OBJECTIVE:To compare PrecisionPoint and grid-based biopsies on rates of clinically significant prostate cancer (csPCa) detection and complications when transperineal MRI-fusion targeted biopsy is performed. MATERIALS AND METHODS:We queried a prospectively maintained prostate biopsy database to identify men ages 18-89 who underwent transperineal MRI-fusion targeted prostate biopsies (including concurrent systematic biopsies) between August 1, 2020 and September 1, 2024. The primary outcome was detection of csPCa in the MRI region of interest. 30-day complications and overall rates of csPCa were examined at the patient level. Subgroup outcomes included cancer detection in anterior MRI lesions and stratification by prior biopsy status. Logistic regression was performed. RESULTS:1134 MRI lesions in 890 patients were included in the analysis (PrecisionPoint: 542 patients/714 lesions; grid-based biopsy: 348 patients/420 lesions). There were no differences in prostate cancer detection between the two groups overall. For patients with a prior negative biopsy, a grid-based approach detected a higher rate of csPCa (P=.021). On logistic regression, biopsy approach was not a significant predictor of csPCa at either the patient (P=.797) or lesion (P=.473) levels. Complication rates and the ability to detect csPCa in anterior lesions were similar between approaches. CONCLUSION:PrecisionPoint and grid-based biopsies identified similar rates of prostate cancer, including in anterior MRI lesions, when transperineal MRI-targeted prostate biopsy was performed in this cohort. Complication rates were low and did not differ based on technique.

We evaluated preoperative weight loss and days from initial consult to surgery in patients with BMI ≥50 kg/m2 who were and were not enrolled in medical weight management (MWM) prior to laparoscopic sleeve gastrectomy. We retrospectively identified patients with BMI ≥50 kg/m2 who had primary sleeve gastrectomy between 2014 and 2019 at two bariatric surgery centres in our healthcare system. Patients presenting after 2017 that received preoperative MWM (n = 28) were compared to a historical cohort of non-MWM patients (n = 118) presenting prior to programme initiation in 2017 on preoperative percent total body weight loss (%TBWL) and days from initial consult to surgery. A total of 151 patients (MWM, 33; non-MWM, 118) met inclusion criteria. BMI was significantly greater in MWM versus non-MWM (p = .018). After propensity score matching, median BMI at initial consult in non-MWM versus MWM no longer differed (p = .922) neither were differences observed on the basis of weight, age, sex, race or ethnicity. After PSM, MWM had significantly lower BMI at surgery (p = .018), lost significantly more weight from consult to surgery (p < .001) and achieved significantly greater median %TBWL from consult to surgery (p < .001). We noted no difference between groups on 6-month weight loss (p = .533). Days from initial consult to surgery did not differ between groups (p < .863). A preoperative MWM programme integrated into multimodal treatment for obesity in patients with a BMI ≥50 kg/m2 resulted in clinically significant weight loss without prolonging time to surgery.

INTRODUCTION:Optimal pain control methods after total shoulder arthroplasty (TSA) achieve reduced opioid consumption, shortened hospital stay, and improved patient satisfaction in addition to adequate analgesia. Interscalene brachial plexus block is the gold standard for TSA, yet it typically does not provide pain relief lasting beyond 24 hours. Liposomal bupivacaine (LB) purportedly provides prolonged analgesia, yet it has been minimally explored for interscalene block, and it is significantly more expensive than standard bupivacaine. METHODS:This is a prospective, 2-arm, double-blinded randomized controlled trial. Subjects presenting for anatomic or reverse TSA were randomized in a 1:1 ratio to receive interscalene brachial plexus block with either LB plus bupivacaine (LBB group) or bupivacaine plus dexamethasone and epinephrine (BDE group). The primary outcome was 120-hour postoperative opioid consumption. Secondary outcomes were pain scores up to 96 hours postoperatively, pain control satisfaction, complications, level of distress from block numbness, and hospital stay. RESULTS:Ninety patients, 45 per group, were included in the intention-to-treat analysis and randomized. Because of withdrawal of consent and loss to follow-up, 40 in each group completed enrollment through postoperative day 60. Total 120-hour postoperative opioid consumption was similar between groups (P = .127), with no differences within 24- or 48-hour time intervals. Postoperative pain scores at 24-48 hours, 48-72 hours, 72-96 hours, and day 60 were significantly lower for the LBB group. DISCUSSION:LB interscalene brachial plexus block before total shoulder arthroplasty did not reduce 120-hour postoperative opioid consumption but significantly reduced postoperative pain between 24 and 96 hours and at postoperative day 60.

Revisional bariatric surgery after an index adjustable gastric band (AGB) may be indicated to remedy weight relapse or band-related complications. We examined outcomes five years following revision from AGB to laparoscopic sleeve gastrectomy (AGB-LSG) or to Roux-en-Y gastric bypass (AGB-RYGB). We conducted a retrospective review to identify patients (men and women, age 18–80) who underwent one revisional bariatric procedure with AGB as the index procedure at two medical centers in our healthcare system between January 2012 and February 2017. We only included patients with a pre-revision BMI > 30 kg/m2 for whom 5-year follow-up data were available. We compared 5-year weight loss and remission of comorbidities in patients undergoing AGB-LSG and AGB-RYGB conversion. A total of 114 patients met inclusion criteria (65 AGB-LSG, 49 AGB-RYGB). At 5-year post-revision, percent total weight loss (3.4

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP20)1 May 2024MP20-20 Outcomes Following Robotic-Assisted Simple Prostatectomy in Patients on Active Surveillance/Watchful Waiting or with Incidental Prostate Cancer Diagnosis on Pathology Dylan Buller, Ilene Staff, Tara McLaughlin, Kevin Pinto, Laura Olivo Valentin, Joseph Tortora, David Ahlborn, Brandon Stahl, Ryan Dorin, Stuart Kesler, and Joseph Wagner Dylan BullerDylan Buller , Ilene StaffIlene Staff , Tara McLaughlinTara McLaughlin , Kevin PintoKevin Pinto , Laura Olivo ValentinLaura Olivo Valentin , Joseph TortoraJoseph Tortora , David AhlbornDavid Ahlborn , Brandon StahlBrandon Stahl , Ryan DorinRyan Dorin , Stuart KeslerStuart Kesler , and Joseph WagnerJoseph Wagner View All Author Informationhttps://doi.org/10.1097/01.JU.0001008732.80104.31.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic-assisted simple prostatectomy (RASP) is an effective surgical option for men with benign prostatic hyperplasia (BPH), particularly for men with large/very large prostates. Outcomes have not been studied in men undergoing RASP with prior diagnosis of prostate cancer (PCa) on active surveillance (AS)/watchful waiting (WW) or who have PCa incidentally identified on pathology specimen. Additionally, the proportion of patients who subsequently undergo radical treatment for PCa is unknown. Our goal was to analyze oncologic and surgical outcomes of these groups. METHODS: We performed a retrospective analysis of all men aged 18-89 who underwent RASP from 8/1/2016 to 9/30/2023 at our institution. Men who were on AS/WW or who had PCa first identified on RASP pathology were included. Here, we present descriptive statistics on oncologic and surgical outcomes. RESULTS: Of 288 patients who underwent RASP, 23 (8%) were on AS/WW and 20 (7%) had new PCa diagnosis on RASP pathology. Of those 43 patients, median pre-operative PSA was 8.5 and median first post-RASP PSA was 1.2. No patient required additional BPH surgery. There were no instances of bladder neck contracture. All 43 were able to void spontaneously following RASP, including 18 patients (42%) in retention at the time of surgery. Five patients (1.7% of total cohort) underwent subsequent radical therapy for PCa, including 2 with high risk PCa on RASP pathology and 3 with pathologic upstaging on subsequent prostate biopsy; of the five, 2 were on AS/WW and 3 had new PCa diagnosis (Figure 1). Median follow-up after surgery was 14 months. Table 1 lists oncologic and surgical outcomes. CONCLUSIONS: RASP is safe and effective in men with a prior diagnosis of PCa or with new diagnosis of PCa on RASP pathology. Few men undergoing RASP in our cohort proceeded to radical therapy for PCa. Nonetheless, patients on AS/WW undergoing RASP or those with PCa diagnosed on RASP specimen should be monitored for progression of PCa warranting further intervention. Download PPT Source of Funding: Unfunded © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e328 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Dylan Buller More articles by this author Ilene Staff More articles by this author Tara McLaughlin More articles by this author Kevin Pinto More articles by this author Laura Olivo Valentin More articles by this author Joseph Tortora More articles by this author David Ahlborn More articles by this author Brandon Stahl More articles by this author Ryan Dorin More articles by this author Stuart Kesler More articles by this author Joseph Wagner More articles by this author Expand All Advertisement PDF downloadLoading ...

Research on the use of prophylactic inferior vena cave filter (IVCF) placement prior to metabolic and bariatric surgery (MBS) in high risk patients has yielded conflicting results. We evaluated thrombotic events and mortality in patients with a history of venous thromboembolism (VTE) who underwent IVCF placement in anticipation of MBS. We queried the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for all patients undergoing primary sleeve gastrectomy or Roux-en-Y gastric bypass from 2015 to 2019 with a history of VTE. We tabulated yearly IVCF use and compared 30-day rates of deep venous thrombosis (DVT), pulmonary embolism (PE), readmission, mortality, and serious adverse events in patients with and without prophylactic IVCF placement. Multivariate logistic regression was used to assess the relationship between preoperative placement of an IVCF and postoperative outcomes. Of 754,397 patients undergoing MBS, 16,683 (2.2

Abstract Introduction Male sexual dysfunction (MSD) in the form of erectile dysfunction (ED), Peyronie’s disease, or orgasmic dysfunction is a motivating condition for men to seek care. The impact on self-image and sexual confidence negatively affects the mental health (MH) of patients to varying degrees, some severe. Identifying individuals at risk of MH crises (eg, self harm or suicidal ideation [SI]) in the urology outpatient setting may allow for timely behavioral health interventions. Objective The objective of this study is to identify risk factors associated with SI and MH complaints among men presenting with MSD. Methods We retrospectively identified men seeking urologic care from a men’s health clinic with a primary complaint of MSD presenting 3/1/2019–2/29/2020 (pre-COVID). MH struggles were self-reported on men’s health checklists and patients were screened for SI on chart review. Positive SI screening was defined as any positive answer on the Columbia-Suicide Severity Rating Scale or a non-zero score on question 9 of the Patient Health Questionnaire-9. To increase group size, the SI cohort also included men with MSD and positive SI screening identified by an embedded men’s health psychologist from 3/1/2021–8/31/2022. Clinical and demographic characteristics were compared for men reporting SI, MH struggles but no SI, and no MH struggles. Kruskal Wallis tests were used to compare groups on nonparametric continuous data and Pearson's chi-squared and Fisher Freeman Halton exact tests for categorical data. Logistic regressions (LR) were used to predict any MH issue, specifically SI. SPSSv26 and R v4.3.1 were used for statistical analyses. Results A total of 289 men with MSD were identified including 275 from a men’s health checklist and 14 by the psychologist. Six men from the checklist group were missing MH struggles data leaving 283 men in the overall cohort (see Table). Of the checklist-screened men, 52 (18.9%) self-identified as struggling with mental health, 12 (4.4%) of whom demonstrated SI on chart review. Including men identified by the psychologist, 26 men (9.0%) in our overall population were at risk of suicide. Significant differences were noted in age, insurance type, and self-reported struggles with weight among groups. Men with SI tended to be younger and have private insurance while all reported being up to date with PCP visits. A higher proportion of men struggling with weight reported MH struggles but not SI. LR confirmed that weight struggles significantly predicted any MH issue without SI. Age, particularly being under 40, was a significant predictor of SI. Conclusions Nearly 1 in 5 men presenting to the urology office with MSD and completing a men’s health checklist are struggling with mental health. Nearly 5% harbor SI. The key predictive risk factor for SI is younger age. Screening should be considered for all men with MSD, particularly younger men, with intervention plans in place to address active SI. Disclosure No.

Introduction: National guidelines recommend a multi-disciplinary approach to determine surgical candidacy for patients seeking bariatric surgery. Here, we describe an interdisciplinary team (IDT) approach to evaluating surgical candidacy for bariatric patients who may be at high risk.Methods: We reviewed the clinical records to identify patients 18 years or older who were deemed "high risk" for bariatric surgery and subsequently referred to the IDT for evaluation over a 5 year period. We compared those who did and did not progress to surgery on demographics and pre-established risk factors, and we calculated weight change up to 3 years post-surgery, when available.Results: A total of 515 patients were evaluated by the IDT during the study period. The top 3 risk factors were psychological (n = 318), dietetic (n = 177), and medical (n = 131). After IDT intervention, 136 patients advanced to surgery. The odds of surgical advancement did not differ according to age, gender, or number of risk factors present. Of those who advanced to surgery, % total body weight loss at years 1 and 3 was 23.0% & PLUSMN; 11.8% and 22.3% & PLUSMN; 13.5%, respectively.Conclusions: IDT may be a promising approach to facilitate bariatric surgery for high-risk patients.

Industry funds nearly two-thirds of US healthcare research, and industry-sponsorship may produce more favorable research results and conclusions. Medical students report feeling inadequately prepared to avoid negative industry influence. Research of educational interventions that educate students on the potential effects of industry influence is lacking, and no interventions have demonstrated long-term benefit. Surveying and assessing student opinions of the relationship between industry and research may help improve future educational interventions. We surveyed preclinical and clinical students at seven US medical schools regarding their attitudes towards industry conflicts of interest (COIs) in medical research. A total of 466 medical students including 232 preclinical and 234 clinical students completed the survey. Of those who had research experience, clinical students were more likely than preclinical students to look for COIs (62.0% v 45.9%, p = .014) and to consider whether author COIs are pertinent to the article (68.1% v 54.1%, p = .023). Many disagreed that they felt adequately educated on the issue of COIs (42.7%), but most agreed that medical school should take a role in guiding student interactions with industry (65.0%). Students responded that all listed financial relationships between industry and investigator, except for providing food and/or beverage, would likely bias the investigator’s research. Many students feel inadequately educated on industry issues in biomedical research, and most believe medical schools should help guide interactions with industry. Our findings support further development of educational interventions that prepare students to navigate the relationship between industry and medical research during and after medical school.

Abstract Introduction Images featured in patient educational materials can enhance comprehension of medical conditions, particularly those associated with sensitive issues like erectile dysfunction (ED). Past research indicates that minority men are often underrepresented in online urological content and thus may not relate to the material. Objective The present study aims to evaluate the representation of racial, ethnic, and sexual orientation diversity in ED and men’s health content on reputable urology program websites. Methods Websites of the top urology departments from U.S. News & World Reports 2022 rankings were reviewed as sources of high quality content. All subpages were reviewed to identify ED and men’s health sites with extraction of photo and video imagery depicting human subjects. A three-person review team interpreted race, ethnicity, and sexual orientation categorically. Race was also interpreted using a numeric scale, Fitzpatrick skin rating, and median ratings classified as white (1-3) or non-white (4-6). Consensus ratings were summarized descriptively. Spearman’s rank correlation was used to measure inter-rater reliability of Fitzpatrick ratings and MedCalc’s z-test used to compare diversity proportions to national rates from census data. Results The top 50 ranked urology program websites were reviewed. Seven programs did not have any patient-facing ED or men’s health web pages. Nearly half of programs with sites did not contain any human images (n=19/43, 44%). A total of 113 images were collected and reviewed. Race in the 102 (90.3%) interpretable images included 6 (5.9%) Asian, 16 (15.7%) black, 75 (73.5%) white, and 5 (4.9%) other men. Latino men were represented in 3/70 (4.3%) images. Utilizing Fitzpatrick ratings, 94 (83.2%) subjects were classified as white and 19 (16.8%) non-white. Most images [67 (59.3%)] demonstrated a man without a partner which precluded sexual orientation evaluation. Of those pictured with a partner, 25 (92.6%) were interpreted as heterosexual and 2 (7.4%) as same sex. Between reviewer correlation coefficients for Fitzpatrick ratings ranged from 0.66-0.69. Table 1 compares interpreted image data to population benchmarks from United States census data. Conclusions Limited imagery on academic urology ED websites continues to underrepresent some groups, namely Latinos. Although men in same sex relationships were depicted, the absolute number of such images was low. Conscious effort to improve diversity in online men’s health, and namely ED, content is needed. Disclosure No.

INTRODUCTION:Optimal pain management following video-assisted thoracoscopic surgery (VATS) is key to promoting efficient recovery while minimizing the incidence of postoperative complications. Regional anesthesia can help achieve greater pain control, fostering enhanced recovery and increased patient satisfaction, though debate remains over the most effective technique for VATS. This study sought to compare the analgesic efficacy of two continuous regional anesthetic techniques commonly used for VATS, the serratus anterior plane block (SAPB or CSAPB) and the erector spinae plane block (ESPB or CESPB). This study also sought to identify the clinical benefits of regional anesthesia (CSAPB or CESPB) versus no regional anesthesia in the setting of VATS. METHODS:A retrospective study was conducted, including 397 adult patients who underwent VATS and received multimodal analgesia. Postoperative outcomes were compared among patients who received CSAPB versus those who received CESPB; these outcomes were also compared between patients who received either regional anesthesia technique (CSAPB or CESPB, block group) and patients who did not receive regional anesthesia (non-block group). Co-primary outcomes included opioid consumption during hospital admission (presented as morphine milligram equivalents) and pain (minimum, maximum, and average numeric pain scale scores) in the first 72 postoperative hours. Secondary postoperative outcomes included post-anesthesia care unit (PACU) length of stay, time from procedure end to discharge, time to first opioid medication, ambulation distance on day one, medication use, and incidence of surgical or block-related complications. All data were retrospectively obtained from patients' electronic medical records. RESULTS:Comparing regional anesthesia techniques, patients who received CESPB reported lower pain with activity postoperatively than patients who received CSAPB (3.6 vs. 4.2, p=0.009). There were no other significant differences in postoperative outcomes between these groups. Comparing the block and non-block groups, the block group exhibited a higher overall comorbidity burden than the non-block group (p=0.001). Even so, the block group reported less postoperative pain at rest and with activity than the non-block group (mean: 3.6 vs. 4.1, p=0.012; mean 3.8 vs. 4.4, p=0.012). PACU stay and time to discharge were longer in the block group than non-block group (3.3 vs. 2.6 hours, p=0.004 and 3.1 vs. 2.9 days, p=0.012, respectively). However, the block group ambulated a significantly longer distance than the non-block group on the first postoperative day (median: 181.1 m vs. 73.2 m, p<0.001). The block group more often received acetaminophen and/or aspirin and gabapentinoids than the non-block group (94.5% vs. 75.0%, p<0.001 and 84.8% vs. 62.0%, p<0.001, respectively). CONCLUSION:Both CESPB and CSAPB are effective regional anesthesia techniques for VATS postoperative pain management with clear clinical benefits over no regional anesthesia. A direct comparison of the analgesic efficacy of CESPB versus CSAPB indicated that CESPB is more effective than CSAPB in terms of pain control. These findings are consistent with existing literature and most recent practice recommendations.

To evaluate a single surgeon’s 20-year experience with robotic radical prostatectomy. Patients who had undergone robot-assisted laparoscopic prostatectomy by a single surgeon were identified via an IRB approved prospectively maintained prostate cancer database. Patients were divided into 5-year cohorts (cohort A 2001–2005; cohort B 2006–2010; cohort C 2011–2015; cohort D 2016–2021) for analysis. Oncologic and quality of life outcomes were recorded at the time of follow-up visits. Continence was defined as 0–1 pad with occasional dribbling. Potency was defined as intercourse or an erection sufficient for intercourse within the last 4 weeks. Three thousand one hundred fifty-two patients met criteria for inclusion. Clavien ≥ 3 complication rates decreased from 5.9