urethral expansion diameter and duration leads to decreased tissue microperfusion. There is evidence of acute inflammation initially that resolves after 1 week although no scar formation is noted over this time period. Future studies will assess for scar formation with longer expansion times and further time points. Source of Funding: Maryland Innovation Initiative (MII) & Johns Hopkins-Coulter Translational Partnership Baltimore, MD© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e390-e390 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Teja Maruvada* More articles by this author Gregory Joice More articles by this author Chanya Elakkad More articles by this author Sarah Beck More articles by this author E. James Wright More articles by this author Expand All Advertisement PDF downloadLoading ...

Adenocarcinoma is a rare finding following urinary diversion with gastrointestinal segments. This report describes an 80-year-old woman with a history of bladder cancer who subsequently developed a pT4 adenocarcinoma 8 years following her radical cystectomy and Indiana Pouch continent urinary diversion. An en bloc resection of the pouch and affected small bowel was performed and the patient underwent conversion to an ileal conduit diversion. We use this case to highlight a mechanism for possible pathogenesis and the management of adenocarcinoma in urinary diversions including the need for regular surveillance and the surgical approach.

This study aimed to determine the prevalence of mild cognitive impairment (MCI) and early dementia among women >55 years seeking care for pelvic floor disorders (PFDs) and to describe the impact of cognitive impairment on condition-specific quality of life (QoL). We hypothesized that the prevalence of MCI would be at least 15% among this population.

Cancer survivors often have poor outcomes compared to their peers without cancer. Mortality from prostate cancer has been steadily decreasing, and these cancer survivors have other comorbidities that progress over time. Current study explores the type of admissions and associated risk factors with recurrent hospitalizations among prostate cancer survivors. A retrospective review of medical records was performed at a single academic institution for male patients aged 40 years and older who were diagnosed with prostate cancer more than 2 years prior to the study’s observation period from January 2008 to December 2010. Unpaired t test and Chi-square tests were used to compare patients’ characteristics, and logistic regression models were used to assess risk factors association with recurrent admissions. In total, 245 prostate cancer survivors were stratified by single versus recurrent hospital admission. The characteristics of the study population were similar to the exception of mean Gleason score that was lower, while cardiovascular admissions and clinical comorbidities were higher in the recurrent group. In the multivariable regression analyses where sociodemographic, primary prostate cancer treatment-related sequelae and clinical comorbid conditions were simultaneously analyzed, congestive heart failure (OR 3.90, 95% CI 1.25–12.2) and history of metastasis (OR 8.10, 95% CI 1.10–60.1) were associated with recurrent hospital admissions. Prostate cancer survivors experience a greater number of recurrent admissions, and therefore, understanding the nature of these admissions and associated medical comorbidities may help us in developing screening or preventive strategies to reduce the readmissions for this group of cancer survivors.

Paratesticular tumors are rare and often benign causes of scrotal masses. Intrascrotal angiolipomas are an uncommon paratesticular tumor that has seldom been reported in the literature. This report describes a 77 year old man who presented with a 15 cm extratesticular mass. The mass was removed due to increasing discomfort and specimen pathology confirmed it as an angiolipoma. This case highlights the feasibility of conservative management for slow growing masses, such as angiolipomas.

Over the last 5 decades, health-care advances have yielded quantum improvements in the life expectancy of individuals with congenital genitourinary conditions (CGCs), leading to a crisis of care. Many individuals with CGC enter adulthood unprepared to manage their condition. Pediatric CGC specialists lack training to manage adulthood-related health-care issues, whereas adult genitourinary specialists lack training within the context of CGCs. To address these challenges, the National Institutes of Diabetes and Digestive and Kidney Diseases convened individuals with CGCs and experts from a variety of fields to identify research needs to improve transitional urology care. This paper outlines identified research needs.

INTRODUCTION: Bladder exstrophy is a complex congenital anomaly with long-term impact on the health of patients. Our objective was to determine the psychosexual health outcomes of adult women with bladder exstrophy. METHODS: We performed a qualitative study using an online survey posted through social media. RESULTS: Of 147 respondents, 98 were female >18 years old with bladder exstrophy (range 19–66 years, mean 35.5). The majority were non-Hispanic white (87.8%), at least some college (74.5%), yearly income less than $30,000 (39.4%), married or living with a partner (43.2%), heterosexual (90.7%), and employed (69.8%). Mean age of first sexual activity was 19.2 years (SD 3.5). Due to exstrophy, 32.1% reported impairment of daily life. Many (63.0%) hide their diagnosis from peers or coworkers. Participants with poor coping abilities were not more likely to report daily impairment (P=.37), nor to hide their diagnosis (P=.69). The median number of people outside the family that know an individual's diagnosis was 10 (mean 21). The majority of participants were uncomfortable undressing in front of others (77.6%). Many have never masturbated (25.7%), or do so less than once per month (39.2%). While 18% have no anxiety concerning sexual intercourse, almost one-third have a lot of anxiety (31.1%). The majority of the respondents are sexually active (77.6%), with 31 participants who have been pregnant. Of the women who have never been pregnant, 44.8% want to be pregnant now or in the future. CONCLUSION: Counseling patients with bladder exstrophy regarding psychosexual health issues is important as they transition from pediatric to adult care.

Purpose: The artificial urinary sphincter is the gold standard long-term solution for male stress incontinence. Some urologists believe that including a second urethral cuff at the time of placement can improve efficacy but strong evidence is lacking. We compared the functionality of a single vs a tandem cuff in a cadaver model. Materials and Methods: Artificial urinary sphincter reservoir pressure was confirmed at 61 to 70 cm H2O. The bulbar urethra was dissected through a perineal approach in each of 4 cadavers. Distal and proximal bulbar urethral circumference was measured. The membranous urethra was transected. Cuffs sized based on circumference measurements were placed distal and proximal, and connected to the reservoir and pump. Retrograde leak point pressure was measured sequentially across the distal, proximal and tandem cuffs. We used the Friedman test to compare retrograde leak point pressure among the 3 cuff positions, the paired t-test to compare distal and proximal urethral circumferences and the Spearman correlation to compare urethral circumference to retrograde leak point pressure. Results: Mean retrograde leak point pressure across the distal, proximal and tandem cuffs was 73.5, 77.75 and 79.25 cm H2O, respectively (p = 0.44). Mean urethral circumference of the distal and proximal bulbar urethra was 4.78 and 5.83 cm, respectively (p = 0.019). There was a strong positive correlation between urethral circumference and retrograde leak point pressure (r(s) = 0.5). Conclusions: The tandem cuff did not improve retrograde leak point pressure. Proximal bulbar urethral circumference was greater than distal circumference and increasing urethral circumference correlated with increasing retrograde leak point pressure. Therefore, the perceived benefit of tandem cuffs may reflect more proximal placement of one of the cuffs.