Introduction: In May 2022, lawmakers in Oklahoma passed House Bill 4327, which outlawed abortion after fertilization. The governor signed the bill on May 25, 2022. It is uncertain whether these changes will motivate more men in Oklahoma to undergo vasectomy. Materials and methods: Males seeking vasectomy were informed of the study and asked to participate. Participants filled out a survey regarding their marital status, number of children, fertility treatment history, and their influences in making the decision to pursue vasectomy. We removed the identifying information from the survey. After collection, the data was imported to a database. Medical records were investigated to confirm patients underwent the procedure. Results: Of the 126 participants, 116 underwent vasectomy. Patients who did not undergo vasectomy tended to be older (38.4 vs. 34.2, p = 0.03). Participants who underwent vasectomy and were concerned about abortion laws tended to be married (69.7 vs. 30.3%, p = 0.04) with fewer children (1.2 vs. 2.3, p < 0.0001). When correlating specifically "concern about abortion laws" and going through with vasectomy, the risk ratio of 1.12 (95% CI 1.04, 1.20) indicates that patients concerned about abortion laws were slightly more likely to undergo vasectomy. Conclusions: Over 26% of men said that their decisions were somewhat impacted by abortion law changes. The concern about abortion law changes seemed to be predictive of patients undergoing vasectomy. Continued data collection will help determine whether there is a time-sensitive nature regarding the impact of abortion law changes on motivation to vasectomy.

In clinical cancer medicine, the current inability to quantify intracellular chemotherapy drug concentrations in individual human cells limits the personalization and overall effectiveness of drug administration. New bioanalytical methods capable of real-time measurement of drug levels in live single cancer cells would allow for more adaptive and personalized administration of chemotherapy drugs, potentially leading to better clinical outcomes with fewer side effects. In this study, we report the development of a new quantitative single cell mass spectrometry (qSCMS) method capable of providing absolute drug amounts and concentrations in single cancer cells. Using this qSCMS system, quantitative analysis of the intracellular drug gemcitabine present in individual bladder cancer cells is reported, including in bladder cancer cells isolated from patients undergoing standard-of-care gemcitabine chemotherapy. The development of single cell pharmacology bioanalytical methods can potentially lead to more effective and safely administered drug medications in patients, especially in the treatment of cancer.

Penile cancer is a rare cutaneous malignancy associated with HPV infection, poor hygiene, and chronic inflammation. It has a high rate of cure when treated in its earliest stages, but a markedly poor prognosis when it is invasive to subcutaneous tissue. It has multiple presentations that are similar to squamous malignancy found elsewhere on the body, however the nature of the genital malignancy makes early stage treatment a greater challenge. Surgery is a mainstay of early treatment, although radiation for penile sparing has gained some traction. Proper staging and, when required, lymphadenectomy, are important and should not be omitted. Locally advanced disease requires aggressive management and staging of the pelvic lymph nodes. Patients with spread into the pelvic nodes or beyond are typically not curable, however multiagent chemotherapy has shown promise in small scale studies. Because of the rarity of the disease, randomized studies are rare and small-scale series and anecdotal cases inform the mainstay of treatment.

We describe a 39-year-old male patient who presented with a large perineal mass found to represent an entity rarely seen involving the genitourinary tract, a perineal schwannoma. We also provide a discussion regarding the common presentation, diagnostic approaches and treatment options for patients who present with this rare entity.

Introduction: To determine whether quantifying the proximity of positive prostate biopsy cores to the capsular edge may aid in identifying patients at risk for extracapsular extension (ECE) at the time of radical prostatectomy (RP). Materials and methods: We reviewed a single-surgeon experience of 429 systematic transrectal prostate biopsies from 2010-2014. Marking ink was applied to the capsular edge ex vivo following specimen acquisition, and the proximity of cancer to the stained capsular edge was measured. Primary outcome was ECE at RP. Demographics, PSA, DRE findings, Gleason score, core location and involvement, and RP pathology were recorded. Predictors of ECE were identified using multivariable logistic regression. Receiver operating characteristic (ROC) analyses were performed to assess the predictive value of variables alone and in combination. Results: One hundred and one patients who underwent staining during biopsy received RP (202 hemiprostates). Thirty-three patients (40 hemiprostates) exhibited ECE. There were 343 positive stained biopsy cores. Mean proximity of carcinoma to capsule was 4.7 mm. On univariable analysis, proximity of positive core <= 1 mm to capsule was predictive of side-specific ECE (OR 2.86, p = 0.013), though significance was lost in multivariable models. Area under the curve (AUC) for proximity was 0.571 alone and 0.804 in combination with PSA, cT stage, and total biopsy Gleason score. Conclusion: Proximity of positive biopsy core to capsular margin may supply additional information in predicting ECE but requires validation in a larger cohort. Implementation of a staining technique at the time of systematic biopsy may be helpful in counseling patients and determining utility of nerve-sparing approaches.

Introduction: To assess the quality of resident dictations for transurethral resection of bladder tumor (TURBT). One indicator of surgical quality is the completeness of the operative report. Surprisingly, there is a paucity of standardized operative templates for TURBT and little formalized instruction for learners. The quality of TURBT dictations was assessed and areas of improvement were determined after implementation of a 10 item TURBT checklist. Materials and methods: A retrospective review of the last 50 TURBT operative reports dictated by residents was performed. A "TURBT checklist" was used assessing 10 key factors in documentation. A formal training session regarding TURBT dictations was given with TURBT checklists handed out to each trainee. Fifty TURBT dictations were subsequently analyzed. Results: TURBT dictations improved across the board following checklist implementation. Total number of checklist items dictated increased to 7.0 from 2.6 prior (p < 0.05). When stratified by resident experience, TURBT dictations improved across different resident years (p <0.05). Junior resident dictations statistically improved in every checklist item (p < 0.05). Senior resident dictations improved in almost every category but only two reached statistical significance. A regression model demonstrated checklist implantation to be a significant predictor of improvement in mean number of checklist items dictated independent of PGY level. Conclusions: Our study demonstrates that prior to implementation, TURBT operative dictations performed by residents lacked many of the critical components required for a quality TURBT. However, once properly instructed, a relatively simple "checklist" can be easily implemented and serve as a teaching tool for residents in training to ensure critical procedural elements are documented.

Clostridium difficile infection (CDI) is a high-impact hospital-acquired condition and a chief driver of excess morbidity, mortality, and treatment cost. The diagnosis, treatment, and prevention of CDI are key components of any hospital-based practice. Urologists see a small percentage of all patients with CDI, but traditionally utilize antibiotic agents that put patients at risk of CDI. Urologic procedures making use of bowel have a significantly higher rate of CDI than other procedures. This review addresses concepts that practicing urologists should be aware of and should be able to put into practice to diagnose, treat, and prevent CDI.

Introduction: Leadership is an integral component of medical practice. Nevertheless, during residency minimal attention is paid to developing this important domain. Therefore, we report on our experience with a formal leadership curriculum for senior urology residents. Methods: In consultation with a leadership expert a curriculum was developed with readings and discussion questions focusing on understanding and applying leadership theory. A symposium was then organized to discuss leadership theory as applied to clinical practice and debate how to be a successful leader in urology. Results: Our first cohort of residents completed the curriculum in 2015. Due to its success it was repeated for a second cohort of residents in 2016. A formal assessment of the curriculum showed that 91% (10 of 11) and 73% (8 of 11) of residents strongly or somewhat agreed that they will adopt new leadership strategies and are more confident as leaders, respectively. Conclusions: We developed and successfully implemented a leadership curriculum for urology residents. The curriculum goals were met with participants reporting that they acquired new leadership strategies and had increased confidence as a leader. We now expand on these initial efforts by proposing the core leadership dimensions for residents of managing the self, managing the clinical experience and managing the clinical team. In each dimension there are specific competencies that can be mapped to measure resident performance over time. It is our hope that this conceptual framework will help guide future local and national surgical leadership training.

Abstract Penile cancer is a rare cutaneous malignancy associated with HPV infection, poor hygiene, and chronic inflammation. It has a high rate of cure when treated in its earliest stages, but a markedly poor prognosis when it is invasive to subcutaneous tissue. It has multiple presentations that are similar to squamous malignancy found elsewhere on the body, however the nature of the genital malignancy makes early stage treatment a greater challenge. Surgery is a mainstay of early treatment, although radiation for penile sparing has gained some traction. Proper staging and, when required, lymphadenectomy, are important and should not be omitted. Locally advanced disease requires aggressive management and staging of the pelvic lymph nodes. Patients with spread into the pelvic nodes or beyond are typically not curable, however multiagent chemotherapy has shown promise in small scale studies. Because of the rarity of the disease, randomized studies are rare and small-scale series and anecdotal cases inform the mainstay of treatment.

INTRODUCTION Alvimopan has been shown to improve time to return of bowel function in patients undergoing bowel resection. The objective of this study is to determine if alvimopan has similar benefits for patients undergoing robot-assisted radical cystectomy (RARC). MATERIALS AND METHODS All RARC cases were reviewed from January 2008 to March 2012. All patients during this time were administered alvimopan unless they had been receiving narcotics preoperatively. Patients receiving alvimopan received a preoperative dose of 12 mg perorally and then were dosed twice daily for 7 days or until first bowel movement. Clinicopathologic outcomes were summarized and compared, and functional outcomes of treated patients were compared with outcomes of untreated patients. RESULTS One hundred seventeen RARCs meeting study criteria were performed. All urinary diversions used an extracorporeal approach. Urinary diversions consisted of 50 Studer neobladders, 22 Indiana pouches, and 45 ileal conduits. Fifty-four patients received alvimopan, and 63 did not. The median time to first bowel movement was 5 days in the alvimopan group and 6 days in the untreated group (P=.03). Median time to solid diet was 6 days in the treated group and 7 days in the untreated group (P=.03). There was a trend toward fewer hospital days in the alvimopan group (alvimopan, 8 days; untreated, 9 days; P=.1). CONCLUSIONS Alvimopan administration appears to reduce the time to return of bowel function and initiation of diet following RARC. This was a trend toward shorter hospitalization in the alvimopan group. Alvimopan should be considered in ongoing research into protocols to aid in shorter convalescence following RARC.

A major problem in cancer research is the lack of a tractable model for delayed metastasis. Herein we show that cancer cells suppressed by SISgel, a gel-forming normal ECM material derived from Small Intestine Submucosa (SIS), in flank xenografts show properties of suppression and re-activation that are very similar to normal delayed metastasis and suggest these suppressed cells can serve as a novel model for developing therapeutics to target micrometastases or suppressed cancer cells. Co-injection with SISgel suppressed the malignant phenotype of highly invasive J82 bladder cancer cells and highly metastatic JB-V bladder cancer cells in nude mouse flank xenografts. Cells could remain viable up to 120 days without forming tumors and appeared much more highly differentiated and less atypical than tumors from cells co-injected with Matrigel. In 40% of SISgel xenografts, growth resumed in the malignant phenotype after a period of suppression or dormancy for at least 30 days and was more likely with implantation of 3 million or more cells. Ordinary Type I collagen did not suppress malignant growth, and tumors developed about as well with collagen as with Matrigel. A clear signal in gene expression over different cell lines was not seen by transcriptome microarray analysis, but in contrast, Reverse Phase Protein Analysis of 250 proteins across 4 cell lines identified Integrin Linked Kinase (ILK) signaling that was functionally confirmed by an ILK inhibitor. We suggest that cancer cells suppressed on SISgel could serve as a model for dormancy and re-awakening to allow for the identification of therapeutic targets for treating micrometastases.

Penile cancer is an uncommon disease in the industrialized world that most frequently presents at low stage and is cured with treatment of local and regional surgery. In cases of advanced cancer, the use of more aggressive surgical techniques and the addition of adjuvant therapy may be warranted. So far, few agents have been found that improve survival with metastatic disease and thus aggressive primary treatment is required. This review discusses diagnosis, staging, and therapy for high risk penile cancer.

Multiple Endocrine Neoplasia type 2A (MEN-2a) is a rare disease associated with tumors of endocrine organs. Presentation most commonly is with medullary thyroid cancer and infrequently with other complaints. Pituitary adenoma has been seen coincidentally with this disease very rarely. Presented is a case of coincident MEN-2a with a symptomatic pituitary adenoma and an asymptomatic pheochromocytoma. A brief review is also provided.

You have accessJournal of Urology1 Apr 2009PROGRESSION OF HYDRONEPHROSIS CORRELATES WITH WORSENING RENAL FUNCTION IN CHILDREN Jonathan E Heinlen, Bradley P. Kropp, and Dominic C Frimberger Jonathan E HeinlenJonathan E Heinlen More articles by this author , Bradley P. KroppBradley P. Kropp More articles by this author , and Dominic C FrimbergerDominic C Frimberger More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)61257-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "PROGRESSION OF HYDRONEPHROSIS CORRELATES WITH WORSENING RENAL FUNCTION IN CHILDREN." The Journal of Urology, 181(4S), p. 443 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181 Issue 4S April 2009 Page: 443 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetrics Author Information Jonathan E Heinlen More articles by this author Bradley P. Kropp More articles by this author Dominic C Frimberger More articles by this author Expand All Advertisement PDF downloadLoading ...

Penile strangulation is a rarely described medical emergency, especially in the adolescent population. This case demonstrates the successful removal of a constricting metal ring from the penis of a 14-year-old male with a diamond blade equipped orthopedic oscillating saw while under ketamine anesthesia in the emergency department.

You have accessJournal of Urology1 Apr 2008USE OF ANTIBIOTICS IN CHILDREN WITH UPPER URINARY TRACT OBSTRUCTION Christopher C Roth, Mikel J Hubanks, Brianna C Bright, Jonathan E Heinlen, Ben O Donovan, Bradley P Kropp, and Dominic Frimberger Christopher C RothChristopher C Roth More articles by this author , Mikel J HubanksMikel J Hubanks More articles by this author , Brianna C BrightBrianna C Bright More articles by this author , Jonathan E HeinlenJonathan E Heinlen More articles by this author , Ben O DonovanBen O Donovan More articles by this author , Bradley P KroppBradley P Kropp More articles by this author , and Dominic FrimbergerDominic Frimberger More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61047-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "USE OF ANTIBIOTICS IN CHILDREN WITH UPPER URINARY TRACT OBSTRUCTION." The Journal of Urology, 179(4S), pp. 357–358 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 357-358 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Christopher C Roth More articles by this author Mikel J Hubanks More articles by this author Brianna C Bright More articles by this author Jonathan E Heinlen More articles by this author Ben O Donovan More articles by this author Bradley P Kropp More articles by this author Dominic Frimberger More articles by this author Expand All Advertisement PDF downloadLoading ...