To provide a comprehensive review of new and emerging literature on B cells and tertiary lymphoid structures (TLS) in urothelial cancer. The presence of certain subsets of B cells and TLS in MIBC are associated with improved outcomes and response to immunotherapy. However, the role in NMIBC is less clear. TLS in NMIBC is likely associated with more aggressive disease but may also be associated with improved outcomes to intravesical BCG. This review outlines an emerging potential biomarker (TLS) for predictive and prognostic outcomes for patients with urothelial cancer receiving either intravesical BCG or systemic immunotherapy. B cells play a complex role in the tumor immune microenvironment and can be either anti- or pro-tumor. Activated B cells form TLS which lead to a robust response to immunotherapy. This has led some investigators to attempt therapeutic manipulation to induce TLS in otherwise immunologically “cold” tumors.

OBJECTIVE:The objective of this study is to identify variables associated with clinical outcomes after urologic transfers before and during the COVID pandemic. METHODS:After IRB approval, a retrospective chart review was performed on adult patients transferred to our institution from 01/01/2018 to 12/31/2019 ("pre-COVID") and from 01/02/2020 to 12/31/2022 ("COVID"). We identified demographics, origin hospitals, ICD-10 pre- and post-transfer diagnoses, distance of transfer, and post-transfer CPT codes. RESULTS:During the study period, our adult urology service accepted 160 transfers with a mean patient age of 71 years. A total of 49/160 (30%) of subjects made up the "pre-COVID" cohort and 111/160 (70%) made up the "COVID" cohort. There were 11/111 (10%) transfers of >100 miles in the COVID period but 0/49 in the pre-COVID period (p = 0.02). Patients from the COVID period waited on average 1.2 days longer for a procedure after transfer compared to pre-COVID period (p = 0.03). The time until a patient's surgical procedure after transfer was a significant predictor of length of stay > 5 days (OR 1.91, CI 1.43 - 2.58, p < 0.01). Different diagnosis upon re-evaluation after transfer was associated with a decreased rate of subsequent readmission (OR 0.30, CI 0.09-0.97, p = 0.05). CONCLUSIONS:Long-distance transfer, even >100 miles (which we termed "mega-transfers"), was a new pandemic-related phenomenon at our institution. Delays in definitive care and changes in diagnoses after transfer were associated with readmission and length of stay. Our findings illustrate the importance of inter-institutional communication, diagnostic accuracy, and post discharge planning when managing transfer patients.

Primary tumors of the epididymis are rare and commonly benign in nature. Leiomyoadenomatoid tumors are a rare subvariant of adenomatoid tumors that combines features of leiomyomas. Tumor histology is notable for tubular spaces lined by mesothelial cells with a proliferative spindle cell component. To the best of our knowledge, few cases have been reported in the literature. We report a case of leiomyoadenomatoid tumor in a 58-year-old male.

You have accessJournal of UrologyCME1 Apr 2023PD20-02 UNDERREPRESENTATION OF RACIAL AND ETHNIC DIVERSITY IN THE LITERATURE INFORMING THE 2022 AMERICAN UROLOGICAL ASSOCIATION/AMERICAN SOCIETY OF RADIATION ONCOLOGY/SOCIETY GUIDELINE ON CLINICALLY LOCALIZED PROSTATE CANCER David Ambinder, Monica He, Pressler Mariel, Parissa Alerasool, Daniel Bassily, Akhil Saji, Evan Spencer, Majid Eshghi, Muhammad Choudhury, and John Phillips David AmbinderDavid Ambinder More articles by this author , Monica HeMonica He More articles by this author , Pressler MarielPressler Mariel More articles by this author , Parissa AlerasoolParissa Alerasool More articles by this author , Daniel BassilyDaniel Bassily More articles by this author , Akhil SajiAkhil Saji More articles by this author , Evan SpencerEvan Spencer More articles by this author , Majid EshghiMajid Eshghi More articles by this author , Muhammad ChoudhuryMuhammad Choudhury More articles by this author , and John PhillipsJohn Phillips More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003286.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The relationship between race and prostate cancer is complex. African American patients with prostate cancer are more likely to present with more advanced prostate cancer compared to their white counterparts. This may be associated with genetic differences but are also attributed to socioeconomic status and reduced access to healthcare. It follows that guideline informing data should a) include baseline demographic data including race and ethnicity and b) demographics should include a diverse patient population that is generalizable across racial and ethnic populations. The purpose of our study is to investigate and characterize the demographic representation in the literature that was cited in the 2022 American Urological Association guidelines on clinically localized prostate cancer. METHODS: Research that was cited by the guideline were reviewed based on a set of inclusion and exclusion criteria. Studies included were based in the United States and included patient demographics and patient ethnicity and race. RESULTS: We reviewed the 297 studies cited in the AUA guideline. After excluding 166 studies based on our predetermined exclusion criteria, we included 131 studies in our further analysis. Of these, 68 studies were based exclusively in the U.S. Of the 68 U.S.-based studies, 35 (51.5%) reported racial demographic data. Of these, 9 (25.7%) were randomized controlled trials, 18 were retrospective cohort studies (51.4%), 11 were prospective cohort studies (31.4%), and the 1 remaining was a cross-sectional study (4%). Of these studies that reported racial data, 21 (60.0%) reported race as either white/Caucasian, black/African American, or other/unknown. Overall of these studies that included race, 81.7% of patients were white/Caucasian, 9.9% were black/African American, and 8.4% were other/unknown including Hispanic and Asian. CONCLUSIONS: The vast majority of the research used in the establishment of the most recent guidelines on clinically localized prostate cancer did not include patient racial demographics. In the studies that included race, the majority only provided information on white/Caucasian and black/African American patients and did not capture other racial categories such as Hispanic or Asian. Overall, white/Caucasian patients were greatly overrepresented in relation to black/African American patients while Hispanic and Asian patients were underrepresented or categorically excluded. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e583 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Ambinder More articles by this author Monica He More articles by this author Pressler Mariel More articles by this author Parissa Alerasool More articles by this author Daniel Bassily More articles by this author Akhil Saji More articles by this author Evan Spencer More articles by this author Majid Eshghi More articles by this author Muhammad Choudhury More articles by this author John Phillips More articles by this author Expand All Advertisement PDF downloadLoading ...

A 56-year-old adult presented 25 years after penile inversion genital gender affirming vaginoplasty with complaints of abdominal pain and purulent neovaginal discharge. Physical exam revealed a patent neovagina with diffuse tumor involving the cul-de-sac and rectum. She was sexually active. A neo-urethral meatus was patent and functional without involvement. Colonoscopy revealed an obstructing rectal mass. Cross sectional imaging revealed a 10-cm mass in the pelvis, extending from the anterior rectal wall to the posterior bladder wall. Chest imaging was unremarkable for metastasis. Biopsies revealed poorly differentiated HPV-associated squamous cell carcinoma (SCC). Cystoscopy was negative for urethral or bladder invasion (Figure 1, Figure 2, Figure 3). Figure 2Bladder, prostate, neovagina, rectum, anus, and colon. A: Unopened specimen with ureteric catheter inserted. View Large Image Figure Viewer Download Hi-res image Figure 3Histological feature of the tumor. Poorly differentiated squamous cell carcinoma (×100). Pleomorphic nuclei (black arrows) and keratin pearls (blue arrows) are seen. View Large Image Figure Viewer Download Hi-res image

OBJECTIVE To evaluate racial data in studies used in current NCCN prostate cancer guidelines. These guidelines represent the latest information that informs clinical practice. Prostate cancer dis-proportionately affects mortality in Black patients compared to White patients at a 2.1-fold higher death rate. However, this racial disparity is not accounted for when including patients in research.METHODS The studies referenced in the latest NCCN guidelines were evaluated for inclusion of racial demographics, and whether they properly account for the higher mortality rate of prostate cancer seen in Black patients. We then analyzed topics within prostate cancer.RESULTS After application of exclusion criteria, 547 of 878 studies were included for analysis; of those, only 32.4% included demographic data. Overall, Black patients accounted for 472,476 (12.8%) of total patients, while 3,023,007 (81.7%) patients were White. These findings were consistent with specific areas including risk stratification (12% vs 75%), imaging and staging (11% vs 80%), treatment (16% vs 81%), recurrence (15% vs 73%), castration-sensitive prostate cancer (9% vs 84%), castration-resistant prostate cancer (8% vs 73%), and metastatic bone disease (7% vs 84%). CONCLUSION Our analysis showed consistently that although the guidelines utilize the best research, such studies often do not report racial demographics or have patient populations that do not reflect racial differences in mortality of prostate cancer. Our study questions the generalization of these studies to Black patients. Future research should emphasize inclusion of racial demographics and recruit appropriately representative study cohorts. UROLOGY 180: 28-34, 2023. (c) 2023 Elsevier Inc. All rights reserved.

Transverse myelitis is an inflammatory disorder of the spinal cord that can present with a wide array of lower urinary tract symptoms including urinary retention, frequency, urgency, and urge incontinence. We report a case of a 15 year old male with new onset urinary incontinence who initially presented to the urologist and was subsequently diagnosed with transverse myelitis.

Hepatocellular carcinoma (HCC) arises from several different etiologies and carries a poor prognosis. Extrahepatic metastases of HCC are most frequently found in the lungs, lymph nodes, and bones, with adrenal metastases reported in less than 15% of metastatic cases. Herein, we report a case of a 71-year-old man without prior liver disease who presented with a 9-cm right adrenal mass extending into the IVC consistent with HCC on subsequent surgical pathology and immunohistochemical staining. Etiological possibilities for an adrenal tumor as the first presentation of HCC include metastasis from occult primary liver HCC, intra-adrenal hepatic heterotopia, and adrenohepatic fusion.

You have accessJournal of UrologyCME1 May 2022MP40-18 OFFICE-BASED FLEXIBLE URETEROSCOPY FOR ACTIVE SURVEILLANCE FOR UPPER TRACT UROTHELIAL CARCINOMA FOLLOWING NEPHRON-SPARING SURGERY Nathan Colin Wong, Sameh Naim, Jonathan Wagmeister, Ariel Schulman, Bertie Zhang, John Phillips, Muhammad Choudhury, and Majid Eshghi Nathan Colin WongNathan Colin Wong More articles by this author , Sameh NaimSameh Naim More articles by this author , Jonathan WagmeisterJonathan Wagmeister More articles by this author , Ariel SchulmanAriel Schulman More articles by this author , Bertie ZhangBertie Zhang More articles by this author , John PhillipsJohn Phillips More articles by this author , Muhammad ChoudhuryMuhammad Choudhury More articles by this author , and Majid EshghiMajid Eshghi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002600.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephron-sparing surgery (NSS) for upper tract urothelial carcinoma (UTUC) offers select patients renal preservation but demands close surveillance including routine ureteroscopy that typically require general anesthesia. We report feasibility and our experience in utilizing ureteric orifice meatotomy to facilitate office-based flexible ureteroscopy under local anesthesia. METHODS: A retrospective chart review was conducted including consecutive patients who underwent NSS of UTUC at our tertiary center. Patients underwent ureteric orifice meatotomy followed by attempted flexible ureteroscopy in the office setting under local anesthesia with transurethral 2% lidocaine jelly. Otherwise, patients underwent routine ureteroscopic surveillance under general anesthesia and all patients underwent routine cross-sectional imaging including 3-D ‘virtual ureteroscopy’ by reconstruction of CT urography to evaluate for disease recurrence. RESULTS: A total of 16 patients (7 male; 9 female) with UTUC were treated with NSS – 9/16 (56%) were initially managed ureteroscopically and 7/16 (44%) percutaneously. Median age at diagnosis was 79 (IQR 71.5, 81.5) and median follow-up was 3 years (IQR 2, 3.5). The majority of patients had high grade disease (75%) and tumor location was typically renal pelvis (10/16; 63%) followed by distal ureter (4), mid ureter (1) and proximal ureter (1). A total of 3/16 (18%) had history of contralateral UTUC, 3/16 (18.8%) had solitary kidney and 10/16 (62%) had concomitant bladder cancer. A total of 10/16 patients (63%) who underwent ureteric orifice meatotomy tolerated flexible ureteroscopy in an office-based setting under local anesthesia, the rest required general anesthesia. Overall, 8/16 (50%) had disease recurrence, typically at the location of their initial site of disease. Of the 10 patients with renal pelvic disease, 6 (60%) recurred in the renal pelvis. Of the 6 patients with ureteral disease, 2 (33%) recurred in the ureter. Of those who recurred, 4 (50%) were successfully managed with ongoing endoscopic therapy and 4 (50%) ultimately underwent radical nephroureterectomy, 3 of which had disease upstaging on final pathology. There were 2 deaths related to comorbidities, both of who had a solitary kidney. There were no UTUC-related deaths. CONCLUSIONS: In select patients with UTUC who undergo NSS, ureteric orifice meatotomy is feasible and allows the majority of patients to tolerate office based flexible ureteroscopy under local anesthesia without compromising oncologic outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e682 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Colin Wong More articles by this author Sameh Naim More articles by this author Jonathan Wagmeister More articles by this author Ariel Schulman More articles by this author Bertie Zhang More articles by this author John Phillips More articles by this author Muhammad Choudhury More articles by this author Majid Eshghi More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE To characterize the rates of endovascular stapler complications during hilar ligation in minimally invasive radical nephrectomy over the last 10 years. MATERIAL AND METHODS We reviewed the Food and Drug Administration Manufacturer and User Facility Device Experience database from January 1, 2009 to August 1, 2019. Staplers were categorized according to type, namely Ethicon Inc. endocutters (Johnson & Johnson, New Brunswick NJ); Endo-GIA (Medtronic, Minneapolis MN); and Endo-TA (Medtronic, Minneapolis MN). RESULTS There were 383 cases of complications involving staplers, 63% with Ethicon endocutters; 28% with GIA; and 9% with TA. 22 deaths (5.7% of total complications) were attributed to staplers. No deaths or reoperations occurred due to TA staplers. TA staplers were also associated with a reduced incidence of conversion to open as compared to Ethicon and GIA staplers. Apart from one device, manufacturer evaluation of returned devices either showed no abnormalities or attributed fault to improper use of staplers. DISCUSSION We characterized stapler complications during a 10-year period for minimally invasive radical nephrectomy. No deaths or reoperations occurred due to TA staplers, perhaps due to cutting and stapling occurring in separate steps. Based on manufacturer evaluation attributing stapling malfunctions to human errors, training of operating room staff on proper use of these devices is critical to prevent potentially significant complications from occurring. (C) 2021 Elsevier Inc.

Objectives The annual addresses of the President of the American Urological Association (AUA) may articulate and reflect the contemporary goals, values, and concerns of contemporary AUA membership. There is no organized archive of such addresses. We aimed to create a searchable database of all AUA Presidents and their addresses to determine variables associated with speech sentiment including positivity, negativity, and emotional tone through the 117 years of the AUA’s history. Methods We queried AUA archives, journals, recorded tape, and personal records, to create a database of all existing AUA Presidential addresses and biographic data. We applied natural language processing and machine learning techniques to evaluate the addresses for overall sentiment with validation using analog analyses (i.e reading and annotation). Multivariable logistic regression was performed to identify significant predictors of Presidential address sentiment. Results Between 1902-2019, a total of 113 AUA meetings were held. A total of 85 of 113 (75.22%) presidential addresses were transcribed and archived in the database representing 254,124 words by male presidents with a median (IQR) age of 61.43 (53.1-66.5) years. AUA Presidents during the second half of the history of the AUA (1960-2019) were significantly older at time of inauguration and gave more positive speeches in the active voice than presidents during the first half (1902-1959) (p < .05). The only significant independent predictor of the degree of positivity in an AUA President’s annual address was speaker age (95% CI 1.007-1.119). Conclusions We created the first digital, searchable database of all AUA Presidential speeches from 1902-2019 and aim to add additional addresses prospectively. Artificial intelligence analyses mirrored the findings of human reading and demonstrated that from 1902-2019 AUA Presidential addresses became more positive and optimistic with increasing speaker age but without consistent predictors of a speech’s emotional or factual content.

OBJECTIVE To assess interviewing applicant perceptions of a virtual urology residency interview in the setting of changes mandated by COVID-19 and to determine applicant preference for virtual or in person interviews. Applicant perceptions of multiple interview components were queried to identify program specific and interview modality specific strengths or weaknesses in the 2020 to 2021 Urology Match. METHODS A 12 question multiple choice and free text survey was emailed to 66 virtually interviewed applicants for open residency positions at a metropolitan training program after conclusion of interviews. Items of interest included interview type preference, overall interview impression, and recommendations for improvement. RESULTS A total of 50 of 66 (76%) applicants completed the survey corresponding to approximately 11% of the 2020 national urology applicant pool. A total of 49 of 50 (96%) respondents assessed faculty interaction and the virtual platform positively. A total of 38 of 50 (76%) was satisfied with their resident interaction and 32 of 50 (64%) applicants stated they were able to satisfactorily evaluate the site and program. Ultimately, 39 of 50 (78%) respondents would have preferred an in person interview to our virtual interview. Respondents cited challenges in assessing program culture and program physical site virtually. CONCLUSION The majority of survey respondents indicated a preference for in person interviews. A smaller proportion of applicants preferred virtual interviews citing their convenience and lower cost. Efforts to improve the virtual interview experience may focus on improving applicant-resident interaction and remote site assessment. (C) 2021 Elsevier Inc.

INTRODUCTION AND OBJECTIVE:Recent literature across a spectrum of surgical specialties has identified operative duration (OD) as an important predictor of increased postoperative complications and ...

OBJECTIVE:Rezūm vapor ablation is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses injections of sterile water vapor directly into the prostate for tissue ablation. Although Rezūm is currently indicated for use in men with prostate sizes ≥30 and ≤80 ml, it is unclear how effective Rezūm is for men in urinary retention. We sought to determine whether Rezūm is effective in the treatment of catheter-dependent urinary retention secondary to BPH. METHODS:A retrospective chart review was conducted on consecutive patients who presented for urinary retention and subsequently treated with Rezūm. We evaluated procedural details and examined variables pre- and post-Rezūm (at 6 months) including International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL), maximum flow (Qmax ), post void residual volume (PVR), prostate specific antigen, rate of retention, and use of alpha blockers and 5-alpha reductase inhibitor (5ARI). RESULTS:Of the 49 patients included in this study, median age of was 73 years, median prostate volume was 73cc (Interquartile range [IQR]: 50, 103) and a median lobe was present in 80% of patients. All patients were in urinary retention before treatment with a median PVR of 900 ml (IQR: 566, 1146). Following Rezum, IPSS (17 pre-Rezūm, 4 post-Rezūm) and IPSS-QOL (4 pre-Rezūm, 1 post-Rezūm) both improved at 6 months (p < 0.01). Qmax increased from 3 to 6 ml/s (p = 0.03) and PVR decreased from 900 to 78 ml (p < 0.01). Only 17/38 patients taking alpha-blockers and 7/15 patients on 5ARIs continued therapy at 6 months following Rezūm (p < 0.01). Of the 49 patients treated, 10 (20.4%) remained in catheter dependent urinary retention following the procedure, and 6 remained in retention at 6 months (12.2%) even after further surgical therapies for BPH (p < 0.01). CONCLUSION:Rezūm is a safe and effective therapy for treating catheter dependent urinary retention in patients with BPH, including those with median lobes. As a minimally invasive therapy, it is a promising option in patient, particularly those who are not suitable for prolonged anesthesia.

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP01)1 Sep 2021MP01-09 REZŪM FOR RETENTION - A RETROSPECTIVE ANALYSIS OF REZŪM FOR BENIGN PROSTATIC HYPERPLASIA IN MEN WHO PRESENT WITH CATHETER-DEPENDENT URINARY RETENTION Daniel Bassily, Vincent Wong, John Phillips, Mitchell Fraiman, Ross Bauer, Christopher Dixon, and Nathan Wong Daniel BassilyDaniel Bassily More articles by this author , Vincent WongVincent Wong More articles by this author , John PhillipsJohn Phillips More articles by this author , Mitchell FraimanMitchell Fraiman More articles by this author , Ross BauerRoss Bauer More articles by this author , Christopher DixonChristopher Dixon More articles by this author , and Nathan WongNathan Wong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001962.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rezūm is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses injections of sterile water vapor directly into the prostate for ablation. Although Rezūm is currently indicated for use in men with prostate sizes ≥30mL and ≤80mL, it is unclear how effective Rezūm is for men in acute or chronic urinary retention. Our objective is to determine whether Rezūm vapor ablation is effective in the treatment of acute/chronic catheter-dependent urinary retention. METHODS: A retrospective chart review was conducted on 49 consecutive patients who presented for acute/chronic urinary retention and were treated with Rezūm. We evaluated procedural details including type of anesthesia, operating room time, treatment time, number of steam treatments, length of hospital stay and catheter duration. We examined details pre- and post-Rezūm including International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL), maximum flow (Q max), post void residual volume (PVR), PSA, rate of retention, and use of alpha blockers and 5-alpha reductase inhibitor (5ARI). RESULTS: The median age of treated patients was 73 years with a median prostate volume of 73cc (Interquartile range (IQR) 50, 103). All patients were in urinary retention prior to treatment with a median PVR of 900mL (IQR 566, 1146). Following treatment, IPSS (17 pre-Rezūm, 4 post-Rezūm) and IPSS-QOL (4 pre-Rezūm, 1 post-Rezūm) both improved (p <0.01). Qmax increased from 3mL/s to 6mL/s (p=0.03) and PVR decreased from 900mL to 78mL (p <0.01). Only 17/38 patients taking alpha-blockers required continued alpha blocker therapy and 7/15 patients on 5ARIs required continued 5ARI therapy (p <0.01). Of the 49 patients treated, 10 remained in catheter dependent urinary retention following the procedure, and 6 remained in retention at 6 months even after further, more invasive surgical therapies for BPH (p <0.01). CONCLUSIONS: Rezūm is an effective therapy for treating acute/chronic urinary retention in patients with BPH. As a minimally invasive therapy, it can be used in patient who cannot tolerate general anesthesia. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e3-e4 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Bassily More articles by this author Vincent Wong More articles by this author John Phillips More articles by this author Mitchell Fraiman More articles by this author Ross Bauer More articles by this author Christopher Dixon More articles by this author Nathan Wong More articles by this author Expand All Advertisement Loading ...

OBJECTIVES To review medical malpractice trends and to identify the most common claims filed against medical providers for the management of patients with priapism. METHODS Using the Westlaw legal database, a search was done for the keyword "priapism" between July 1, 1980 and July 1, 2020. Cases were evaluated for plaintiff demographics, reasons for filing claims, management outcomes, legal verdicts and awards and further categorized based upon the timing of the alleged malpractice. RESULTS Alleged negligence during the pre-management period was cited in 30 cases. Administration of psychotropic medications was the most common reasons for filing pre-management claims 22/56 (39.3%). Delay in care accounted for 18/56 (32.1%) and complications of surgery were 5/56 (8.9%) of claims. The majority of the completed cases were in favor of the defendants (39/47; 83.0%). There was no association between type of health care provider or timing of alleged malpractice and ultimate verdict. CONCLUSIONS Prescribing psychoactive medications without warning of the adverse effect profile is the most common reason for claims filed against providers with trazodone as the leading medication. Medical providers should ensure that patients are well informed of this adverse effect prior to prescription. Regardless, the majority of medical malpractice cases carry a verdict in favor of the defendant. (C) 2021 Elsevier Inc.

Prostatic PIRADS 4 and 5 lesions on multiparametric MRI typically represent adenocarcinoma with small lymphocytic lymphoma being a rare pathological finding. We report a case of small lymphocytic lymphoma masquerading as PIRADS 4 and 5 lesions with associated lymphadenopathy in a 69-year-old male on active surveillance for low-risk prostate cancer that was subsequently confirmed on targeted and systematic prostate biopsy. Following treatment of lymphoma with ibrutinib, there was complete resolution of the PIRADS lesions on follow-up mpMRI.

You have accessJournal of UrologyBladder & Upper Tract Urothelial Oncology (V13)1 Sep 2021V13-01 EXTENDED URETERAL MEATOTOMY FOR OUTPATIENT CHEMOTHERAPY ADMINISTRATION AND URETEROSCOPY IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA Nikhil Gopal, Sameh Naim, Bertie Zhang, John Phillips, and Majid Eshghi Nikhil GopalNikhil Gopal More articles by this author , Sameh NaimSameh Naim More articles by this author , Bertie ZhangBertie Zhang More articles by this author , John PhillipsJohn Phillips More articles by this author , and Majid EshghiMajid Eshghi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002100.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with ureteral tumors managed endoscopically often benefit from adjuvant immuno-chemotherapy and require interval upper tract surveillance with ureteroscopy. However, both often require general anesthesia, which can be problematic for a predominantly elderly population with multiple co-morbidities. Here we describe an endoscopic technique of ureteral meatotomy to not only predictably allow for reflux of intravesical agents through the ureter, but also to allow upper tract endoscopy to be performed in the office setting. METHODS: From 2015-2021, we performed ureteral meatotomy on 10 patients. All patients who underwent this procedure had upper tract urothelial tumors deemed suitable for primary endoscopic management, based on patient’s clinical characteristics; tumor number; size; location; and/or biopsy grade.Under general anesthesia, a 10 F dual lumen ureteral catheter or 6-12 F Nottingham dilator was inserted into the distal ureter in order to allow for alignment of the ureter towards the bladder neck and to ensure the orifice is incised in the correct direction. Using either a Holmium laser or Collin’s knife, a full-thickness 2 cm incision was made on the distal intramural ureter at the 12 o’clock position, until the anterior portion of the catheter was visualized. Intraoperative cystogram was used to confirm ureteral reflux. A double J stent was then left in place for 3 weeks for mucosal healing and reshaping of the distal ureteral segment. Postoperatively, patients underwent 6 cycles of mitomycin, either via indwelling Foley catheter or nephrostomy tube. Lower and upper urinary tract surveillance was performed using flexible cystoscope and/or ureteroscope in the office every 3-6 months for the first two years and annually thereafter. RESULTS: 10 patients with average age of 77 years, 40% of whom were male, underwent ureteral meatotomy between 2015 and 2021. 90% of tumors were either in the distal ureter or UPJ/renal pelvis. Average tumor size was 1.6 cm. 70% of tumors were low grade on biopsy. 3 patients had concomitant bladder cancer. There were no complications associated with chemotherapy instillation. Of the patients who had only upper tract disease, none developed a new recurrence in the bladder. CONCLUSIONS: We describe a novel anterior intramural ureteral incision technique in patients with ureteral tumors managed endoscopically that reliably allows for both chemotherapy administration and upper tract surveillance in an office setting. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1078-e1078 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikhil Gopal More articles by this author Sameh Naim More articles by this author Bertie Zhang More articles by this author John Phillips More articles by this author Majid Eshghi More articles by this author Expand All Advertisement Loading ...

You have accessJournal of UrologyHistory of Urology Forum II (HF02)1 Sep 2021HF02-01 SENTIMENT ANALYSIS AND PREDICTORS OF OPTIMISM IN THE AUA PRESIDENTIAL ADDRESSES: 1902-2019 Akhil A. Saji, Rachel Passarelli, Ashley Dixon, and John L. Phillips Akhil A. SajiAkhil A. Saji More articles by this author , Rachel PassarelliRachel Passarelli More articles by this author , Ashley DixonAshley Dixon More articles by this author , and John L. PhillipsJohn L. Phillips More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001993.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The AUA Presidential address has been a tradition at the national meeting since 1902 when the first address was given by Ramon Guiteras. We sought to collect and archive each address given between 1902-2019 to characterize AUA Presidents as a group and analyze speech sentiment over the past century. METHODS: We queried AUA archives, journals, recorded tape, and personal records to create a database of all existing AUA Presidential addresses. Each address was categorized by theme and author demographic data was collected. We applied natural language processing utilizing the Python Textblob library to evaluate each address for the overall sentiment, a measure of positivity or negativity and subjectivity, a measure of non-factual opinion usage. Sentiment was validated by manual analysis with reading and annotation to compute sentiment ratios, a measure of positive statements divided by negative statements per address. Multivariate logistic regression was performed to identify significant predictors of presidential address sentiment. RESULTS: Between 1902-2019 a total of 113 AUA meetings were held. A total of 85 of 113 (75.22%) presidential addresses were transcribed and archived representing seven general categories in 254,124 words by male presidents with a median (IQR) age of 61.43 (53.1-66.5) years. AUA Presidents during the second half of the history of the AUA (1960-2019) were significantly older at the time of inauguration and gave more positive speeches in the active voice than presidents during the first half (1902-1959) (p<.05). Age was associated with increasing speech positivity (OR 1.059 (1.007-1.113), p=0.025) but not subjectivity (OR 0.958 (0.913-1.005), p=0.082). Median (IQR) age of ‘Arts & Philosophy’ speakers (61.9 (58.4-67.8)) was significantly older than those of ‘Scope & Practice’ (52.3 (43.5-61.2), p-value, <.01) (Figure 1). Significant independent predictors of positive speech sentiment were age (95% CI 1.007-1.119) and sentiment ratio (95% CI 1.154-2.444) (p=0.001). CONCLUSIONS: The first digital database was created containing all extant AUA Presidential speeches from 1902-2019. Computational and analog analysis mirrored the findings of analog human reading demonstrating that AUA Presidential addresses became more positive with increasing speaker age but without consistent predictors of a speech’s emotional or factual content. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e237-e237 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akhil A. Saji More articles by this author Rachel Passarelli More articles by this author Ashley Dixon More articles by this author John L. Phillips More articles by this author Expand All Advertisement Loading ...